15. Liver Lesions Flashcards Preview

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Flashcards in 15. Liver Lesions Deck (39):
1

What are the three benign primary liver lesions?

1. Hemangioma
2. Focal nodular hyperplasia (FNH)
3. Adenoma

2

What are the two malignant primary lesions of the liver?

1. Hepatocellular carcinoma (HCC)
2. Cholangiocarcinoma (CCA)

3

What lesion does oral contraceptive use increase the risk for?

Hepatic adenoma

4

What lesion does a hx of extrahepatic malignancy increase the risk for?

Metastatic disease

5

What lesion does underlying liver disease increase the risk for?

Hepatocellular carcinoma

6

What lesion does a hx of primary sclerosing cholangitis (PSC) increase risk for?

Cholangiocarcinoma (CCA)

7

Malignant lesions in a noncirrhotic liver are primarily:

Metastases from the GI tract
**also from the lung, UG tract, breast

8

Malignant lesions in a cirrhotic liver are primarily:

Primary liver lesions (77%)

9

What is the most common benign liver lesion? What kind of liver gets these?

Hemangioma
Non-cirrhotic

10

What are hemangiomas?

Congenital vascular malformations--blood filled cavities lined by endothelium

11

When are the majority of hemangiomas diagnosed? Size?

Third to fifth decade (asymptomatic)
1-20 cm (over 10 called giant hemangioma)

12

Hemangiomas are multiple in __% of cases

30%

13

Do hemangiomas have malignant potential?

NO

14

When is the only time that a hemangioma or focal nodular hyperplasia will cause sx?

When the lesion is close to the surface and stretches the capsule, which has higher innervation

15

What is characteristic of focal nodular hyperplasia (FNH) on imaging

Central stellate scar

16

What is the second most common benign liver lesion?

Focal nodular hyperplasia

17

What kind of liver gets FNH?

Non-cirrhotic liver

18

What causes FNH?

Anomolous artery develops, leading to hyperperfusion
Hyperperfused area enlarges until it outgrows the blood supply

19

Who usually gets FNH?

Women between the ages of 20 and 50

20

What is the typical size of FNH?

<5 cm, rarely exceeds 10 cm

21

How often is FNH multiple?

10-20% of cases

22

What is growth of a hepatic adenoma associated with?

Estrogen

23

What type of liver is an adenoma found in? Benign proliferation of:

Non-cirrhotic
Hepatocytes

24

Who typically gets hepatic adenomas?

Women of childbearing age

25

Hepatic adenomas are associated with the use of:

Contraceptives

26

What are two situations that may give rise to multiple hepatic adenomas?

Glycogen storage disease
Diabetes mellitus

27

What is there a risk for with hepatic adenomas?

Hemorrhage
Malignant transformation

28

Treatment for hepatic adenoma?

Avoid contraceptives
Avoid pregnancy
Surgical resection if recommended to avoid risk of cancer and tumor rupture

29

What is the #1 cause of HCC worldwide? In the US?

HBV
HCV

30

Why is HCC on the rise in the US right now?

Lots of HCV infection occured in the 70s-80s, takes about 20-30 years to develop cirrhosis, and cirrhosis much come before transformation to HCC in HCV infection

31

What is the most common cause of HCC in Asian americans? Non-asians?

HBV
HCV

32

What is characteristic of blood flow in HCC?

Usually, 70% of blood flow is venous
HCC leads to a predominance of arterial blood flow, visualize by infusing contrast into the arteries

33

What produces alpha fetoprotein (AFP)

Fetal liver
Placenta
**malignant liver cells

34

Alpha fetoprotein is elevated in ___% of patients wtih HCC

60-70%
**can also be elevated with hepatic inflammation in the absence of HCC and with cirrhosis

35

Values of AFP over ___ ng/ml in conjugation with liver lesion on imaging is consistent with HCC

200

36

Prevention of HCC

HBV vaccination
Treatment of viral hepatitis
Coffee (decreased liver enzymes, cirrhosis, and HCC)

37

Multiple liver lesions in a non-cirrhotic liver without arterial enhancement on imaging should make you think of:

Metastatic disease

38

What will the AFP level be with metastatic carcinoma in the liver?

Normal (not over 200)

39

What are common sources of metastatic carcinoma?

GI: colon, pancreas, eso, gastric
Lung
UG
Breast
Melanoma