Flashcards in Benign Lesions in the Liver Deck (53):
1
Solid liver lesions in older patients are more likely to be what?
Malignant with metastases more common than primary liver cancer in the absence of liver disease
2
WHat are solid liver lesions in patients with chronic liver disease more likely to represent?
Primary Liver Cancer rather than metastases or benign tumour
3
What is the most common solid liver tumour in non cirrhotic patients
Hemangioma (benign)
4
Name 4 benign liver tumours
Hemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts
5
Name the 2 main types of malignant tumours
Primary liver cancers
Metastases
6
What are the 2 types of Primary liver cancers
Hepatocellular carcinoma
Cholangiocarcinoma
7
What is the commonest liver tumour
Hemangioma
8
Describe a hemangioma
A vascular tumour
Usually single and small
Well demarcated capsule
Usually asymptomatic
9
How do we diagnose a Hemangioma
Ultrasound is key
CT
MRI
10
What is the treatment for hemangioma
No treatment
11
Describe a focal nodular hyperplasia
enign nodule formation of normal liver tissue
congenital anomaly
12
What is the classic appearance of a focal nodular hyperplasia
A central scar through the middle of the mass
13
Who is more likely to have a focal nodular hyperplasia
Young and middle aged women
14
What type of response is a focal nodular hyperplasia?
A hyperplastic response to abnormal arterial flow
15
How can we diagnose a focal nodular hyperplasia
Ultrasound
CT
MRI
Fine needle aspiration
16
What is the treatment for Focal nodular hyperplasia
No treatment
No change is required for pregnancy or hormones
17
What is a hepatic adenoma
Benign neoplasm composed of normal hepatocytes with no portal tract, central veins or bile ducts
18
Who is more likely to get hepatic adenomas?
Women
19
What are hepatic adenomas associated with
The contraceptive hormones - mostly oestrogen
20
What are the symptoms of hepatic adenoma
Usually asymptomatic but may have RUQ pain
21
How might hepatic adenomas present
Rupture, haemorrhage or malignant transformation
22
Where are hepatic adenomas most commonly found
In the right lobe in young women
23
How can regression of hepatic adenomas occur
If the oral contraceptive is discontinued
24
How can we diagnose hepatic adenoma
US
CT
MRI
FNA
25
What is the treatment for hepatic adenomas
Stop the hormones and observe every 6 months for 2 years
If there is no regression then surgical incision may be appropriate
26
What liver structures do adenomas contain
Purely hepatocyte tumours
27
What liver structures do focal nodular hyperplasias contain
All of the liver ultrastructure - RES and bile ductules
28
What type of benign tumour imay bleed
Adenoma
29
What type of benign tumour has the risk of developing into a malignant tumour
Adenoma
30
How can you describe both adenomas and focal nodular hyperplasia
Hypervascular
31
What is a simple cyst
A liquid collection lined by an epithelium
32
What do simple cysts look like on US
Black holes
33
How common are simple cysts in the liver
2nd most common to hemangiomes
34
When would we consider surgical intervention in a simple cyst
If the patient was symptomatic
35
What is the cause of hydatid cysts
Sheep born parasite
36
What can hydatid cysts erode into?
The IVC
37
What is the treatment of a hydatid cyst
Marsupialisation or resection
Albendazole (also used for tapeworms)
38
What is polycystic liver disease a result of
Embryonic ductal plate malformation of the intrahepatic biliary tree
39
What are the 3 types of polycystic liver disease
Von Meyenburg complexes
Polycystic liver disease
Autosomal dominant polycystic kidney disease
40
What is the most common form of PLD
Autosomal recessive
41
What are Von Meyenburg complexes
Benign cystic nodules throughout the liver
42
When do Von Meyenburg complexes occur
During liver development
43
What do the symptoms of PCLD depend on
The size of the cysts
44
What is the main What does autosomal dominant polycystic kidney disease result in
Renal failure
45
What is the main method of managing polycystic liver disease
Conservative treatment
46
What drug is used in PLD for symptom relief and liver volume reduction
Somatostatin
47
What are the 3 common symptoms of a liver abscess
high fever
Leukocytosis
Abdominal Pain
48
Who tends to appear more unwell a patient with a liver abscess or a patient with metastasis?
Liver abscess
49
What is the common history of a patient with liver abscess
Abdominal or biliary infection
Dental procedure (rare)
50
What is the treatment for a liver abscess treatment
Initial broad spectrum antibiotics
Aspiration/ drainage
51
Why do we do an ECHO on patients with a liver abscess
To rule out bacterial endocarditis
52
What do we do for a patient if there is no clinical improvement?
Open drainage and resection
53