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Flashcards in Focal Liver Lesions Deck (57):
1

A solid liver lesion in older patients in the absence of liver disease is most likely to be?

A malignant metastases

2

A solid liver lesion in chronic liver disease patients is most likely to be?

Primary liver cancer

3

What is the most common solid liver tumour in non cirrhotic patients?

Haemangioma

4

What are the four kinds of benign liver tumours?

Haemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

5

What are the two types of malignant liver tumours?

Primary liver cancers
Metastases

6

What are the three kinds of primary liver cancer?

Hepatocellular carcinoma
Fibrolamelar carcinoma
Hepatoblastoma

7

What are the clinical features of Haemangioma?

More common in females
Hypervascular tumour
Usually single small
Well demarcated capsule
Usually asymptomatic

8

How do you diagnose a Haemangioma?

Ultrasound = Echogenic spot, well demarcated
CT = venous enhancement from periphery to centre
MRI = High intensity area

9

What is the treatment for Haemangioma?

None needed
Benign incidental fining which does not go on to develop into anything else

10

What are the clinical features of Focal Nodular Hyperplasia?

Benign nodule foramen of normal liver tissue
Congenital vascular abnormality
Classically appears as a central scare contain a large artery with branches radiating to the periphery
Hyper plastic response to abnormal arterial flow
More common in young and middle age women
Usually asymptomatic, may cause minimal pain

11

What would you see on histology of Focal Nodular Hyperplasia?

Sinusoids, bile ductules and Kupffer cells present

12

How do you diagnose Focal Nodular Hyperplasia?

US = Nodule with varying echogenicty
CT = Hypervascular mass with central scar
MRI = Iso- or hypo- intense
FNA = Normal hepatocytes and Kupffer cells with central core

13

What is the treatment of Focal Nodular Hyperplasia?

None needed

14

What are the clinical features of Hepatic Adenoma?

Benign neoplasm composed of normal hepatocytes with NO portal tract, central vein or bile ducts
More common in women
Associated with contraceptive hormones
Usually asymptomatic, with possible RUQ pain
rarely presents with rupture, haemorhhage or very rarely malignant transformation

15

In which part of the liver are most Hepatic Adenomas found?

Right lobe

16

What is a Hepatic Adenoma?

Most are solitary fat containing lesions

17

What is Adenomatosis?

A rare condition of multiple adenomas associated with Glycogen Storage Disease

18

How does use of OC contribute to Hepatic Adenomas?

Risk related to duration of use
The oestrogen component causes the adenoma
Regression can occur on stopping the OC

19

How do you diagnose Hepatic Adenoma?

US = Filling defect
CT = Diffuse arterial enhancement
MRI = Hypo or hyper intense lesion

20

What is the treatment for Hepatic Adenomas?

Stop hormone
Observe every 6m for 2y
If no regression, then surgical excision

21

What types of cyclic lesions can occur?

Simple
Hydatid
Atypical
Polycystic
Pyogenic or amoebic

22

What are the clinical features of a simple cyst?

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

23

What are the symptoms of a simple cyst?

Mostly asymptomatic
Symptoms can be related to:
Intracystic haemorrhage
Infection
Rupture (rare)
Compression on adjacent structures

24

How do you manage a simple cyst?

No follow up necessary
If in doubt, imaging in 3-6 months
If symptomatic, consider surgical intervention

25

What is the cause of a Hydatid Cyst?

Echinoccocus granulosus
TAPEWORM

26

How might a patient with a Hydatid Cyst present?

Disseminated disease
erosion of cysts into adjacent structures and vessels

27

How do you diagnose a Hydatid Cyst?

History
Appearance
Serological testing detection of anti-Echinococcus antibodies

28

What treatment is available for Hydatid Cysts?

Surgery = Conservative or Radical
Medical = Albendazole
Percutaneous Drainage = PAIR

29

What types of surgery are available to treat Hydatid Cysts?

Conservative =
Open cystectomy
Marsupialisation

Radical =
Pericystectomy
Lobectomy

30

What risks are associated with Hydatid Cysts?

Operative morbidity
Anaphylaxis
Dissemination of infection

31

What is Polycystic Liver Disease?

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

32

What are the three types of Polycystic Liver Disease?

