Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1. GI > Focal Lesions in the liver > Flashcards

Focal Lesions in the liver Flashcards

1
Q

In non cirrhotic patients what is the most common solid liver tumour?

A

haemangioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name some benign liver lesions?

A

Haemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name some malignant liver lesions?

A
  1. Primary liver cancers
    - Hepatocellular carcinoma
    - Cholangiocarcinoma
    Fibrolamellar carcinoma
    Hepatoblastoma
    Angioscarcoma
    Haemangioendothelioma
  2. Metastases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is Haemangioma diagnosed and treated?

A

US: echogenic spot, well demarcated
CT: venous enhancement from periphery to center
MRI: high intensity area
NO TREATMENT REQUIRED

more common in females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe Focal Nodular Hyperplasia (FNH)
?

A

Hyperplastic response to abnormal arterial flow
Sinusoids, bile ductules and Kupffer cells present on histology – normal liver tissue
More common in young and middle age women
Usually asymptomatic, may cause minimal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is Focal Nodular Hyperplasia (FNH)
 diagnosed and treated?

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

NO TREATMENT REQUIRED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the features of Hepatic Adenomas?

A

Benign neoplasm composed of normal hepatocytes no portal tract, central veins or bile ducts
More common in women
Associated with contraceptive pill hormones and anabolic steroids
Usually asymptomatic but may have RUQ pain
May present with rupture, hemorrhage, or malignant transformation (very rare)
Malignant transformation risk higher in males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are multiple adenomas associated with?

A

Glycogen Storage Diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the diagnostic methods for hepatic adenoma?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the treatments for hepatic adenoma?

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical features of the simple cyst?

A 
Liquid collection lined by an epithelium
No biliary tree communication
Solitary and uniloculated
Most of the time asymptomatic
Symptoms can be related to 
   Intracystic haemorrhage
   Infection
   Rupture (rare) 
   Compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the management of a simple cyst?

A

No follow up usually needed
If doubt, imaging in 3-6 months
If symptomatic or uncertain diagnosis (complex cystic lesion), then consider surgical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the features of a Hydatid Cyst
?

A

Echinoccocus granulosus
Patients may present with disseminated disease, or erosion of cysts into adjacent structures and vessels (IVC)
Comes from regions like east europe, central and south america etc..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the diagnostic procedures for a Hydatid Cyst?

A

history
appearance
serologic testing-detection of anti-Echinococcus antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the management for a Hydatid Cyst?

A

Surgery: 
Most common
Conservative: 
Open cystectomy, Marsupialization
Radical: 
Pericystectomy, lobectomy
Risks: Operative morbidity, anaphylaxis, dissemination of 
infection
Medical: Albendazole
Percutaneous Drainage: PAIR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Polycystic Liver Disease (PLD)?

A

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

17
Q

What are the three types of Polycystic Liver Disease?

A

Von Meyenburg complexes (VMC)
Polycystic Liver disease
Autosomal dominant Polycystic Kidney disease

18
Q

What are Von Meyenburg complexes (VMC) ?

A

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
19
Q

Describe autosomal dominant polycystic kidney disease (ADPKD)?

A

Renal failure due to polycystic kidneys and non-renal extra-hepatic features are common in ADPKD

ADPKD genes – PKD1 and PKD2

20
Q

Describe Polycystic liver disease (PCLD)?

A

Liver function preserved
Sometimes renal failure
PCLD gene – PRKCSH and SEC63

21
Q

What is the management of Polycystic liver disease?

A

Conservative treatment - to halt cyst growth to allow abdominal decompression and ameliorate symptoms
Invasive procedures are required only in selective patient group with advanced PCLD, ADPKD or liver failure
- Defenestration/aspiration
- Liver transplantation

22
Q

What is the Clincial presentation of Polycystic liver disease?

A

abdominal pain
abdominal distension
atypical symptoms due to voluminous cysts resulting in compression of adjacent tissue or failure of the affected organ

23
Q

What is the typical clinical presentation of liver abscesses?

A 
High fever
Leukocytosis – high white cell 
Abdominal Pain
Complex liver lesion
History of:
–  Abdominal or biliary infection
–  Dental procedure
24
Q

What is the management of liver abscesses?

A

Initial empiric broad spectrum antibiotics
Aspiration/drainage percutaneously
Echocardiogram
Operation if no clinical improvement:
- Open drainage
- Resection
4 weeks antibiotic therapy with repeat imaging

25
Q

What is the most common malignant liver tumour?

A

Hepatocellular carcinoma (HCC)

26
Q

What are the risk factors for HCC?

A 
The most important risk factor is cirrhosis from any cause:
Hepatitis B (integrates in DNA)
Hepatitis C
Alcohol
Aflatoxin
27
Q

What are the signs and symptoms of HCC?

A

Wt loss and RUQ pain (most common)
Asymptomatic
Worsening of pre-existing chronic liver disease
Acute liver failure

O/E:
Signs of cirrhosis
Hard enlarged RUQ mass
Liver bruit (rare)

28
Q

What is an HCC tumour marker?

A

AFP (Alfa fetoprotein)

Values > 100ng/ml highly suggestive of HCC

29
Q

How is HCC diagnosed?

A 
Clinical presentation
Elevated AFP
US
Triphasic CT scan: very early arterial perfusion
MRI
Biopsy
30
Q

What is the best management of HCC?

A

liver transplant

only if single tumour less than 5cm or less than 3 tumours less than 3cm each

31
Q

Apart from tansplant, what are the other ways of managing HCC?

A

Resection - feasible for small tumours with preserved liver function 
(no jaundice or portal HTN)
Local ablation - for non resectable patients
For patients with advanced liver cirrhosis
Alcohol injection
Radiofrequency ablation
Temporary measure only
Chemoembolization -
TransArterial ChemoEmbolization - TACE
Inject chemotherapy selectively in hepatic artery
Then inject an embolic agent
Only in patients with early cirrhosis

32
Q

What are the characteristics of Fibro-Lamellar Carcinoma?

A

Presents in young pt (5-35)
AFP is normal
CT shows typical stellate scar with radial septa showing persistent enhancement
Surgical resection or transplantation is the standard of care for fibrolamellar carcinoma
TACE for patients with unresectable tumour

33
Q

What are the most common sites of primaries for secondary liver metasteses?

A

colon, breast, lung, stomach, pancreas and melanoma

1. GI (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions