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Gastrointestinal > Focal Liver Lesions and Hepatomegaly > Flashcards

Focal Liver Lesions and Hepatomegaly Flashcards

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1
Q

describe liver lesions in the elderly

A

more likely to be malignant - metastases more common than primary liver cancer in absence of liver disease

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2
Q

describe liver lesions in chronic liver disease

A

more likely to be a primary liver cancer than metastases or benign tumours

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3
Q

describe liver tumours in non-cirrhotic patients

A

most common tumour is haemangioma

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4
Q

bengin liver lesions

A

haemangioma
focal nodular hyperplasia
adenoma
liver cysts

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5
Q

malignant liver lesions

A

primary liver cancers

metastaes

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6
Q

primary liver cancers

A 
hepatocellular carcinoma (HCC)
cholangiocarcinoma
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7
Q

types of cholangiocarcinoma

A

fibrolamella carcinoma

hepatoblastoma

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8
Q

types of hepatoblastoma

A

angiosarcoma

haemangioendothelioma

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9
Q

epidemiology of haemangioma

A

most common liver tumour

female

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10
Q

pathology of haemangioma

A

hyper vascular tumour (attached to lots of blood vessels)
single and small
well demarcated capsule

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11
Q

symptoms of haemangioma

A

asymptomatic

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12
Q

complications of haemangioma

A

bleeding (due to hypervascularity)

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13
Q

tests for haemangioma

A

ultrasound
CT
MRI

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14
Q

treatment for haemangioma

A

none

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15
Q

pathology of focal nodular hyperplasia (FNH)

A

nodule formation
congenital vascular anomaly (associated with Osler-Weber-Rendu and liver haemangioma)
central scar containing a large artery, radiating branches to the periphery
Hyperplastic response to abnormal arterial flow

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16
Q

epidemiology of FNH

A

young and middle aged woman - no relation with sex hormones

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17
Q

symptoms of FNH

A

asymptomatic

minimal pain

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18
Q

histology of FNH

A

sinusoid
bile ductules
kupffer cells

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19
Q

tests for FNH

A

ultrasound
CT
MRI
fine needle aspiration (FNA)

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20
Q

treatment for FNH

A

none

no change in pregnancy or hormones

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21
Q

pathology of hepatic adenoma

A

neoplasm composed of normal hepatocytes, no portal tract, central veins or bile ducts
solitary fat containing lesions
hypervascular
usually right lobe

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22
Q

epidemiology of hepatic adenoma

A

female
contraceptive hormones
androgenic steroids
malignant transformation risk is higher in males

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23
Q

symptoms of hepatic adenoma

A

asymptomatic

right upper quadrant pain

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24
Q

rare signs of hepatic adenoma

A

size related;
rupture
haemorrhage
malignant transformation

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25
what is multiple adenomas
rare conditions associated with glycogen storage disease
26
tests for hepatic adenoma
ultrasound CT MRI FNA
27
treatment for hepatic adenoma
stop hormones weight loss males - surgical excision females - imaging in 6 months, surgical incision then dependent on size (>5 cm - remove)
28
types of cystic lesions
``` simple hydatid atypical polycystic lesion pyogenic or amoebic abscesses ```
29
pathology of simple cyst
liquid collection lined by epithelium no biliary tree communication solitary and uniloculated
30
symptoms of simple cyst
asymptomatic | symptoms due to complications
31
complications of simple cyst
intracystic haemorrhage infeciton rupture (rare) compression
32
treatment for simple cyst
no follow up necessary if doubt - imaging 3-6 months surgical intervention - symptomatic or uncertain diagnosis
33
pathology of hydatid cyst
echinoccocus granulosus (Cestoda)
34
signs of hydatid cyst
disseminated disease erosion of cysts into adjacent structures and vessels (IVC) detection of anti-echinococcus antibodies
35
treatment for hydatid cyst
surgery drug - albendazole percutaneous drainage
36
pathology of polycystic liver disease (PLD)
embryonic ductal plate malformation of the intrahepatic biliary tree numerous cysts throughout liver parenchyma
37
types of PLD
von meyenburg complexes (VMC) polycystic liver disease (PCLD) autosomal dominant polycystic kidney disease (ADPKD)
38
pathology of VMC
benign cystic nodules throughout liver cystic duct malformation originating from peripheral biliary treee remnants develop into small hepatic cysts and remain asymptomatic
39
aetiology of VMC
not germline genetically driven | incidental finding
40
aetiology of PCLD
mutation in PCLD gene - PRKCSH and SEC63
41
pathology of PCLD
liver function preserved | renal failure is rare
42
symptoms of PCLD
dependent on size of cysts; abdominal pain abdominal distension atypical symptoms
43
pathology of ADPKD
renal failure due to polycystic kidneys non-renal extra hepatic features potential massive hepatic enlargement
44
aetiology of ADPKD
mutation in ADPKD genes - PKD1 and PKD2
45
treatment of polycystic liver disease
conservative invasive (only in those with advanced PCLD, ADPKD or liver failure) - defenestration/aspiration, liver transplantation somatostatin
46
action of somatostatin in polycystic liver disease management
symptom relief | liver volume reduction
47
symptoms/signs of liver abscess
high fever leukocytosis abdominal pain complex liver lesion
48
aetiology of liver abscess
abdominal or biliary infection | dental procedure
49
treatment of liver abscess
empiric broad spectrum antibiotics aspiration/drianinage surgery (no improvement) 4 weeks antibiotic therapy with repeat imaging
50
epidemiology of HCC
men
51
risk factors for HCC
``` cirrhosis from any cause; HBV (integrates DNA) HCV alcohol aflatoxin other ```
52
symptoms/signs of HCC
``` weight loss right upper quadrant pain asymptomatic worsening of pre-existing chronic liver disease acute liver failure ```
53
signs of HCC
signs of cirrhosis hard enlarged right upper quadrant mass liver bruit (rare) elevated alfa fetoprotein (AFP)
54
metastases of HCC
``` rest of the liver portal vein lymph nodes lung bone brain ```
55
describe AFP
HCC tumour marker | >100ng/ml - high probability of HCC
56
tests for HCC
``` AFP ultrasound triphasic CT MRI biopsy ```
57
treatment for HCC
``` liver transplantation resection local ablation chemoembolization - TACE systemic therapies ```
58
describe local ablation treatment in HCC
ethanol injection | radiofrequency ablation
59
liver transplantaiton in HCC
low recurrence rate
60
resection in HCC
small tumours with preserved liver function, high recurrence rate
61
local ablation in HCC
non resectable tumour
62
TACE in HCC
inject chemotherapy selectively in hepatic artery then inject embolic agent only in patients with early cirrhosis
63
systemic therapies in HCC
sorafenib
64
action of sorafenib
multikinase inhibitor of vascular endothelial gf receptor, platelet derived gf receptor and Raf common side effects but increased survival
65
epidemiology fibro-lamellar carcinoma
young patients | not related to cirrhosis
66
pathology of fibro-lamellar carcinoma
AFP normal | stellate scar with radial septa showing persistent enhancement
67
treatment for fibro-lamellar carcinoma
surgical resection transplantation TACE - unresectable tumour
68
describe secondary liver metastases
most common site for blood born metastases
69
common primaries for secondary liver metastases
``` colon breast lung stomach pancreas melanoma ```
70
pathology of secondary liver metastases
mild evaluated ALP | preserved liver function
71
tests for secondary liver metastases
ultrasound CT MRI FNA
72
treatment for secondary liver metastases
dependent on primary cancer | resection or TACE may be possible

Gastrointestinal (71 decks)

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