Liver cysts abscess and cancer

Question 1

Simple Cysts

Answer 1

Fluid-filled epithelial-lined sacs within the liver commonly n right lobe

Question 2

Clinical Features of simple cysts

Answer 2

Normally asymptomatic

Symptoms:

• Abdo pain
• Nausea
• Early satiety

Question 3

Investigations cysts

Answer 3

Abdo exam
Routine bloods + CEA, CA19-9
(normal LFTs)

USS - gold standard

Question 4

Management of simple cysts

Answer 4

cysts >4cm - follow-up USS at 3, 6 and 12 months post-detection

If unchanged for 2 - 3 years, no further scans needed

If symptomatic or growth - aspiration

Question 5

Autosomal dominant Polycystic liver disease

Answer 5

Presence of ≥20 cysts within the liver parenchyma, each of which are ≥1cm in siz

Question 6

Mx of ADPLD

Answer 6

Normally left alone

Symptomatic or uncertain malignancy:

• Laparoscopic de-roofing of cysts
• USS guided aspiration

Question 7

Hydatid Cysts

Answer 7

Result from infection by the tapeworm via faeco - oral route

USS - calcified, spherical lesion with multiple septations

Mx - surgical with cyst deroofing

Question 8

Causative organisms for liver abscesses

Answer 8

E. Coli
K. pneumoniae
S. constellatus

Question 9

Clinical Features of liver abscesses

Answer 9

Fever
Rigors
Abdo pain

Other:
Bloating
Nausea
Anorexia
Weight loss
Fatigue 
Jaundice

Question 10

Examination of liver abscess

Answer 10

RUQ tenderness +/- hepatomegaly

Question 11

Investigations for liver abscesses

Answer 11

Abdo exam 
Routine bloods:
- leucocytosis
- raised ALP
- deranged ALT and bilirubin 

Blood culture - MC+S

USS

CT with contrast

Question 12

Mx of liver abscesses

Answer 12

Fluid resuscitation

Abx + Drainage via USS guided aspiration

Question 13

Amoebic Abscess

Answer 13

Causes by Entamoeba histolytica

Spreads via faeco - oral route

Commonly in South America, the Indian subcontinent, and Africa

Question 14

Clinical features of amoebic abscess

Answer 14

Vague symptoms of:

• abdominal pain
• nausea
• fever
• rigors
• weight loss
• bloating

THx in 6 months

Question 15

Mx of Amoebic Abscess

Answer 15

abx alone- metronidazole or tinidazole

If large - drainage

Question 16

Hepatocellular Carcinoma risk factors

Answer 16

Viral hepatitis - B+C
Alcohol 
Smoking 
70+ yo
Aflatoxin exposure
FHx or liver disease

Question 17

Clinical Features of Hepatocellular Carcinoma

Answer 17

Liver cirrhosis

Fatigue 
Fever 
Weight loss 
Lethargy 
Dull ache in RUQ - uncommon but sensitive

Question 18

Hepatocellular Carcinoma on examination

Answer 18

irregular, enlarged, craggy and tender liver

Question 19

Investigations for Hepatocellular Carcinoma

Answer 19

Abdo exam
Obs
Routine bloods + LFT, AFP

USS
CT staging
Biopsy or percutaneous fine-needle aspiration - last resort

Question 20

rising AFP and suggestive US nodules Ix

Answer 20

MRI liver

Question 21

Risk assessment tools

Answer 21

Child-Pugh and MELD scores

Question 22

Mx of liver cancer

Answer 22

Surgical resection and transplantation - curative

Surgical resection – in patients without cirrhosis and with a good baseline health status

Question 23

Milan Criteria for transplantation

Answer 23

One lesion is smaller than 5cm or three lesions are smaller than 3cm

There are no extrahepatic manifestations

There is no vascular infiltration

Question 24

Non-Surgical Management of hepatocellular cancer

Answer 24

Image-guided ablation - early HCC

Transarterial Chemoembolisation (TACE) - large multinodular tumour

Question 25

Metastasise to liver

Answer 25

Bowel 
Breast
Pancreas 
Stomach
Lung