Flashcards in Focal Liver Lesions Deck (57)
What is Polycystic Liver Disease?
Embryonic ductal plate malformation of the intrahepatic biliary tree
Numerous cysts throughout liver parenchyma
What are the three types of Polycystic Liver Disease?
Von Meyenburg Complexes
Polycystic Liver Disease (PCLD)
Autosomal Dominant Polcystic Kidney Disease (ADPKD)
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
What are the differences between PCLD ad ADPKD?
Liver function preserved and renal failure rare
Symptoms depend on cyst size
Potential massive liver enlargement
Renal failure, extra hepatic features (e.g. hypertension, cardiac valve abnormalities, abdominal aneurysms) are common
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
What are the clinical features of a liver abscess?
Complex liver lesion
What may be found in the history of someone with a liver abscess?
Abdominal or biliary infection
What is the management for a liver abscess?
Initial empire broad spectrum antibiotics
Echocardiogram to look for signs of endocarditis
4 weeks antibiotic therapy with repeat imaging
Operation if no improvement (open drainage or resection)
What is the most important risk factor for Hepatocellular Carcinoma?
Cirrhosis (from any cause)
What are the clinical features of Hepatocellular Carcinoma?
Worsening of pre-existing chronic liver disease
Acute liver failure
What may be seen on examination of a patient with Hepatocellular Carcinoma?
Signs of cirrhosis
Hard enlarged RUQ mass
Liver bruit (rare)
What are the metatastic sites for Hepatocellular Carcinoma?
Rest of liver
Which tests might you run to diagnose Hepatocellular Carcinoma?
Labs of lier cirrhosis
Alpha Fetoprotein - HCC tumour marker (secreted by tumours)
How do you diagnose Hepatocellular Carcinoma?
Triphasic CT scan = very early arterial perfusion
Which factors contribute to the prognosis of Hepatocellular Carcinoma?
Underlying liver disease
Pt performance status
How is liver transplantation used in treatment of Hepatocellular Carcinoma?
Removes tumour and liver
Only if one single tumour
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
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
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
What systemic therapies can be used in the treatment of Hepatocelular Carcinoma?
Survival advantage in advanced HCC, but common GI side effects
When does Fibre-Lemellar Carcinoma commonly present?
Young patients (5-35)
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
What is the treatment for Fibre-Lamellar Carcinoma?
Surgical resection to transplantation is standard
TACE for patients with unresectable tumour
What are the common primaries for secondary liver metastases?
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
How do you diagnose Secondary Liver Metastases?