Liver, etc. 9 - Focal Liver Lesions Flashcards Preview

1st Year - Gastroenterology > Liver, etc. 9 - Focal Liver Lesions > Flashcards

Flashcards in Liver, etc. 9 - Focal Liver Lesions Deck (61):
1

What are solid liver lesions in older patients most likely to be?

Malignant - usually metastases if the patient does not have liver disease (then it is more likely to be a primary liver cancer)

2

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

Haemangioma

3

What are the causes of a benign focal liver lesions? (4)

HaemangiomaFocal nodular hyperplasiaAdenomaLiver cysts

4

What are the 2 causes of malignant focal lesions of the liver?

Primary liver cancersMetastases

5

What are the types of primary liver cancers? (6)

Hepatocellular carcinomaCholangiocarcinomaFibrolamellar carcinomaHepatoblastomaAngiosarcomaHaemangioendothelioma

6

Clinical features of haemangioma:-more common in M or F?- blood supply?- size/ number of them?- border?- symptoms?

FemalesHypervascular tumourUsually single and smallWell demarcated capsuleusually asymptomatic

7

Diagnosis of haemangioma?

US: echogenic spot, well demarcatedCT: venous enhancement from periphery centreMRI: high intensity areaNo need for FNA

8

Treatment for haemangioma?

No need for treatment

9

What is a focal nodular hyperplasia?

Benign nodule formation of normal liver tissue (hyper plastic growth of normal hepatocytes)

10

What is usually the cause of a focal nodular hyperplasia?What 2 other conditions is FNH therefore associated with?

Congenital vascular anomaly - hyperplastic response to abnormal arterial flowOsler-Weber-RenduLiver haemangioma

11

What is the classical appearance of a focal nodular hyperplasia?

Central scar containing a large artery, radiating branches to the periphery (Hub and spoke) - not always

12

What 3 things are present on histology focal nodular hyperplasia?

SinusoidsBile ductulesKupffer cells

13

What age groups and gender are focal nodular hyperplasia more common in?

Young and middle age women (no relation with sex hormones)

14

Symptoms of focal nodular hyperplasia?

Usually asymptomatic, amy cause minimal pain

15

Diagnosis of focal nodular hyperplasia?

US: nodule with varying echogenicityCT: hypervascular scar with central scarMRI: Iso or hypo intenseFNA: normal hepatocytes and cupful cells with central core

16

Treatment of focal nodular hyperplasia?

No treatment necessary(no change required regarding pregnancy and hormones - some older texts give mixed message)

17

What is a hepatic adenoma?

Benign neoplasm composed of normal hepatocytes - most are solitary fat containing lesionsNo portal tract, central veins or bile ducts

18

Clinical features of hepatic adenoma:Which sex is it more common in?What is it commonly associated with?Symptoms?What can it rarely present with?

FemalesContraceptive hormonesUsually asymptomatic but may have RUQ pain - symptoms are size relatedMay present with rupture, haemorrhage or malignant transformation (very rare)

19

What lobe of the liver are hepatic adenomas commonly found in?

The right lobe

20

What is multiple adenomas called?What is this associated with?

AdenomatosisGlycogen storage diseases

21

What has been identified within adenomas that confer malignant risk?

Identifiable oncogene mutations

22

How are hepatic adenomas related to Oral Contraceptive?

Related to duration of OC use (>2 years) and oestrogen component, but adenomas have been described with even 6 months of OS use

23

What can happen do hepatic adenomas after discontinuation of Oral contraceptives?

Regression

24

Diagnosis of hepatic adenoma?

US: filling defectCT: diffuse arterial enhancementMRI: hypo or hyper intense lesionFNA: may be needed

25

Treatment for a hepatic adenoma?

Stop hormonesObserve every 6m for 2yif no regression then surgical excisionNew guidelines suggest that male patients should have them removed straight away as they are more prone to developing a malignant transformation

26

Difference between an adenoma and focal nodular hyperplasia appearance?

Adenoma = purely a hepatocyte tumour which is cold on nuclear sulfur colloid scanFocal nodular hyperplasia = contains all the liver ultrastructure including ES and bile ductules (isointense on sulfur colloid scan) - central scar

27

Malignant risk with adenoma and focal nodular hyperplasia?

Adenoma = malignant degenerationFocal nodular hyperplasia = no malignant risk

28

Type of cystic lesions of the liver? (5)

SimpleHydatidAtypicalPolycystic lesionPyogenic or amoebic abcess

29

Clinical features of a simple cyst:-Appearance-Biliary tree communication?-Symptoms?

