Benign Lesions in the Liver

Question 1

Solid liver lesions in older patients are more likely to be what?

Answer 1

Malignant with metastases more common than primary liver cancer in the absence of liver disease

Question 2

WHat are solid liver lesions in patients with chronic liver disease more likely to represent?

Answer 2

Primary Liver Cancer rather than metastases or benign tumour

Question 3

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

Answer 3

Hemangioma (benign)

Question 4

Name 4 benign liver tumours

Answer 4

Hemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

Question 5

Name the 2 main types of malignant tumours

Answer 5

Primary liver cancers

Metastases

Question 6

What are the 2 types of Primary liver cancers

Answer 6

Hepatocellular carcinoma

Cholangiocarcinoma

Question 7

What is the commonest liver tumour

Answer 7

Hemangioma

Question 8

Describe a hemangioma

Answer 8

A vascular tumour
Usually single and small
Well demarcated capsule
Usually asymptomatic

Question 9

How do we diagnose a Hemangioma

Answer 9

Ultrasound is key
CT
MRI

Question 10

What is the treatment for hemangioma

Answer 10

No treatment

Question 11

Describe a focal nodular hyperplasia

Answer 11

enign nodule formation of normal liver tissue

congenital anomaly

Question 12

What is the classic appearance of a focal nodular hyperplasia

Answer 12

A central scar through the middle of the mass

Question 13

Who is more likely to have a focal nodular hyperplasia

Answer 13

Young and middle aged women

Question 14

What type of response is a focal nodular hyperplasia?

Answer 14

A hyperplastic response to abnormal arterial flow

Question 15

How can we diagnose a focal nodular hyperplasia

Answer 15

Ultrasound
CT
MRI
Fine needle aspiration

Question 16

What is the treatment for Focal nodular hyperplasia

Answer 16

No treatment

No change is required for pregnancy or hormones

Question 17

What is a hepatic adenoma

Answer 17

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

Question 18

Who is more likely to get hepatic adenomas?

Answer 18

Women

Question 19

What are hepatic adenomas associated with

Answer 19

The contraceptive hormones - mostly oestrogen

Question 20

What are the symptoms of hepatic adenoma

Answer 20

Usually asymptomatic but may have RUQ pain

Question 21

How might hepatic adenomas present

Answer 21

Rupture, haemorrhage or malignant transformation

Question 22

Where are hepatic adenomas most commonly found

Answer 22

In the right lobe in young women

Question 23

How can regression of hepatic adenomas occur

Answer 23

If the oral contraceptive is discontinued

Question 24

How can we diagnose hepatic adenoma

Answer 24

US
CT
MRI
FNA

Question 25

What is the treatment for hepatic adenomas

Answer 25

Stop the hormones and observe every 6 months for 2 years | If there is no regression then surgical incision may be appropriate

Question 26

What liver structures do adenomas contain

Answer 26

Purely hepatocyte tumours

Question 27

What liver structures do focal nodular hyperplasias contain

Answer 27

All of the liver ultrastructure - RES and bile ductules

Question 28

What type of benign tumour imay bleed

Answer 28

Adenoma

Question 29

What type of benign tumour has the risk of developing into a malignant tumour

Answer 29

Adenoma

Question 30

How can you describe both adenomas and focal nodular hyperplasia

Answer 30

Hypervascular

Question 31

What is a simple cyst

Answer 31

A liquid collection lined by an epithelium

Question 32

What do simple cysts look like on US

Answer 32

Black holes

Question 33

How common are simple cysts in the liver

Answer 33

2nd most common to hemangiomes

Question 34

When would we consider surgical intervention in a simple cyst

Answer 34

If the patient was symptomatic

Question 35

What is the cause of hydatid cysts

Answer 35

Sheep born parasite

Question 36

What can hydatid cysts erode into?

Answer 36

The IVC

Question 37

What is the treatment of a hydatid cyst

Answer 37

Marsupialisation or resection | Albendazole (also used for tapeworms)

Question 38

What is polycystic liver disease a result of

Answer 38

Embryonic ductal plate malformation of the intrahepatic biliary tree

Question 39

What are the 3 types of polycystic liver disease

Answer 39

Von Meyenburg complexes Polycystic liver disease Autosomal dominant polycystic kidney disease

Question 40

What is the most common form of PLD

Answer 40

Autosomal recessive

Question 41

What are Von Meyenburg complexes

Answer 41

Benign cystic nodules throughout the liver

Question 42

When do Von Meyenburg complexes occur

Answer 42

During liver development

Question 43

What do the symptoms of PCLD depend on

Answer 43

The size of the cysts

Question 44

What is the main What does autosomal dominant polycystic kidney disease result in

Answer 44

Renal failure

Question 45

What is the main method of managing polycystic liver disease

Answer 45

Conservative treatment

Question 46

What drug is used in PLD for symptom relief and liver volume reduction

Answer 46

Somatostatin

Question 47

What are the 3 common symptoms of a liver abscess

Answer 47

high fever Leukocytosis Abdominal Pain

Question 48

Who tends to appear more unwell a patient with a liver abscess or a patient with metastasis?

Answer 48

Liver abscess

Question 49

What is the common history of a patient with liver abscess

Answer 49

``` Abdominal or biliary infection Dental procedure (rare) ```

Question 50

What is the treatment for a liver abscess treatment

Answer 50

Initial broad spectrum antibiotics | Aspiration/ drainage

Question 51

Why do we do an ECHO on patients with a liver abscess

Answer 51

To rule out bacterial endocarditis

Question 52

What do we do for a patient if there is no clinical improvement?

Answer 52

Open drainage and resection

Question 53

What is the minimum number of weeks of atibiotic therapy for a liver abscess patient

Answer 53

4 weeks