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Focal lesions in the liver Flashcards

1
Q

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

A

Malignant, with metastases more common than primary liver cancer

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2
Q

What are solid liver lesions in patients with chronic liver disease (cirrhosis or active Hep B) likely to be?

A

Primary liver cancer than metastases or benign tumours

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3
Q

What are solid liver lesions in non cirrhotic patients likely to be?

A

Heamangioma

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4
Q

What are the benign focal lesions of the liver?

A

Haemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

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5
Q

What are the malignant focal leisons of the liver?

A

Primary liver cancer: hepatocellular carcinoma, cholangiocarcinoma (fibrolamellar carcinoma, heptpblastoma)
Metasatses

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6
Q

What are the clinical features of a haemanagioma?

A

Commonest liver tumour
Hypervascular tumour
Usually single and small in a well demarcarted capsule
Usually asymptomatic

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7
Q

How is a haemangioma diagnosed?

A

US: echogenic spot, well demarcated
CT: venous enhancement from periphery to center
MRI: high intensity area

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8
Q

What is the treatment for a haemangioma?

A

No need for treatment

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9
Q

What are the clinical features of focal nodular hyperplasia?

A

Benign nodule formation of normal liver tissue

Congenital vascular anomaly; associated with osler-weber-rendu and liver haemangioma

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10
Q

What does it classically look like?

A

Central scar containing a large artery, radiating branches to the periphery
Hyperplastic response to abnormal arterial flow

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11
Q

What does a focal nodular hyperplasia look like histologically?

A

Sinudoids, bile ductules and Kupffer cells

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12
Q

Who is FNH likely to affect?

A

Young and middle aged woman but has no relation with sex hormones

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13
Q

How is FNH diagnosed?

A

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

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14
Q

What is the treatment for FNH?

A

No treatment necessary

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15
Q

What are the clinical features of a hepatic adenoma?

A

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

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16
Q

Who is hepatic adenoma likely to affect?

A

More common in women and is associated with OC

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17
Q

What can hepatic adenomas present with?

A

Usually asymptomatic but may have RUQ pain

May present with rupture, hemorrhage or malignant transformation

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18
Q

What lobe are hepatic adenomas likely to be found in?

A

Usually in the right lobe

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19
Q

How are hepatic adenomas diagnosed?

A

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

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20
Q

How are hepatic adenomas treated?

A

Stop hormones (OC or anaebolic steroids)
Males - surgical excision
Females - imagin after 6 months

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21
Q

What is the difference between adenomas and FNH?

A

FNH has no malignant risk whereas adenomas do
Adenomas can cause pain and bleed
FNH contains all the lvier ultrastructures whereas adenomas are made up purely of hepatocytes

22
Q

What are the clinical features of simple cysts?

A

Liquid collection lined by an epithelium
No biliary tree communication
Solitary and unilocaulated
Most of the time asymptomatic

23
Q

What can symtoms of a simple cyst be related to?

A

Intracystic haemorrhage
Infection
Rupture
Compression

24
Q

How are simple cysts managed?

A

No FU necessary
If in doubt, image in 3-6 months
If symptomatic then consider drainage

25
Q

What are the clinical features of a hydatid cytst?

A

Echinoccocus granulosus

Present with disseminated disaese or erosion of cysts into adjacent structures and vessels (IVC)

26
Q

What is the clinical diagnosis of a hydatid cyst based on?

A

History, appearance, and serological testing detection of enti-echinococcus antibodies

27
Q

How are hydatis cytsts managed?

A

Surgery: open cystectomy, lobectomy
Medical: albendazole
Percutaenous drainage

28
Q

What is polycystic liver disease?

A

Embryonic ductal plate malformation of the intraheaptic biliary tree
Numerous cycsts thorughout the liver parenchyma

29
Q

What are the three different types of polycystic liver disease?

A

Von meyenburg complexes
Polycystic liver disease
Austosomal dominant polycystic kidney disease

30
Q

What are von meyenburg complexes?

A

Benign cystic nodules throughout the liver
Cystic bile duct malformation, originating from the peripheral biliary tree
Remnants develop into small hepatic cysts and usually remain silent

31
Q

What are the features of polycystic liver disease?

A

Liver function preserved and renal failure is rare

Symptoms depend on size of cysts

32
Q

What are the features of autosomal dominant polycystic kidney disease?

A

Renal failure due to polycystic kidneys and non-renal extra-hepatic features
Potential massivae hepatic enlargement

33
Q

How is polycystic liver disease managed?

A

Conservative treatment to halt cyst growth to allow abdo decompression
invasive procedures only required with advanced disaese
Pharma treatment with somatostatin analogues for symtom relief and liver volume reduction

34
Q

What are the symptoms of polycystic liver disease?

A

Abdo pain
Abdo distention
Atypical symtoms of voluminous cysts resulting in compression of adjacent tissue or failure of the affected organ

35
Q

What are the clinical features of a liver abscess?

A

High fever
Leukocytosis
Abdo pain
Complex liver lesion

36
Q

What will the history look like in liver abscess?

A

Abdo or biliary infection

Dental procedure

37
Q

How are liver abscesses managed?

A

Initial emperic broad spectrum antibiotics
Aspiration/ drainage percutaneously
Echocardiogram
Operation if no clinical improvement: open drainage, reseciton
4 week antibiotic therapy with repeat imaging

38
Q

What is the most common primary liver cancer?

A

Hepatocellular carcinoma

39
Q

What are the risk factors for hepatocellular carcinoma?

A

Cirrhosis from any cause:

Hep B, Hep C, Alcohol, Aflatoxin

40
Q

What are the clinical features of HCC?

A 
Wt loss and RUQ pain 
Worsening of pre-existing chronic liver disease 
Acute liver failure 
Signs of cirrhosis
Hard enlarged RUQ mass
Liver bruit (rare)
41
Q

Where are HCC likely to metastases to?

A 
Rest of the liver
Portal vein
Lymph nodes
Lung
Bone
Brain
42
Q

What labs should be done to confirm the diagnosis fo HCC?

A

AFP - HCC tumour marker, values over 100ng/ml

Labs of liver cirrhosis

43
Q

How is HCC diagnosed?

A 
Clinical presentation 
Elevated AFP
US
Triphasic CT
MRI
Biopsy
44
Q

How is the prognosis determined for HCC?

A

Tumour size
Extrahepatic spread
Underlying disease
Pt performance status

45
Q

What is the best available treatment for HCC?

A

Liver transplantation

Resection for small tumours with preserves liver function (no jaundice of portal HTN)

46
Q

What else can be done to treat HCC?

A

Radio-frequency ablation
Chemoembolization - inject chemo into hepatic artery, then inject an emoblic agent
Sorafenib

47
Q

What are the features of a fibro-lamellar carcinoma?

A

Presents in younger patients
Not related to cirrhosis
AFP normal

48
Q

What are the CT findings of a fibro-lamellar carcinoma?

A

Stellate scar with radial septa showing persistent enhancement

49
Q

What is the standard of care for fibro-lamellar carcinoma?

A

Surgical resection or transplantation

50
Q

What are common primaries that metastasise to the liver?

A

Colon, breast, lung, stomach, pancreas, melanoma

GI (42 decks)

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