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GI > 15. Liver Lesions > Flashcards

15. Liver Lesions Flashcards

1
Q

What are the three benign primary liver lesions?

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

What are the two malignant primary lesions of the liver?

A
  1. Hepatocellular carcinoma (HCC)

2. Cholangiocarcinoma (CCA)

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3
Q

What lesion does oral contraceptive use increase the risk for?

A

Hepatic adenoma

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4
Q

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

A

Metastatic disease

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5
Q

What lesion does underlying liver disease increase the risk for?

A

Hepatocellular carcinoma

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6
Q

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

A

Cholangiocarcinoma (CCA)

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7
Q

Malignant lesions in a noncirrhotic liver are primarily:

A

Metastases from the GI tract

**also from the lung, UG tract, breast

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8
Q

Malignant lesions in a cirrhotic liver are primarily:

A

Primary liver lesions (77%)

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9
Q

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

A

Hemangioma

Non-cirrhotic

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10
Q

What are hemangiomas?

A

Congenital vascular malformations–blood filled cavities lined by endothelium

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11
Q

When are the majority of hemangiomas diagnosed? Size?

A

Third to fifth decade (asymptomatic)

1-20 cm (over 10 called giant hemangioma)

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12
Q

Hemangiomas are multiple in __% of cases

A

30%

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13
Q

Do hemangiomas have malignant potential?

A

NO

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14
Q

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

A

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

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15
Q

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

A

Central stellate scar

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16
Q

What is the second most common benign liver lesion?

A

Focal nodular hyperplasia

17
Q

What kind of liver gets FNH?

A

Non-cirrhotic liver

18
Q

What causes FNH?

A

Anomolous artery develops, leading to hyperperfusion

Hyperperfused area enlarges until it outgrows the blood supply

19
Q

Who usually gets FNH?

A

Women between the ages of 20 and 50

20
Q

What is the typical size of FNH?

A

<5 cm, rarely exceeds 10 cm

21
Q

How often is FNH multiple?

A

10-20% of cases

22
Q

What is growth of a hepatic adenoma associated with?

A

Estrogen

23
Q

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

A

Non-cirrhotic

Hepatocytes

24
Q

Who typically gets hepatic adenomas?

A

Women of childbearing age

25
Q

Hepatic adenomas are associated with the use of:

A

Contraceptives

26
Q

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

A

Glycogen storage disease

Diabetes mellitus

27
Q

What is there a risk for with hepatic adenomas?

A

Hemorrhage

Malignant transformation

28
Q

Treatment for hepatic adenoma?

A

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

29
Q

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

A

HBV

HCV

30
Q

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

A

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
Q

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

A

HBV

HCV

32
Q

What is characteristic of blood flow in HCC?

A

Usually, 70% of blood flow is venous

HCC leads to a predominance of arterial blood flow, visualize by infusing contrast into the arteries

33
Q

What produces alpha fetoprotein (AFP)

A

Fetal liver
Placenta
**malignant liver cells

34
Q

Alpha fetoprotein is elevated in ___% of patients wtih HCC

A

60-70%

**can also be elevated with hepatic inflammation in the absence of HCC and with cirrhosis

35
Q

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

A

200

36
Q

Prevention of HCC

A

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

37
Q

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

A

Metastatic disease

38
Q

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

A

Normal (not over 200)

39
Q

What are common sources of metastatic carcinoma?

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

GI (28 decks)

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