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GI lectures > Hepatomegaly and Focal Liver Lesions > Flashcards

Hepatomegaly and Focal Liver Lesions Flashcards

1
Q

solid liver lesions in older people?

A

more likely to be malignant

likely to be metasteses

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2
Q

solid liver lesions in chronic disease?

A

.

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3
Q

when are liver lesions detected?

A

cirrhosis screening

imaging for abdominal pain, deranged LFTs, resp problems

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4
Q

benign liver lesions?

A

haemangioma
focal nodular yperplasia
adenoma
liver cysts

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5
Q

malignant liver lesions?

A

primary liver lesions
- hepatocellular carcinoma
- choloangiocarcinoma
metastases

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6
Q

what is a haemoangioma?

A 
most common liver tumour
more in females
hypervascular tumour
usually singlesmall well dermarcated capsule
usually asymptomatic
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7
Q

how is haemoangioma diagnosed?

A

US = echogenic spot, well dermarcated
CT = venous enhancement from periphery to centre (bright white)
MRI = high intensity area
no need for FNA

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8
Q

how is haemangioma treated?

A

no treatment needed

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9
Q

what is a focal nodular hyperplasia (FNA?)

A

benign nodule formation of normal liver tissue

congenital vascular anomaly; assoc with Osler-Weber-Rendu and liver haemangioma

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10
Q

what are the clinical features of FNH?

A

classically - central scar containing a large artery, radiating branches to the periphery (Hub and Spoke)
Hyperplastic response to abnormal blood flow
Usually asymptomatic, may cause slight pain
More common in young/middle age women

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11
Q

How is FNH diagnosed?

A 
US = nodule with varying echogenicity
CT = hypervascular mass with central scar
MRI = Iso or Hypo intense
FNA = normal hepatocytes and kupffer cells with central score
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12
Q

how is FNA treated?

A

no treatment needed

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13
Q

what is a hepatic adenoma?

A

benign neoplasm composed of normal hepatocytes, no portal tract, central veins or bile duct
More common in women, assoc with contraceptive pill and anabolic steroids

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14
Q

what are the clinical features of hepatic adenoma?

A

usually asymptomatic, can have RUQ pain
May present with rupture, haemorrhage or malignant transformation (V. rare, more in males)
Symptoms depend on size

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15
Q

describe the most common hepatic adenoma

A

usually solitary fat containing lesions
usually in right lobe
Multiple adenomas (adenomatosis) is a rare condition assoc with glycogen storage disease

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16
Q

what are hepatic adenomas associated with?

A

oral contraception
androgenic steroids
regression can occur after discontinuation

17
Q

how are hepatic adenomas diagnosed?

A 
US = filling defect
CT = diffuse arterial enhancement
MRI = hypo/hyper intense lesion
FNA = may be needed
18
Q

how are hepatic adenomas treated?

A 
Stop hormones, weight loss
Males = surgical excision
Females = imaging after 6 months
- < 5cm or reducing = annual MRI
- > 5cm or growing = surgical excision
19
Q

what are the clinical features of a simple cyst?

A

liquid collection lined by epithelium
No biliary tree communication
Solitary and uniloculated

20
Q

what are the symptoms of a simple cyst?

A 
usually asymptomatic
Symptoms related to
- intracystic haemorrhage
- infection
- rupture
- compression
21
Q

how is a simple cyst managed?

A

no follow up needed
Imaging after 3-6 months if in doubt
Consider surgery if symptomatic or uncertain diagnosis

22
Q

what are the clinical features of hydatid cyst?

A 
echinococcus granulosus (tapeworm)
Travel to East Europe, Central/South America, Middle East and North Africa
23
Q

what are the symptoms of Hydatid cyst?

A

disseminated disease

erosion of cysts into adjacent structures and vessels (IVC)

24
Q

how is Hydatid cyst diagnosed?

A

history
appearance
serologic testing - detects anti echinococcus antibodies

25
Q

How are Hydatid cysts managed?

A 
Usually surgery
- open cystectomy, marsupialization
- Pericystectomy, lobectomy
Medical = Albendazole
Percutaneous drainage
26
Q

What is polycystic liver disease (PLD)?

A

Embryonic ductal plate malformation of the intrahepatic biliary tree
Numerous cysts throughout liver parenchyma

27
Q

what are the 3 types of polycystic liver disease?

A

Non Meyenburg complexes (VMC)
Polycystic Liver disease
Autosomal dominant polycystic kidney disease

GI lectures (75 decks)

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