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GI > Liver Lesions > Flashcards

Liver Lesions Flashcards

1
Q

what are solid liver lesions in older patients more likely to be

A

malignant- metastases more common that primary when no liver disease

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2
Q

what are solid liver lesions in chronic liver disease patients (cirrhosis or active hep b) more likely to be

A

primary liver cancer- more than metastases or benign tumours

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3
Q

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

A

haemangioma

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4
Q

what are cirrhotic patients screened for

A

hepatoma

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5
Q

when should imaging be done

A

when abdo pain, deranged LFT’s, resp problems

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6
Q

what are 4 benign liver lesion

A

haemangioma, focal nodular hyperplasia, adenoma, liver cysts

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7
Q

what are 2 primary liver cancers

A

hepatocellular carcinoma, cholangiocarcinoma

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8
Q

what are two types of cholangiocarcinoma

A

fibrolamellar carcinoma, hepatoblastoma

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9
Q

what is the most common liver tumour

A

benign- haemangioma

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10
Q

haemangioma more/less commen in males than females

A

more common in females

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11
Q

what are the clinical features of haemangioma

A

usually asymptomatic, usually single and small hypervascular tumour

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12
Q

how do you diagnose haemangioma

A

US: echogenic spot, well demarcated

CT: venous enhancement from periphery to centre

MRI: high intensity area
No need for FNA

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13
Q

what is the treatment for haemangioma

A

no treatment needed

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14
Q

what is an FNH, describe it

A

focal nodular hyperplasia

  • benign nodule formation of normal liver tissue
  • congenital vascular anomaly
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15
Q

what does a FNH classically look like

A

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

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16
Q

what is FNH associated with

A

with Osler-Weber-Rendu and liver haemangioma

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17
Q

what causes FNH

A

hyperplastic response to abnormal arterial flow

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18
Q

what is present in histology of FNH

A

sinusoids, bile ductules and kupffer cells

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19
Q

what are the symptoms of FNH

A

usually asymptomatic, may cause minimal pain

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20
Q

who is FNH more common in

A

young/ middle aged women

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21
Q

how is FNH diagnosed

A

US: Nodule with varying echogenicity

CT: Hypervascular mass with central scar

MRI: Iso or hypo intense

FNA: Normal hepatocytes and Kupffer cells with central core

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22
Q

what is the treatment for FNH

A

no treatment needed

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23
Q

describe a hepatic adenoma

A

benign neoplasm composed of normal hepatocytes, no portal tract, central veins or bile ducts

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24
Q

are hepatic adenomas more common in males or females

A

females 10:1

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25
Q

what are hepatic adenomas associated with

A

contraceptive hormones and anabolic steroids

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26
Q

how might hepaic adenomas present

A

usually asymptomatic but may have RUQ pain

present with rupture, haemorrhage or malignant transformation (rare)

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27
Q

are males or females at a higher risk of malignant transformation of hepatic adenomas

A

men

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28
Q

what is adenomatosis

A

multiple adenomas, a rare condition associated with glycogen storage disease

29
Q

how is hepatic adenoma diagnosed

A

US: Filling defect
CT: Diffuse arterial enhancement
MRI: Hypo or hyper intense lesion
FNA: May be needed

30
Q

how are hepatic adenomas treated

A

Stop hormones, weight loss

Males (irrespective of size) : surgical excision

Females : imaging after 6months
<5cm or reducing in size - annual MRI
>5cm or increase in size - for surgical excision

31
Q

what are the two benign solid liver lesions found in young patients

A

adenoma, focal nodular hyperplasia

32
Q

what are the different types of cystic lesions

A

simple, hydrated, atypical, polycystic lesion, pyogenic or amoebic abscess

33
Q

what is a simple cyst, describe

A

liquid collection lined by an epithelium- no biliary tree communication, solitary and uniloculated

34
Q

when does a simple cyst cause symptoms

A

intracystic haemorrhage, infection, rupture (rare), compression

35
Q

how is a simple cyst managed

A

no follow up needed- if doubt/ symptomatic consider imaging in 3/6 months or surgical intervention

36
Q

what is a hydatid cyst

A

multiple cysts caused by the parasite enchinococcus granulosus

37
Q

how does echinococcus granulosus present

A

disseminated disease, erosion of cysts into adjacent structures and vessels (IVC)

