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Y1 - Gatrointestinal > Liver Lesions > Flashcards

Liver Lesions Flashcards

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1
Q

What are the types of benign hepatic tumours?

A

Haemangioma
Focal nodular hyplasia
Adenoma
Liver cysts

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2
Q

What is the most common liver tumour?

A

Haemangioma

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3
Q

What is a haemangioma?

A 
Hypervascular tumour (blood filled)
Small mass contained within capsule with clear borders
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4
Q

How does haemangioma present?

A

Asymptomatic and incidental finding

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5
Q

How does haemangioma present on imaging?

A

US - echogenic spot that is well demarcated
CT - venous enhancement from periphery to centre
MRI - high intensity area

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6
Q

What is the management for haemangiomas?

A

None

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7
Q

What is focal nodular hyperplasia?

A

Benign nodule on liver

Congenital vascular abnormality causes hyperplasia because of abnormal arterial flow

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8
Q

What is the classical description of focal nodular hyperplasia?

A

Central scar containing a large artery radiating branches to the periphery

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9
Q

How does focal nodular hyperplasia present?

A

Usually asymptomatic but may cause pain if compressing on structures

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10
Q

Who is focal nodular hyperplasia most common in?

A

Middle aged women

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11
Q

What is seen on histology in focal nodular hyperplasia?

A

Kupffer cells, bile ductules, all the liver’s ultra-structure

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12
Q

How does focal nodular hyperplasia present on imaging?

A

US - nodule with varying echogenity
CT - hypervascular mass with a central scar
MRI - iso/hypo intense
FNA - normal hepatocytes and Kupffer cells

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13
Q

What is the management for focal nodular hyperplasia?

A

None as no malignant potential

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14
Q

What is a hepatic adenoma?

A

Benign neoplasm composed of normal hepatocytes

No portal tract, central vein or bile duct involvement

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15
Q

Who is hepatic adenoma more common in?

A

Women

Associated with contraceptive pill use and anabolic steroids

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16
Q

How does hepatic adenoma present?

A

Usually asymptomatic but can be RUQ pain

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17
Q

What complications can occur in hepatic adenomas?

A

Rupture causing haemorrhage

Malignant transformation

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18
Q

How does hepatic adenoma present on imaging?

A

US - filling defect
CT - dissuse arterial enhancement
MRI - hypo-hyper intense lesion
FNA may be required

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19
Q

What is the management for hepatic adenoma?

A

Stop taking oral contraceptives/hormones/anabolic steroids
In males surgical excision irrespective of size
In females annual MRI if <5cm or reducing in size or surgical excision if >5cm or increasing in size

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20
Q

Which are more common in the liver, primary or secondary tumours?

A

Secondary

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21
Q

What is the most common primary liver tumour?

A

Hepatocellular carcinoma

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22
Q

What are the risk factors for hepatocellular carcinoma?

A

Cirrhosis
HBV, HCV
Male sex

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23
Q

What is the pathology of hepatocellular carcinomas?

A

Usually single nodule
Consists of cells resembling hepatocytes
Metastasis can be to bones, lungs, lymph nodes

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24
Q

What are the clinical features of hepatocellular carcinomas?

