Focal Lesions of the Liver

Question 1

what are solid liver lesions in older patients likely to be?

Answer 1

Malignant metastases

Question 2

what are solid liver lesions in chronic liver disease patients likely to be?

Answer 2

Primary liver cancer

Question 3

What are solid tumours in non chronic liver patients likely to be?

Answer 3

Haemangioma

Question 4

Is haemangioma benign or malignant?

Answer 4

Benign

Question 5

What kind of tumour is an haemangioma?

Answer 5

Hyprevascular

Question 6

How many lesions are typical of an haemangioma ?

Answer 6

one single (small) lesion

Question 7

How do haemangiomas present on an US?

Answer 7

Echogenic spot, well demarcated

Question 8

How do haemangiomas present on a CT?

Answer 8

Venous enhancement from peripherally to centre

Question 9

How do haemangiomas present on an MRI?

Answer 9

High intensity area

Question 10

what is the treatment for a haemangioma?

Answer 10

No treatment needed

Question 11

what is focal Nodular Hyperplasia?

Answer 11

Benign nodule formation of normal liver tissue

Question 12

what is focal nodular hyperplasia associated with?

Answer 12

Osler-Weber-Rendu and liver haemangioma

Question 13

what is the common presentation of focal nodular hyperplasia?

Answer 13

Central scar containing a large artery, radiating branches to the periphery

Question 14

what is present in the histology of focal nodular hyperplasia?

Answer 14

Sinusoids, bile ductules and Kupffer cells

Question 15

what kind of mass is a focal nodular hyperplasia?

Answer 15

Hypervascular

Question 16

what is a hepatic adenoma?

Answer 16

Benign neoplasm composed of normal hepatocytes o there is no involvement of the portal tract, central veins or bile ducts

Question 17

how do people with hepatic adenomas present?

Answer 17

Usually asymptomatically but can have RUQ pain (due to rupture, haemorrhage, malignant transformation)

Question 18

what is the usual appearance of a hepatic adenoma?

Answer 18

Solitary fat containing lesion

Question 19

what are hepatic adenomas associated with?

Answer 19

Oral contraception and androgenic steroids

Question 20

How should a hepatic adenoma be treated?

Answer 20

Stop hormones ans observe every 6 months for two years

Question 21

what should be done if a hepatic adenoma doesn’t regress?

Answer 21

Surgical excision

Question 22

what is a simple cyst?

Answer 22

Liquid collection lined by an epithelium with no biliary tree communication

Question 23

Most of the time it is asymptomatic, but what can symptoms be related to?

Answer 23

Intracystic haemorrhage
Infection
Rupture
Compression of surrounding organs

Question 24

what is a hydatid cyst?

Answer 24

Echinoccocus granulosus

Question 25

what are the surgical options for a hydatid cyst?

Answer 25

copen cystectomy Marsupialization Pericystectomy Lobectomy

Question 26

what medication can be used to treat a hydatid cyst?

Answer 26

Albendazole

Question 27

what is polycystic Liver disease?

Answer 27

Enbryonic ductaal plate malformation of the intrahepatic biliary tree - many cysts throughout the parenchyma

Question 28

what are the 3 types of polycystic liver disease?

Answer 28

Von Meyenburg complexes (VMC) Polycystic Liver disease Autosomal dominant Polycystic Kidney disease

Question 29

What are von meyenburg complexes?

Answer 29

Benign cyst nodules throughout the liver

Question 30

where do cystic bile duct malformations originate in von meyenburg complexes?

Answer 30

from the peripheral biliary tree

Question 31

which genes are involved in Polycystic liver disease?

Answer 31

PCLD gene – PRKCSH and SEC63

Question 32

which genes are involved in Dominant Polycystic Kidney disease?

Answer 32

ADPKD genes – PKD1 and PKD2

Question 33

what are the clinical features of liver abscesses?

Answer 33

High fever Leukocytosis - increased number of white cells Abdominal Pain Complex liver lesion

Question 34

what is important in the history for liver abscesses?

Answer 34

abdominal/biliary infection or recent dental treatment

Question 35

what is the initial treatment for liver abscesses?

Answer 35

Empire broad spectrum antibiotics

Question 36

what are the surgical options for liver abscess treatment?

Answer 36

aspiration/drainage percutaneously open drainage resection

Question 37

what is the most common primary liver cancer?

Answer 37

Hepatocellular carcinoma

Question 38

what are the risk factors for hepatocellular carcinoma?

Answer 38

Cirrhosis of any cause: Hep B or C Alcohol Aflatoxin

Question 39

what are the clinical features of hepatocellular carcinomas?

Answer 39

Wt loss and RUQ pain Asymptomatic Worsening of pre-existing chronic liver disease Acute liver failure

Question 40

where are hepatocellular carcinomas likely to metastasise to?

Answer 40

portal vein, lymph nodes, lung, bone, brain

Question 41

what is Alfa Fetoprotein

Answer 41

AFP is an HCC tumour marker

Question 42

what values of AFP suggests HCC as a likely diagnosis?

Answer 42

100ng/ml or greater

Question 43

what investigations are used in the diagnosis of hepatocellular carcinoma?

Answer 43

Ultrasound CT scan MRI Biopsy

Question 44

what is the criteria for liver transplant in hepatocellular carcinoma?

Answer 44

Single tumour less than 5cm or 3 tumours less than 3cm each

Question 45

when can resection be used?

Answer 45

For small tumours with preserved liver function

Question 46

when can local ablation be used?

Answer 46

when resection can't - those who have advanced liver cirrhosis

Question 47

what are the two forms of ablation used in HCC?

Answer 47

Alcohol injection | Radiofrequency ablation

Question 48

what does TACE stand for?

Answer 48

Transarterial Chemoablation

Question 49

for which patients can TACE be used?

Answer 49

In patients with early cirrhosis

Question 50

In which patients does Fibre-Lamellar Carcinoma present?

Answer 50

Young patients

Question 51

What would a CT show in Fibre-Lamellar Carcinoma?

Answer 51

stellate scar with radial septal showing persistent enhancement

Question 52

what is the treatment for Fibre-Lamellar Carcinoma?

Answer 52

resection or transplantation - TACE if unresectable

Question 53

What are the common primary sites for secondary liver metastases?

Answer 53

colon, breast, lung, stomach, pancreas and melanoma