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Flashcards in Focal Lesions of the Liver Deck (53):
1

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

Malignant metastases

2

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

Primary liver cancer

3

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

Haemangioma

4

Is haemangioma benign or malignant?

Benign

5

What kind of tumour is an haemangioma?

Hyprevascular

6

How many lesions are typical of an haemangioma ?

one single (small) lesion

7

How do haemangiomas present on an US?

Echogenic spot, well demarcated

8

How do haemangiomas present on a CT?

Venous enhancement from peripherally to centre

9

How do haemangiomas present on an MRI?

High intensity area

10

what is the treatment for a haemangioma?

No treatment needed

11

what is focal Nodular Hyperplasia?

Benign nodule formation of normal liver tissue

12

what is focal nodular hyperplasia associated with?

Osler-Weber-Rendu and liver haemangioma

13

what is the common presentation of focal nodular hyperplasia?

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

14

what is present in the histology of focal nodular hyperplasia?

Sinusoids, bile ductules and Kupffer cells

15

what kind of mass is a focal nodular hyperplasia?

Hypervascular

16

what is a hepatic adenoma?

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

17

how do people with hepatic adenomas present?

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

18

what is the usual appearance of a hepatic adenoma?

Solitary fat containing lesion

19

what are hepatic adenomas associated with?

Oral contraception and androgenic steroids

20

How should a hepatic adenoma be treated?

Stop hormones ans observe every 6 months for two years

21

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

Surgical excision

22

what is a simple cyst?

Liquid collection lined by an epithelium with no biliary tree communication

23

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

Intracystic haemorrhage
Infection
Rupture
Compression of surrounding organs

24

what is a hydatid cyst?

Echinoccocus granulosus

25

what are the surgical options for a hydatid cyst?

copen cystectomy
Marsupialization
Pericystectomy
Lobectomy

26

what medication can be used to treat a hydatid cyst?

Albendazole

27

what is polycystic Liver disease?

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

28

what are the 3 types of polycystic liver disease?

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

29

What are von meyenburg complexes?

Benign cyst nodules throughout the liver

30

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

from the peripheral biliary tree

31

which genes are involved in Polycystic liver disease?

PCLD gene – PRKCSH and SEC63

32

which genes are involved in Dominant Polycystic Kidney disease?

ADPKD genes – PKD1 and PKD2

33

what are the clinical features of liver abscesses?

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

34

what is important in the history for liver abscesses?

abdominal/biliary infection or recent dental treatment

35

what is the initial treatment for liver abscesses?

Empire broad spectrum antibiotics

36

what are the surgical options for liver abscess treatment?

aspiration/drainage percutaneously
open drainage
resection

37

what is the most common primary liver cancer?

Hepatocellular carcinoma

38

what are the risk factors for hepatocellular carcinoma?

Cirrhosis of any cause:
Hep B or C
Alcohol
Aflatoxin

39

what are the clinical features of hepatocellular carcinomas?

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

40

where are hepatocellular carcinomas likely to metastasise to?

portal vein, lymph nodes, lung, bone, brain

41

what is Alfa Fetoprotein

AFP is an HCC tumour marker

42

what values of AFP suggests HCC as a likely diagnosis?

100ng/ml or greater

43

what investigations are used in the diagnosis of hepatocellular carcinoma?

Ultrasound
CT scan
MRI
Biopsy

44

what is the criteria for liver transplant in hepatocellular carcinoma?

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

45

when can resection be used?

For small tumours with preserved liver function

46

when can local ablation be used?

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

47

what are the two forms of ablation used in HCC?

Alcohol injection
Radiofrequency ablation

48

what does TACE stand for?

Transarterial Chemoablation

49

for which patients can TACE be used?

In patients with early cirrhosis

50

In which patients does Fibre-Lamellar Carcinoma present?

Young patients

51

What would a CT show in Fibre-Lamellar Carcinoma?

stellate scar with radial septal showing persistent enhancement

52

what is the treatment for Fibre-Lamellar Carcinoma?

resection or transplantation - TACE if unresectable

53

What are the common primary sites for secondary liver metastases?

colon, breast, lung, stomach, pancreas and melanoma