A 
Weight loss, malaise, fever, anorexia
Ache in RUQ
Worsening of pre-existing chronic liver disease
Ascites
Rapid progression of these
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25
What are examination findings that are suggestive of hepatocellular carcinoma?
Signs of cirrhosis Hard enlarged RUQ mass Liver bruit
26
What investigations can be done for hepatocellular carcinoma?
Serum alpha-fetoprotein is HCC marker but is normal in 1/3 of cases US CT (MRI needed if <1cm) Tumour biopsies are less frequent
27
What is the characteristic appearance of a hepatocellular carcinoma?
Hypervascularity of the nodule and a lack of portal vein washout
28
What scoring system is used to determine prognosis of hepatocellular carcinoma?
Child-Pugh score
29
What is the first choice treatment for hepatocellular carcinomas, and when can this be done?
Resection Small lesions with preserved liver function No jaundice or pulmonary hypertension
30
What is the second choice treatment for hepatocellular carcinomas, and when can this be done?
Liver transplantation | If there is one nodule <5cm or up to three, all <3cm
31
What treatment is done if you can't get liver transplant?
Local ablation - temporary measure
32
What is TACE?
Transarterial chemoembolisation Chemotherapy is selectively injected into the hepatic artery Then an embolic agent is injected Given to patients with early cirrhosis
33
What is sorafenib?
Used in hepatocellular carcinoma if there are no other options Kinase inhibitor Gives a few extra months
34
Who is fibre-lamellar carcinoma more common in?
Younger patients
35
Which primary liver cancer is not associated with cirrhosis?
Fibro-lamellar carcinoma
36
What investigations are done for fibre-lamellar carcinoma, and what does it show?
CT - stellate scar with a radial spot showing persistent enhancement
37
What is the treatment for fibre-lamellar carcinoma?
Surgical resection or transplant if possible | TACE if not
38
What is a cyst?
A liquid collection lined by epithelium
39
What is a simple cyst?
A solitary cyst that doesn't involve the biliary tree
40
How do simple cysts present?
Usually asymptomatic but may cause RUQ pain from compression or fever if infection or rupture
41
What investigation is used for simple cysts?
US | If any doubt follow up
42
What is the treatment for simple cysts?
If asymptomatic then none | If symptomatic/uncertain diagnosis then surgical removal
43
What is a hydatid cyst caused by?
The tape worm echinococcus granulosus
44
Who presents with hydatid cysts?
Faming communities as a result of contact with livestock
45
How do hydatid cysts present?
Often asymptomatic but can cause dull ache and swelling in right hypochondrium due to erosion into adjacent structures and vessels
46
What is the investigation for hydatid cysts?
AXR - cyst calcificatin US/CT - diagnostic Anti-echinococcus antibodies
47
What is a diagnostic sign of hydatid cysts?
The presence of daughter cysts
48
What is the treatment for hydatid cysts?
Surgery Albendazole to reduce size Can be drained using PAIR
49
What does PAIR stand for?
Puncture Aspiration Injection Re-aspiration
50
What is polycystic liver disease caused by?
Embryonic ductal plate malformation Causes malformed bile ducts This leads to the formation of numerous cysts throughout the liver
51
What are the three types of polycystic liver disease?
Von Meyenburg complex Polycystic liver disease Autosomal dominant polycystic kidney disease
52
What is von meyenburg complex?
Benign cystic nodules throughout the liver Originate in the peripheral biliary tree as a result of the ductal plate malformation Incidental finding and asymptomatic
53
What is polycystic liver disease?
The presence of cysts in the liver Liver function preserved and kidneys functioning normally Symptoms depend on the size of the cyst and may cause RUQ pain and distension
54
What is autosomal dominant polycystic kidney | disease?
Polycystic disease in the kidneys which can cause hepatic manifestation Reduction in kidney function but liver function should be preserved Liver maybe massively enlarged
55
What is the clinical presentation of polycystic liver disease?
Abdominal pain Abdominal distension May be atypical symptoms due to many cysts compressing surrounding tissues Liver failure if disease is very severe
56
What investigation is done for polycystic liver disease?
Gene studies CT Kidney function tests
57
What is the treatment for polycystic liver disease?
Surgery - aspiration and liver transplant only in severe disease Somatostatin analogues to reduce liver volume and provide symptomatic relief
58
What is a clue for a patient having liver abscess?
Dental procedure followed by clinical presenation
59
What is the clinical presentation for liver abscess?
``` High fever Abdominal pain Nausea and vomiting Jaundice (+ maybe pleural rub in right lower chest) Malaise for several months ```
60
What is the investigation for liver abscess?
``` Check for leukocytosis CXR - raised right semi-diaphragm US - diagnosis CT - complex and multiple lesions Echocardiogram ```
61
What is the treatment for liver abscess?
Initial empiric broad spectrum antibiotics (amoxicillin, metronidazole, gentamycin) all IV Aspiration/drainage Operation if no improvement Post-op 4 weeks of antibiotic therapy
62
What is haemochromatosis?
Autosomal recessive inherited disease characterised by excess iron deposition in the liver and other organs
63
What are the clinical features of haemochromatosis?
'Bronzed diabetic' (bronze or grey skin pigmentation, hepatomegaly, diabetes mellitus) Cardiac arrhythmias and heart failure in younger patients Signs of liver fibrosis or failure Joint pain Hypogonadism
64
What are the investigations for haemochromatosis?
Serum iron >30 in most cases If normal do genetic testing LFTs often normal MRI
65
What is the management for haemochromatosis?
Venesecation | Avoid iron rich foods
66
What is Wilson's disease?
Autosomal recessive disorder leading to reduced ceruloplasmin (the major copper transporter), causing a defect in copper transporting and excretion into bile
67
What are the symptoms of Wilson's disease?
Kayser-Fleischer rings around eyes Signs of liver disease May show signs of CNS issue
68
What is the investigation for Wilson's disease?
Urinary copper increased | Serum copper and ceruloplasmin usually reduced
69
What is the management for Wilson's disease?
Penicillamine

Y1 - Gatrointestinal (31 decks)

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