-liquid collection lined by an epithelium - solitary and uniloculated- no biliary tree communicationMost of the time asymptomatic but symptoms can be experienced in relation to:-intracsytic haemorrhage-infection-rupture (rare)-compression

30

Management of a simple cyst?

No follow up necessaryif in doubt, image in 3-6 monthsIf symptomatic or uncertain of diagnosis (complex cystic lesion), then consider surigcal intervention

31

What organism causes hydatid cysts?

Echinoccus granulosus

32

Where are endemic regions for hydatid cysts?

Eastern europe central americasouth americamiddle eastnorth africa

33

How can patients with hydatid cysts present?

Disseminated diseaseerosion of cysts into adjacent structures and vessels (IVC)

34

How is a hydatid cyst diagnosed?

Based on history, appearance and serologic testing-detection of anti-echinococcus antibodies

35

Possible management for hydatid cysts? (3)

Surgery - most common form of treatment medicalprecutaneous drainage

36

What are the 2 types of treatment that can be given for a hydatid cyst?

ConservativeRadical

37

Types of conservative surgery for hydatid cyst? (2)

Open cystectomyMarsupialization (slit cut in cyst to allow it to continually drain)

38

Types of radical surgery for a hydatid cyst?

PericystecomyLobectomy

39

Risks of surgery for a hydatid cyst?

Operative morbidityAnaphylacisDissemination of infection

40

Medical treatment for a hydatid cyst?

Albendazole

41

What does PAIR stand for (percutaneous drainage)?

PunctureAspirationInjectionRespiration

42

What causes polycystic liver disease?

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

43

What are the causes of numbers cysts throughout the liver parenchyma?

Von meyenburg complexesPolycystic liver diseaseAutosomal dominant polycystic kidney disease

44

What is von memenburg complexes?

Microhamartomas - benign cystic nodules throughout the liver - cystic bile duct malformations, originating from the peripheral biliary tree - remnants develop into small hepatic cysts and usually remain silent during life - incidental finding

45

Difference between polycystic liver disease and autosomal dominant polycystic kidney disease?

Liver function is preserved and renal failure rare in polycystic liver disease where as renal failures common in polycystic kidney disease often with extra-kidney manifestations

46

Treatment of polycystic liver disease with symptoms due to volume of tumours?

Conservative treatment to half cyst growth - invasive procedures are only required in severe cases (aspiration/ liver transplant)

47

What type of pharmacological therapy leads to a beneficial outcome in polycystic liver disease by relieving symptoms and reducing liver volume?

Somatostatin analogues

48

Clinical features of a liver access?

High feverLeukocytosisAbdominal painComplex liver lesionHistory of abdo or biliary infection or dental procedure

49

Management of liver abscess?

Initial empiric broad spectrum antibioticsAspiration/ drainage percutaneouslyEchocardiogramOperation if no clinical improvement (open drainage/ resection)4 week antibiotic therapy with repeat imaging

50

What is the most common primary liver cancer?

Hepatocellular carcinoma

51

Most important risk factor for hepatocellular carcinoma?

Cirrhosis of any cause

52

Most common symptoms of HCC?

Weight loss and RUQ pain (can be asymptomatic)

53

What is a tumour marker for HCC?

Alfa fetoprotein - values greater than 100ng/ml = highly susceptive of HCC

54

Treatment of HCC if a small tumour with no evidence of raised portal pressure?

Resection

55

Treatment of HCC if single tumour less than 5cm or less than 3 tumour less than 3cm each?

Liver transplant

56

Treatment of HCC if multiple tumour and evidence of dissemination?

Palliative, local ablation, chemoembolisaiton

57

Treatment of a non-resectable patient e.g. advanced liver cirrhosis?

Local ablation - alcohol injection, radio frequency ablation - temporary measure only

58

What is chemoembolisation?

TransArterial ChemoEmbolisation = inject chemo selectively into hepatic artery then inject an embolic agent (only for patients with early cirrhosis

59

What systemic therapy can be given for advanced HCC?

Sorafenib - multikinase inhibitor of vast endothelial gf receptor

60

What is the type of lung cancer that is often seen in young patients (5-35) and is not related to cirrhosis - also causes a normal AFP?

Firbo-Lamellar carcinoma

61

What is the standard treatment for Fibre-Lamellar carcinoma?

Surgical resection or transplantation