Brainscape's Knowledge GenomeTM

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


See full index

GI > Focal Lesions in the Liver > Flashcards

Focal Lesions in the Liver Flashcards

1
Q

Solid liver lesions in older patients are most likely to be malignant metastases. TRUE/FALSE?

A

TRUE

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

Solid liver lesions found in patients with chronic liver disease (such as Hepatitis or cirrhosis) are more likely to be Primary cancers. TRUE/FALSE?

A

TRUE

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

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

A

Haemangioma (benign)

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

Give examples of benign focal lesions in the liver

A

Haemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

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

What malignant cancers can arise in the liver?

A
  • Hepatocellular carcinoma
  • Cholangiocarcinoma
  • OR Metastases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the appearance of a haemangioma and who usually gets these lesions?

A
  • Usually single, small and well demarcated capsule
  • Hypervascular
  • Females> males but often present at autopsy
  • Patients are usually asymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do haemangiomas appear on scans?

A

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

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

Haemangiomas need treated. TRUE/FALSE?

A

FALSE

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

What is follicular nodular hyperplasia and how does it look?

A
  • Benign nodule
  • May be due to a Congenital vascular anomaly;
  • Looks like a central scar containing a large artery, radiating branches to the periphery
  • Hyperplastic response to abnormal arterial flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What signs on histology indicate Follicular Nodular Hyperplasia?

A
  • Sinusoids
  • Bile ductules
  • Kupffer cells present on histology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Who normally experiences Follicular Nodular Hyperplasia? How do these patients present?

A
  • More common in young and middle age women

- Usually asymptomatic, may present with minimal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does Follicular Nodular Hyperplasia appear on scans?

A

US: Nodule with varying echogenicity
CT: Hypervascular mass with central scar
MRI: Iso/Hypo-intense
FNA: Normal hepatocytes and Kupffer cells with central core

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

Follicular Nodular Hyperplasia requires treatment. TRUE/FALSE?

A

FALSE

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

What is a hepatic adenoma?

A
  • Benign neoplasm
  • composed of normal hepatocytes
  • NO portal tract, central veins or bile ducts involved in this lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What groups are at higher risk of a hepatic adenoma?

A
  • More common in women (female: male ratio 10:1)

- Associated with contraceptive hormones and anabolic steroids

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

HOw do patients present with a hepatic adenoma?

A
  • Usually asymptomatic
  • May have RUQ pain
  • May present with rupture, haemorrhage, or malignant transformation (very rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which gender is at higher risk of malignant change in a hepatic adenoma?

A

Malignant transformation risk higher in males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What material do hepatic adenomas usually contain?

A

Fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where in the liver are hepatic adenomas commonly found?

A

Right lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Multiple adenomas (adenomatosis) is associated with what other group of diseases?

A

Glycogen Storage Diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hepatic adenomas can regress after contraceptive hormones are stopped. TRUE/FALSE?

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

HOw does a hepatic adenoma appear on a scan?

A

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

23
Q

How can a hepatic adenoma be treated?

A
  • Stop hormones, weight loss
  • Males (due to malignant potential): surgical excision
  • Females: repeat imaging after 6months
    <5cm or reducing in size - annual MRI
    >5cm or increase in size - for surgical excision
24
Q

What are the two most likely solid liver lesions in young patients and how can we differentiate between them?

A

Adenoma

  • only hepatocytes involved
  • has malignant potential

Focal Nodular Hyperplasia

  • Contains all the liver ultrastructure
  • has a Central scar
25
Q

Describe the appearance of a simple liver cyst

A
  • Liquid collection lined by an epithelium
  • Not connected to biliary tree
  • Solitary
  • usually asymptomatic
26
Q

How are simple liver cysts managed?

A
  • No follow up necessary
  • If doubt, imaging in 3-6 mths
  • If symptomatic/ uncertain diagnosis, consider surgical intervention
27
Q

How do Hyatid cysts usually present?

A
  • disseminated disease

- erosion of cysts into adjacent structures/ vessels (IVC)

28
Q

What regions are considered endemic for hyatid liver cysts?

A
  • Eastern Europe
  • Central America
  • South America
  • Middle East
  • North Africa
29
Q

How is a hyatid cyst managed?

A

Surgery: Most common (lobectomy may be used if emergency)
Medical: Albendazole
Percutaneous Drainage: PAIR

30
Q

What are the potential risks of surgery for a hyatid cyst in the liver?