38
Q

how is hydatid cyst managed

A

conservative (most common)- open cystectomy, marcupialization

radical pericystectomy, lobectomy

medical: albendazole

percutaneous drainage

39
Q

what are the risks of hyatid cyst surgery

A

operative mortality, anaphylaxis, dissemination of infection

40
Q

what is polycystic liver disease

A

when an embryonic ductal plate malformation of the intrahepatic biliary tree causes numerous cysts throught liver parenchyma

41
Q

what are the three types of polycystic liver disease

A
  • von meyeburg complexes (VMC)
  • polycystic liver disease
  • autosomal dominant polycystic kidney disease
42
Q

what are von meyenburg complexes

A

(aka microhamartomas)
bengin cyst nodules throughout the liver
cystic bile duct malformations originating from the peripheral biliary tree

43
Q

what is the outcome of autosomal dominant polycystic kidney disease

A

renal failure due to polycystic kidneys and non renal extra hepatic features

44
Q

in what disease is potential massive hepatic enlargement a threat

A

autosomal dominant polycystic kidney disease

45
Q

how is polycystic liver disease managed

A

management of; abdo pain, abdo distention and atypical symptoms caused by voluminous cysts compressing adjacent tissues or failure of affected organ

conservative treatment to halt cyst growth

invasive porcedures (aspiration/ transplant) in advanced cases

somatostatin can relieve symptoms and reduce liver volume

46
Q

what are the clinical features of liver abcess

A

high fever, leukocytosis,
abdo pain,
complex liver lesions

47
Q

what is the usual history of a liver lesion

A

abdo or biliary infection or dental procedure

48
Q

how are liver abscesses managed

A

initial empiric broad spectrum antibiotics

aspiration/ drainage percutaneously
echocardiogram

open drainage/ resection if no clinical improvement

4 weeks antibiotic therapy with repeat imaging

49
Q

what are the 5 main types of malignant liver tumours

A 
hepatocellular,
fibro-lamellar carcinoma of the liver,
hepatoblastoma,
intrahepatic cholangiocarcinoma,
metastases
50
Q

is hepatocellular carcinoma more common in men or women

A

men

51
Q

cirrhosis is the most important risk factor of HCC, what can cause cirrhosis

A

hepatitis B and C, alcohol, aflatoxin

52
Q

what are the clinical features of HCC

A

Wt loss and RUQ pain (most common)

Asymptomatic

Worsening of pre-existing chronic liver disease

Acute liver failure

53
Q

what might be found on examination of HCC

A

signs of cirrhosis,
hard enlarged RUQ mass,
liver bruit (rare)

54
Q

where is HCC likely to metastasise to

A 
Rest of the liver
Portal vein
Lymph nodes
Lung
Bone
Brain
55
Q

what is AFP (alpha fetoprotein)

A

HCC tumour marker, values >100ng/ml highly suggestive

56
Q

what does a HCC prognosis depend on

A

tumour size, extrahepatic spread, underlying liver disease, patient performance

57
Q

what is the requirement for liver transplantation in HCC

A

single tumour less than 5cm or less than 3 tumours each smaller than 3cm

58
Q

what are the treatment options for HCC

A

liver transplant, resection, percutaneous ethanol injections/ radio-frequency ablation, transarterial chemoembolism, sorafenib, palliative

59
Q

when is resection possible and what is the downfall

A

for small tumour with preserved liver function

recurrence rate is high

60
Q

when is local ablation done

A

when non resectable or advanced liver cirrhosis

61
Q

what is trans arterial chemoembolization (TACE)

A

inject chemotherapy in hepatic artery with embolic agent- only in patients with early cirrhosis

62
Q

what is sorafenib

A

systemic therapy for HCC

63
Q

who does fibro-lamellar carcinoma present in

A

young patients 5-35

64
Q

is fibro lamellar carcinoma associated with cirrhosis

A

no

65
Q

what is the AFP like in fibro lamellar carcinoma

A

AFP

66
Q

what is the management for fibro-lamellar carcinoma

A

surgical resection or transplantation

TACE for unresectable tumours

67
Q

what is the most common site for blood born metasteses

A

liver

68
Q

what are the common metastases of the liver

A

colon, breast, lung, stomach, pancreas and melanoma

GI (64 decks)

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