Von Meyenburg Complexes
Polycystic Liver Disease (PCLD)
Autosomal Dominant Polcystic Kidney Disease (ADPKD)

33

What are Von Meyenburg Complexes?

Microhamartomas = Benign cystic nodules thought the liver
Cystic bile duct malformations, originating in the peripheral biliary tree
Remnants develop into small hepatic cysts and usually remain silent during life

34

What are the differences between PCLD ad ADPKD?

PCLD =
Liver function preserved and renal failure rare
Symptoms depend on cyst size

ADPKD =
Potential massive liver enlargement
Renal failure, extra hepatic features (e.g. hypertension, cardiac valve abnormalities, abdominal aneurysms) are common

35

What is the management for Politic Liver Disease?

Conservative treatment to halt cyst growth and alleviate symptoms
Invasive procedures generally only needed in associate liver failure or cirrhosis
Pharmacological therapy with somatostatin may aid symptom relief

36

What are the clinical features of a liver abscess?

High fever
Leukocytosis
Abdominal pain
Complex liver lesion

37

What may be found in the history of someone with a liver abscess?

Abdominal or biliary infection
Dental procedure

38

What is the management for a liver abscess?

Initial empire broad spectrum antibiotics
Aspiration/drainage percutaneously
Echocardiogram to look for signs of endocarditis
4 weeks antibiotic therapy with repeat imaging
Operation if no improvement (open drainage or resection)

39

What is the most important risk factor for Hepatocellular Carcinoma?

Cirrhosis (from any cause)

40

What are the clinical features of Hepatocellular Carcinoma?

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

41

What may be seen on examination of a patient with Hepatocellular Carcinoma?

Signs of cirrhosis
Hard enlarged RUQ mass
Liver bruit (rare)

42

What are the metatastic sites for Hepatocellular Carcinoma?

Rest of liver
Portal vein
Lymph nodes
Lung
Bone
Brain

43

Which tests might you run to diagnose Hepatocellular Carcinoma?

Labs of lier cirrhosis
Alpha Fetoprotein - HCC tumour marker (secreted by tumours)

44

How do you diagnose Hepatocellular Carcinoma?

Clinical presentation
Elevated AFP
US
Triphasic CT scan = very early arterial perfusion
MRI
Biopsy

45

Which factors contribute to the prognosis of Hepatocellular Carcinoma?

Tumour size
Extrahepatic spread
Underlying liver disease
Pt performance status

46

How is liver transplantation used in treatment of Hepatocellular Carcinoma?

Removes tumour and liver
Only if one single tumour

47

How is resection used in the treatment of Hepatocellular Carcinoma?

Feasible for small tumours with preserved liver function (no jaundice or portal hypertension)
High recurrence rate

48

How is local ablation used in the treatment of Hepatocellular Carcinoma?

For non resectable patients, or those with advanced liver cirrhosis
Alcohol injection or radiofrequency ablation
Temporary measure only

49

How is chemoembolisation used in the treatment of Hepatocellular Carcinoma?

Reserved for patients with well preserved liver function
Inject chemotherapy selectively in hepatic artery, then inject embolic agent - Tumour dies of ischaemic necrosis

50

What systemic therapies can be used in the treatment of Hepatocelular Carcinoma?

Sorafenib =
Survival advantage in advanced HCC, but common GI side effects

51

When does Fibre-Lemellar Carcinoma commonly present?

Young patients (5-35)

52

What are the clinical features of Fibre-Lamellar Carcinoma?

Unrelated to cirrhosis
AFP is normal
CT = Typical stellate scar with radial septa showing persistent enhancement

53

What is the treatment for Fibre-Lamellar Carcinoma?

Surgical resection to transplantation is standard
TACE for patients with unresectable tumour

54

What are the common primaries for secondary liver metastases?

Colon
Breast
Lung
Stomach
Pancreas
Melanoma

55

What are the clinical features of Secondary Liver Metastases?

Mild cholestatic picture (raised ALP) with preserved liver function
May present with jaundice or weight loss

56

How do you diagnose Secondary Liver Metastases?

Imaging
FNA

57

What is the treatment for Secondary Liver Metastases?

Dependent on primary carcinoma
In some cases, resection or chemoembolisation is possible