Liver Cysts Flashcards
(42 cards)
How are liver cysts commonly found?
Incidentally on routine imaging
Explain simple liver cyst
Fluid-filled epithelial-lined sacs
They are most commonly found in the right lobe
Are quite common and increasing incidence with age.
Cause of simple cysts
Congenitally malformed bile duct cells that fail to connect to the extrahepatic ducts.
Clinical features of simple cysts.
Asymptomatic
Usually discovered incidentally.
10-15% may experience symptoms…
Abdo pain, nausea and early satiety.
Lab tests in simple cysts
LFTs usually normal
Some patients might have raised GGT
CEA and CA19-9 tumour markers may also be elevated in some cases
Imaging modality of choice in simple cysts
USS
USS findings in simple cysts
Anechoic
Well-defined
Thin-walled
Oval/spherical lesions with no septations
Strong posterior wall acoustic enhancement
General management of simple cysts.
Usually no management is needed.
> 4cm in size should have follow-up USS at 3, 6 and 12 months
If the size of the cyst remains unchanged after 2-3 years no further scans are needed
Managment in symptomatic patients with simple cysts.
Ultrasound-guided aspiration or laparoscopic de-roofing (cysts have blue hue on this)
Define polycystic liver disease
Presence of 20 or more cysts within the liver parenchyma each of which is 1 cm or more in size.
Caused by usually one of the two following conditions…
Autosomal dominant polycystic kidney disease (ADPKD)
Autosomal dominant polycystic liver disease (ADPLD)
Explain ADPKD
Caused by mutations in the PKD1 and PKD2 genes
10-60% patients will develop liver cysts as well as it is a common extra-renal manifestation
Explain ADPLD
Mutation in the PRKCSH or SEC63 gene
There will be no renal involvement in ADPLD
Pathophysiology of polycystic liver disease
The mutations in the genes lead to aberrant ductal plate configuration during liver embryogenesis.
This means that the structures are not connected to the intrahepatic bile duct
This means that they cannot drain -> dilatation and cyst formation of bile-like fluid.
Clinical features polycystic liver disease
Majority are asymptomatic
Abdominal pain can arise as the cysts grow in size
Hepatomegaly
Concurrent renal disease with urinary tract symptoms
Liver cirrhosis and portal HTN
Lab tests in polycystic liver disease
Usually normal LFTs
ALP can be raised sometimes
Renal function should also be assessed
Definitive diagnosis of polycystic liver disease
Ultrasound imaging with multiple of cysts (>20)
Management of asymptomatic patients of polycystic liver disease
Can be left alone and monitored
Many patients will eventually require some sort of intervention as they are progressive diseases.
Short-term benefit for somatostatin analogues in symptomatic relief might be trialled
This is because it acts to reduce cyst volume
Indications for surgery polycystic liver disease
Intractable symptoms
Inability to rule out malignancy on imaging alone
Prevention of malignancy
Surgical approach polycystic liver disease
US-guided aspiration
Laparoscopic de-roofing of cysts
Explain US guided aspiration in polycystic liver disease
Provides temporary relief
It is not routinely perfored as fluid usually accumulates again
Explain laparoscopic de-roofing of cysts in polycystic liver disease
Preferred technique
Where there are particular liver segments that are heavily affected resection may be preferred
Extreme cases transplantation might even be preferred
Explain cystic neoplasms of the liver
Quite rare and account for <5% of liver cysts
Most of them are cystadenomaswhich arepremalignant lesionsthat can lead tocystadenocarcinomas in around 10% of cases
Clinical features of cystic neoplasms
Most commonly asymptomatic
Since the neoplasms grow slowly, symptoms may present slowly as well.
Abdo pain, anorexia
Nausea, fullness and bloating
