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Study Notes - Gastroenterology > Liver - focal liver lesions > Flashcards

Liver - focal liver lesions Flashcards

1
Q

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

A

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

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2
Q

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

A

Haemangioma

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3
Q

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

A

Haemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

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4
Q

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

A

Primary liver cancers

Metastases

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5
Q

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

A 
Hepatocellular carcinoma
Cholangiocarcinoma
Fibrolamellar carcinoma
Hepatoblastoma
Angiosarcoma
Haemangioendothelioma
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6
Q

Clinical features of haemangioma:

  • more common in M or F?
  • blood supply?
  • size/ number of them?
  • border?
  • symptoms?
A 
Females
Hypervascular tumour
Usually single and small
Well demarcated capsule
usually asymptomatic
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7
Q

Diagnosis of haemangioma?

A

US: echogenic spot, well demarcated
CT: venous enhancement from periphery centre
MRI: high intensity area
No need for FNA

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8
Q

Treatment for haemangioma?

A

No need for treatment

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9
Q

What is a focal nodular hyperplasia?

A

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

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10
Q

What is usually the cause of a focal nodular hyperplasia?

What 2 other conditions is FNH therefore associated with?

A

Congenital vascular anomaly - hyperplastic response to abnormal arterial flow
Osler-Weber-Rendu
Liver haemangioma

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11
Q

What is the classical appearance of a focal nodular hyperplasia?

A

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

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12
Q

What 3 things are present on histology focal nodular hyperplasia?

A

Sinusoids
Bile ductules
Kupffer cells

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13
Q

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

A

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

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14
Q

Symptoms of focal nodular hyperplasia?

A

Usually asymptomatic, amy cause minimal pain

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15
Q

Diagnosis of focal nodular hyperplasia?

A

US: nodule with varying echogenicity
CT: hypervascular scar with central scar
MRI: Iso or hypo intense
FNA: normal hepatocytes and cupful cells with central core

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16
Q

Treatment of focal nodular hyperplasia?

A

No treatment necessary

no change required regarding pregnancy and hormones - some older texts give mixed message

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17
Q

What is a hepatic adenoma?

A

Benign neoplasm composed of normal hepatocytes - most are solitary fat containing lesions
No portal tract, central veins or bile ducts

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18
Q 
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?
A

Females
Contraceptive hormones
Usually asymptomatic but may have RUQ pain - symptoms are size related
May present with rupture, haemorrhage or malignant transformation (very rare)

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19
Q

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

A

The right lobe

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20
Q

What is multiple adenomas called?

What is this associated with?

A

Adenomatosis

Glycogen storage diseases

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21
Q

What has been identified within adenomas that confer malignant risk?

A

Identifiable oncogene mutations

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22
Q

How are hepatic adenomas related to Oral Contraceptive?

A

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

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23
Q

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

A

Regression

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24
Q

Diagnosis of hepatic adenoma?

A

US: filling defect
CT: diffuse arterial enhancement
MRI: hypo or hyper intense lesion
FNA: may be needed

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25
Q

Treatment for a hepatic adenoma?

A

Stop hormones
Observe every 6m for 2y
if no regression then surgical excision
New guidelines suggest that male patients should have them removed straight away as they are more prone to developing a malignant transformation

26
Q

Difference between an adenoma and focal nodular hyperplasia appearance?

A

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

27
Q

Malignant risk with adenoma and focal nodular hyperplasia?

A

Adenoma = malignant degeneration

Focal nodular hyperplasia = no malignant risk

28
Q

Type of cystic lesions of the liver? (5)

A 
Simple
Hydatid
Atypical
Polycystic lesion
Pyogenic or amoebic abcess
29
Q

Clinical features of a simple cyst:

  • Appearance
  • Biliary tree communication?
  • Symptoms?
A

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

30
Q

Management of a simple cyst?

A

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

31
Q

What organism causes hydatid cysts?

A

Echinoccus granulosus

32
Q

Where are endemic regions for hydatid cysts?

A 
Eastern europe 
central america
south america
middle east
north africa
33
Q

How can patients with hydatid cysts present?

A

Disseminated disease

erosion of cysts into adjacent structures and vessels (IVC)

34
Q

How is a hydatid cyst diagnosed?

A

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

35
Q

Possible management for hydatid cysts? (3)

A

Surgery - most common form of treatment
medical
precutaneous drainage

36
Q

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

A

Conservative

Radical

37
Q

Types of conservative surgery for hydatid cyst? (2)

A

Open cystectomy

Marsupialization (slit cut in cyst to allow it to continually drain)

38
Q

Types of radical surgery for a hydatid cyst?

A

Pericystecomy

Lobectomy

39
Q

Risks of surgery for a hydatid cyst?

A

Operative morbidity
Anaphylacis
Dissemination of infection

40
Q

Medical treatment for a hydatid cyst?

A

Albendazole

41
Q

What does PAIR stand for (percutaneous drainage)?

A

Puncture
Aspiration
Injection
Respiration

42
Q

What causes polycystic liver disease?

A

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

43
Q

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

A

Von meyenburg complexes
Polycystic liver disease
Autosomal dominant polycystic kidney disease

44
Q

What is von memenburg complexes?

A

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
Q

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

A

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
Q

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

A

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

47
Q

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

A

Somatostatin analogues

48
Q

Clinical features of a liver access?

A 
High fever
Leukocytosis
Abdominal pain
Complex liver lesion
History of abdo or biliary infection or dental procedure
49
Q

Management of liver abscess?

A

Initial empiric broad spectrum antibiotics
Aspiration/ drainage percutaneously
Echocardiogram
Operation if no clinical improvement (open drainage/ resection)
4 week antibiotic therapy with repeat imaging

50
Q

What is the most common primary liver cancer?

A

Hepatocellular carcinoma

51
Q

Most important risk factor for hepatocellular carcinoma?

A

Cirrhosis of any cause

52
Q

Most common symptoms of HCC?

A

Weight loss and RUQ pain (can be asymptomatic)

53
Q

What is a tumour marker for HCC?

A

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

54
Q

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

A

Resection

55
Q

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

A

Liver transplant

56
Q

Treatment of HCC if multiple tumour and evidence of dissemination?

A

Palliative, local ablation, chemoembolisaiton

57
Q

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

A

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

58
Q

What is chemoembolisation?

A

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

59
Q

What systemic therapy can be given for advanced HCC?

A

Sorafenib - multikinase inhibitor of vast endothelial gf receptor

60
Q

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?

A

Firbo-Lamellar carcinoma

61
Q

What is the standard treatment for Fibre-Lamellar carcinoma?

A

Surgical resection or transplantation

Study Notes - Gastroenterology (42 decks)

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