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Y1 Gastrointestinal > Hepatomegaly and Focal Liver Lesions > Flashcards

Hepatomegaly and Focal Liver Lesions Flashcards

(100 cards)

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1
Q

is a solid liver lesion more likely to be malignant in a younger or older patient?

A

older

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2
Q

what is more common in the absence of liver disease, primary liver cancer or metastases to the liver?

A

metastases to the liver

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3
Q

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

A

haemangioma

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4
Q

name four benign liver lesions

A

haemangioma
focal nodular hyperplasia
adenoma
liver cysts

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5
Q

name two primary liver cancers

A

hepatocellular carcinoma

cholangiocarcinoma

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6
Q

what is the most common liver tumour?

A

haemangioma

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7
Q

is haemangioma more common in males or females?

A

females

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8
Q

describe the appearance of haemangioma

A

usually one, small tumour

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9
Q

what symptoms are usually present with haemangioma?

A

none

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10
Q

what investigations are done into haemangioma?

A

ultrasound
CT
MRI

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11
Q

what is seen on an ultrasound of a haemangioma?

A

a well demarcated echogenic spot

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12
Q

what is seen on a CT of a haemangioma?

A

venous enhancement from the periphery to the centre

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13
Q

what treatment is done for haemangioma?

A

none

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14
Q

what happens in focal nodular hyperplasia (FNH)?

A

a benign nodule of normal liver tissue forms

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15
Q

what causes focal nodular hyperplasia?

A

a congenital vascular anomaly

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16
Q

name two conditions associated with focal nodular hyperplasia

A

osler-webb-rendu

haemangioma

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17
Q

what does FNH look like when imaged?

A

a central scar containing a large artery, with radiating branches to the periphery

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18
Q

what age group and gender most commonly gets FNH?

A

young/middle aged women

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19
Q

what symptoms are associated with FNH?

A

none or minimal pain

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20
Q

what is FNH?

A

focal nodular hyperplasia

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21
Q

what four investigations are done for suspected FNH?

A

ultrasound
CT
MRI
FNA

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22
Q

what is FNA?

A

fine needle aspiration

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23
Q

what is seen on ultrasound in FNH?

A

a nodule with varying echogenicity

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24
Q

what is seen on CT in FNH?

A

a hypervascular mass with a central scar

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25
what is seen on FNA in FNH?
normal hepatocytes and kupffer cells with a central core
26
what treatment is done for FNH?
none is necessary
27
what is a hepatic adenoma?
a benign neoplasm composed of normal hepatocytes
28
is hepatic adenoma more common in males or females?
females
29
what two chemicals are associated with hepatic adenoma?
contraceptive hormones | anabolic steroids
30
what symptoms are associated with hepatic adenoma?
none | may have RUQ pain
31
what rare ways may hepatic adenoma present?
rupture haemorrhage malignant transformation
32
is malignant transformation of hepatic adenoma more common in males or females?
males
33
what lobe is most commonly affected by hepatic adenoma?
the right lobe
34
what is adenomatosis?
multiple adenomas in the liver
35
what is adenomatosis associated with?
glycogen storage diseases
36
what four investigations may be done into hepatic adenoma?
ultrasound CT MRI FNA
37
what conservative treatment can be done for hepatic adenoma?
stop hormones | lose weight
38
what should be done for adenomas present in males?
surgical excision, irrespective of size
39
what is done for hepatic adenomas in females?
imaging after six months
40
what is done for a hepatic adenoma under 5cm or reducing in size in females?
an annual MRI
41
what is done for a hepatic adenoma over 5cm or increasing in size in females?
surgical excision
42
what five types of cystic lesions can be present in the liver?
``` simple hydatid atypical polycystic amoebic abscess ```
43
what is a simple cyst?
a liquid collection lined by an epithelium
44
what are complications of a simple cyst that can cause symptoms?
intracystic haemorrhage infection rupture compression
45
what causes a hydatid cyst?
Echinococcus granulosus
46
what can patients with a hydatid cyst present with?
disseminated disease | erosion of cysts into adjacent structures and vessels
47
what vessel do hydatid cysts commonly erode into?
the IVC
48
what two methods can be used to manage a hydatid cyst?
surgery | percutaneous drainage
49
what drug can be given to treat a hydatid cyst?
albendazole
50
what is the most common way to treat a hydatid cyst?
surgery
51
what conservative surgery can be done for a hydatid cyst?
open cystectomy
52
what radical surgeries can be done for a hydatid cyst?
pericystectomy | lobectomy
53
what is present in polycystic liver disease?
numerous cysts throughout the liver parenchyma
54
what is PLD?
polycystic liver disease
55
what are the three types of PLD?
von meyenburg complexes (VMC) polycystic liver disease autosomal dominant polycystic kidney disease (ADPKD)
56
what is VMC?
von meyenburg complexes
57
what are von meyenburg complexes?
benign cystic nodules throughout the liver
58
what is ADPKD?
autosomal dominant polycystic kidney disease
59
what does ADPKD commonly cause?
renal failure
60
what genes are affected in ADPKD?
PKD1 and PKD2
61
what genes are affected in polycystic liver disease?
PRKCSH and SEC63
62
name two common symptoms of PLD
abdominal pain | distension
63
what type of treatment is recommended in PLD and why?
conservative, to halt cyst growth and reduce symptoms
64
when is invasive treatment required for PLD?
when patients have advanced disease
65
what invasive treatment can be done for PLD?
aspiration | liver transplantation
66
what pharmacological therapy can be given for PLD?
somatostatin analogues
67
what three things does a liver abscess commonly cause?
high fever leukocytosis abdominal pain
68
what two things in a history can indicate towards a liver abscess?
abdominal/biliary infection | dental procedures
69
what investigation can be done for a liver abscess?
echocardiogram
70
what is the initial management of a liver abscess?
empiric broad spectrum antibiotics | aspiration/drainage
71
what is done for liver abscesses if there is no clinical improvement
open drainage or resection
72
what follow up treatment is done for patients with liver abscesses?
four weeks of antibiotic therapy and repeat imaging
73
name four malignant liver lesions
hepatocellular carcinoma fibrolamellar carcinoma of the liver hepatoblastoma intrahepatic cholangiocarcinoma
74
what does HCC stand for?
hepatocellular carcinoma
75
what is the most common primary liver cancer?
hepatocellular carcinoma
76
is HCC more common in men or women?
men
77
what is the most important risk factor for HCC?
cirrhosis of any cause
78
name four clinical features of HCC
weight loss RUQ pain worsening pre-existing chronic liver disease acute liver failure
79
what is seen on examination of HCC?
signs of cirrhosis hard, enlarged RUQ mass liver bruit
80
where can HCC metastasise to?
portal vein lungs bones the brain
81
what protein is a marker for HCC?
AFP
82
what is AFP?
alfa feto protein
83
what value of AFP is seen in the majority of HCC patients?
over 100
84
what is the best possible treatment for HCC?
liver transplant
85
when is liver transplant done in HCC?
one tumour <5cm OR 3 tumours <3cm
86
when is resection feasible for HCC?
small tumours with preserved liver function
87
what two things rule out resection for HCC?
jaundice | portal hypertension
88
what treatment is done for HCC in non-resectable patients or those with advanced liver cirrhosis?
local ablation
89
what two methods can be used for local ablation of HCC?
alcohol injection | radiofrequency ablation
90
what is TACE?
trans arterial chemoembolization
91
what does TACE involve?
injecting chemotherapy and then an embolic agent into a hepatic artery
92
who gets TACE?
HCC patients with early cirrhosis
93
who can't get TACE?
patients with metastatic disease
94
who does fibrolamellar carcinoma present in?
young patients from 5-35
95
what is AFP like in fibrolamellar carcinoma?
it is normal
96
what does a CT of fibrolamellar carcinoma show?
a stellate scar with radial septa
97
what is the standard care for fibrolamellar carcinoma?
surgical resection or transplant
98
what is the treatment for unresectable fibrolamellar carcinoma?
TACE
99
what is the most common site for blood born metastases?
the liver
100
how is a liver metastasis diagnosed?
imaging or FNA

Y1 Gastrointestinal (48 decks)

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