A
  • Operative morbidity
  • anaphylaxis
  • dissemination of infection
31
Q

What conditions can cause numerous cysts throughout liver parenchyma?

A

Polycystic Liver diseases:

  • Von Meyenburg complexes (Microhamartomas)
  • Polycystic Liver disease
  • Autosomal dominant Polycystic Kidney disease
32
Q

What is the difference between Polcystic Liver disease and Autosomal Dominant Polycystic Kidney disease?

A

PLD:

  • Liver function preserved and renal failure rare
  • Symptoms depend on size of cysts
  • different genes (PCLD gene)

ADPKD

  • Renal failure due to polycystic kidneys
  • Potential massive hepatic enlargement
  • different genes affected (PKD1 and PKD2)
33
Q

What are the main clinical features seen if a patient has a liver abscess?

A 
High fever
Leukocytosis
Abdominal Pain
Complex liver lesion
History of:
–  Abdominal or biliary infection
–  Dental procedure
34
Q

How is a liver abscess managed?

A
  • Empirical broad spec. antibiotics
  • Aspiration/drainage percutaneously
  • Echo
  • Operation if no clinical improvement
    (Open drainage/ Resection)
  • 4 weeks antibiotic therapy with repeat imaging
35
Q

What is the most important risk factor for the development of hepatocellular carcinoma?

A 
CIRRHOSIS
caused by:
- Hepatitis B/C
- Alcohol
- Aflatoxin
36
Q

What are the presenting symptoms of HCC?

A
  • Wt loss and RUQ pain (most common)
  • Some pts may be Asymptomatic
  • Worsening of pre-existing chronic liver disease
  • Acute liver failure
37
Q

What signs of HCC can potentially be found on examination of a patient?

A
  • Signs of cirrhosis
  • Hard enlarged RUQ mass
  • Liver bruit (rare)
38
Q

Where else in the body can HCC metastasise to?

A
  • Rest of liver
  • Portal vein
  • Lymph nodes
  • Lung
  • Bone
  • Brain
39
Q

What tumour marker can be used in diagnosing HCC?

A

AFP (Alfa fetoprotein)

  • Values > 100ng/ml are highly suggestive of HCC
  • Elevation is seen in 60-80% of patients with HCC
40
Q

What four factors dictate HCC prognosis?

A
  • Tumour size
  • Extrahepatic spread
  • Underlying liver disease
41
Q

When is a liver transplant used to treat HCC?

A

Only if single tumour <5cm

OR <3 tumours <3cm each

42
Q

When would resection be used to treat HCC?

A
  • For small tumours with preserved liver function

=> (no jaundice or portal HT)

43
Q

Why is liver transplantation a preferred treatment over resection for HCC?

A

With resection of liver, recurrence rate of HCC is still HIGH
- If pt receives transplanted liver, recurrence rate is very low

44
Q

When would local ablation be used for HCC?

A
  • For non resectable pt
  • OR if pt has advanced liver cirrhosis
  • temporary measure only
45
Q

What is chemoembolisation?

A

TransArterial ChemoEmbolization - TACE
Inject chemotherapy selectively in hepatic artery
Then inject an embolic agent
Used in patients with early cirrhosis

46
Q

Fibro-lamellar carcinoma is most common in which age group?

A
  • Presents in young pt (5-35)
47
Q

Firbo-lamellar carcinoma is related to cirrhosis. TRUE/FALSE?

A

FALSE - It is NOT related to cirrhosis

48
Q

Describe the typical appearance of Fibro-Lamellar carcinoma

A
  • stellate scar with radial septa
49
Q

How is Fibro-Lamellar Carcinoma treated?

A
  • Surgical resection
  • OR transplantation
  • TACE for patients with unresectable tumour
50
Q

The liver is the most common site for blood borne metastases. TRUE/FALSE?

A

TRUE

51
Q

What primary cancers commonly metastasise to the liver?

A 
colon
breast
lung
stomach 
pancreas 
melanoma
52
Q

Describe the LFTs of a patient with secondary liver metastases

A

Mild cholestatic picture (ALP)

- BUT preserved liver function

53
Q

How are liver metastases treated?

A
  • Tx depends on primary cancer

- In some cases resection or chemoembolization is possible

GI (33 decks)

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