Benign Liver Diseases

Question 1

What is polycystic liver disease?

Answer 1

Autosomal dominant disease that causes liver cyst formation in liver. Can be associated with polycystic kidney disease

Question 2

What is Gigot classification?

Answer 2

Classification for polycystic liver disease

Question 3

What is Gigot Type 1?

Answer 3

Limited area of large cysts >10cm (<10), liver largely normal

Question 4

What is Gigot Type 2?

Answer 4

Diffuse involvement of parenchyma by medium sized cysts. Large areas of uninvolved liver

Question 5

What is Gigot Type 3?

Answer 5

Massive involvement of liver by small and medium size cysts

Question 6

Treatment for symptomatic polycystic liver

Answer 6

• Medical:
  
  • Somatostatin analogue
• IR:
  
  • Percutaneous aspiration + sclerotherapy
• Surgery
  
  • Laparoscopic fenestration
  • Liver resection with deroofing
  • Liver transplantation

Question 7

Suggested management for Gigot’s classification of liver cysts

Answer 7

• Gigot’s 1: percutaneous sclerotherapy, fenestration
• Gigot’s 2 / 3: liver resection, transplantation

Question 8

What is biliary cystadenoma?

Answer 8

• rare, slow growing cystic lesion
• STRONG malignant potential
• Usually solitary, multiloculated
• Affect female >40

Question 9

Treatment for biliary cystadenoma

Answer 9

Resection due to malignant potential

Question 10

What is a hydatid cyst?

Answer 10

• Infection due to Echinococcus granulosum, originating hosts are dogs
• Men are intermediate hosts from ingesting tapeworm eggs
  *

Question 11

Management for hydatid cyst

Answer 11

Hepatic resection:

Natural progression = progressive enlarging cysts => rupture into peritoneum or thoracic cavity

Percutaneous drainage is contraindicated

Question 12

Pathogenesis of liver abscess

Answer 12

• Hepatic artery origin
• Portal vein origin portal pyemia from appendicitis/ diverticulitis
• Biliary tree origin RPC, GS etc
• Direct invasion from adjacent organ
• Secondary to liver tumor treatment RFTA

Question 13

Microbiological organism in liver abscess

Answer 13

• Bacteria: usually enteric organisms, most common E.coli Klebsiella
• Parasitic, Enameoba Histolytica
  
  • Fungal, usually candida

Question 14

Management of liver abscess

Answer 14

• Manage sepsis
  
  • Percutaneous drainage +/- biliary drainage
  • Prolonged antibiotics for 6 weeks
• Investigate underlying cause
  
  • Colonoscopy: rule out occult colon ca
  • Echo: for hematogenous cause

Question 15

What is a haemangioma?

Answer 15

Most common benign liver lesion

Vascular malformations or hamartomas of congenital origin

Microscopic: Cluster of blood-filled cavities lined by endothelial cells

Growth by ectasia rather than hyperplasia/dysplasia

not neoplastic and no malignant potential

Question 16

Risk factors for hemangioma

Answer 16

Female

Exposure to estrogen

Question 17

Management of hemangioma

Answer 17

Small and asymptomatic → conservative

Large and symptomatic → enucleation

Question 18

What is a hepatic adenoma?

Answer 18

Uncommon solid benign liver lesion. Usually solitary lesions found most commonly in young women with estrogen containing medication

Question 19

Risk factors for hepatic adenoma

Answer 19

Exposure to estrogen

Anabolic androgen use

FAP, Glycogen storage disease

Obesity

Metabolic syndrome

Question 20

Management of hepatic adenoma

Answer 20

• General measures:
  
  • Discontinue estrogen containing medication
  • Diet modification, exercise if high BMI
• Females
  
  • <5cm, asymptomatic: surveillance MRI
  • >5cm, failed general measures: surgical resection vs ablation techniques (TAE, RFA)
  • Avoid pregnancy before resection
• Males: resection b/c increase risk of malignant

Question 21

What is focal nodular hyperplasia?

Answer 21

Benign liver disease composed of proliferation of hyperplastic hepatocytes surrounding a stellate scar