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HPB > Liver Neoplasms, Abscess & Cysts > Flashcards

Liver Neoplasms, Abscess & Cysts Flashcards

1
Q

What are the three main routes of bacterial infection of the liver?

A

Ascending spread from cholangitis
Portal spread from abdominal sepsis
Systemic bloodstream spread in septicaemia

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2
Q

What are the three main types of liver abscess?

A

Pyogenic liver abscess
Amoebic abscess
Hyadit cyst

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3
Q

What are the causes of a pyogenic liver abscess?

A 
Ascending spread
   -appendicitis
   -perforation
Biliary sepsis
Trauma
Bacteraemia
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4
Q

What are the most common causative organisms of a pyogenic liver abscess?

A

E. coli
Strep milleri
Anaerobes

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5
Q

How do patients with a pyogenic liver abscess present?

A 
Long history of malaise but few sx OR
Acutely unwell
   -abdominal sepsis
   -tender hepatomegaly
   -right sided pleural effusion
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6
Q

What investigations are appropriate in suspected pyogenic liver abscess?

A

USS/CT

CXR

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7
Q

What are the management options for a pyogenic liver abscess?

A

Aspiration under USS guidance
IV antibiotics
Treat underlying cause

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8
Q

What are the causes of an amoebic abscess?

A

Travel often implicated

Faecal-oral spread of entamoeba histolytica

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9
Q

How do patients w/ an amoebic abscess present?

A 
Acute presentation
   -asymptomatic OR
   -profuse/bloody diarrhoea
Coalescing microabscesses
   -swinging high fever
   -RUQ pain
   -tenderness
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10
Q

What investigations are appropriate in suspected amoebic abscess?

A

Stool microscopy

USS/CT

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11
Q

What are the management options for an amoebic abscess?

A

Metronidazole for 5/7

USS drainage

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12
Q

What are the causes of a hyatid cyst?

A

Echinococcus granulosus (dog tapeworm)

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13
Q

How do patients w/ a hyatid cyst present?

A

Asymptomatic OR

Dull ache in RUQ

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14
Q

What investigations are appropriate in suspected hyatid cyst?

A

Hyatid complement fixation test
AXR
USS/CT

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15
Q

What are the management options for a hyatid cyst?

A

Albendazole

FNA under USS guidance

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16
Q

What is the most common type of liver neoplasm?

A

90% 2o mets

17
Q

What are the common 1o sites of liver mets?

A 
Lung
Stomach
Colon
Breast
Uterus
18
Q

How are 2o liver mets managed?

A

Investigation to find 1o

Treatment/prognosis vary w/ type of 1o

19
Q

What is the underlying pathophysiology of hepatocellular carcinoma?

A

Malignant tumour of hepatocytes
-90% of liver 1o
Common in China/Sub-Saharan Africa
More common in males

20
Q

What are the causes of hepatocellular carcinoma?

A 
Chronic hepatitis
Cirrhosis
Metabolic liver disease
Aspergillus alfatoxin
Parasites
Anabolic steroids
21
Q

What are the presenting sx of hepatocellular carcinoma?

A

Non-specific fever
Wt loss
Malaise
RUQ pain

22
Q

What are the presenting signs of hepatocellular carcinoma?

A

Hepatomegaly (smooth/hard & irregular)
Signs of chronic liver disease/decompensatino
Abdo mass/bruit over liver
Jaundice (late sign c.f. cholangiocarcinoma)

23
Q

What are the appropriate investigations in suspected hepatocellular carcinoma?

A

Bloods - FBC, LFTs, clotting, hepatitis serology, AFP
USS/CT
MRI
ERCP/biopsy (?cholangiocarcinoma)

24
Q

What are the management options for hepatocellular carcinoma?

A 
Surgery
   -if solitary HCCs <3cm
   -high risk of recurrence
Transplantation
   -if small tumours due to cirrhosis
25
Q

What is the prognosis for hepatocellular carcinoma?

A

<6mo

26
Q

What is a cholangiocarcinoma?

A

Adenocarcinoma arising from biliary tree

-10% of liver 1o

27
Q

How do cholangiocarcinomas present?

A

Painless jaundice

28
Q

What are the risk factors for cholangiocarcinoma?

A

Chronic inflammation

  • 1o sclerosing cholangitis
  • parasite infestation
29
Q

How do cholangiocarcinomas spread?

A

Direct invasion of liver

30
Q

What are the management options for cholangiocarcinomas?

A

Presented early
-extended liver resection (curative)
Presented late
-palliation w/ ERCP stenting

31
Q

What are the most common forms of benign liver tumour?

A

Haemangioma
-incidental finding on CT/USS
Liver cell adenoma
-oyung women on OCP

32
Q

When should benign liver tumours be treated?

A

If symptomatic OR

>5cm

HPB (7 decks)

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