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Gastroenterology (Own) > Focal Lesions of the Liver > Flashcards

Focal Lesions of the Liver Flashcards

1
Q

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

A

Malignant metastases

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2
Q

what are solid liver lesions in chronic liver disease patients likely to be?

A

Primary liver cancer

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3
Q

What are solid tumours in non chronic liver patients likely to be?

A

Haemangioma

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4
Q

Is haemangioma benign or malignant?

A

Benign

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5
Q

What kind of tumour is an haemangioma?

A

Hyprevascular

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6
Q

How many lesions are typical of an haemangioma ?

A

one single (small) lesion

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7
Q

How do haemangiomas present on an US?

A

Echogenic spot, well demarcated

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8
Q

How do haemangiomas present on a CT?

A

Venous enhancement from peripherally to centre

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9
Q

How do haemangiomas present on an MRI?

A

High intensity area

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10
Q

what is the treatment for a haemangioma?

A

No treatment needed

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11
Q

what is focal Nodular Hyperplasia?

A

Benign nodule formation of normal liver tissue

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12
Q

what is focal nodular hyperplasia associated with?

A

Osler-Weber-Rendu and liver haemangioma

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13
Q

what is the common presentation of focal nodular hyperplasia?

A

Central scar containing a large artery, radiating branches to the periphery

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14
Q

what is present in the histology of focal nodular hyperplasia?

A

Sinusoids, bile ductules and Kupffer cells

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15
Q

what kind of mass is a focal nodular hyperplasia?

A

Hypervascular

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16
Q

what is a hepatic adenoma?

A

Benign neoplasm composed of normal hepatocytes o there is no involvement of the portal tract, central veins or bile ducts

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17
Q

how do people with hepatic adenomas present?

A

Usually asymptomatically but can have RUQ pain (due to rupture, haemorrhage, malignant transformation)

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18
Q

what is the usual appearance of a hepatic adenoma?

A

Solitary fat containing lesion

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19
Q

what are hepatic adenomas associated with?

A

Oral contraception and androgenic steroids

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20
Q

How should a hepatic adenoma be treated?

A

Stop hormones ans observe every 6 months for two years

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21
Q

what should be done if a hepatic adenoma doesn’t regress?

A

Surgical excision

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22
Q

what is a simple cyst?

A

Liquid collection lined by an epithelium with no biliary tree communication

23
Q

Most of the time it is asymptomatic, but what can symptoms be related to?

A

Intracystic haemorrhage
Infection
Rupture
Compression of surrounding organs

24
Q

what is a hydatid cyst?

A

Echinoccocus granulosus

25
Q

what are the surgical options for a hydatid cyst?

A

copen cystectomy
Marsupialization
Pericystectomy
Lobectomy

26
Q

what medication can be used to treat a hydatid cyst?

A

Albendazole

27
Q

what is polycystic Liver disease?

A

Enbryonic ductaal plate malformation of the intrahepatic biliary tree - many cysts throughout the parenchyma

28
Q

what are the 3 types of polycystic liver disease?

A

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

29
Q

What are von meyenburg complexes?

A

Benign cyst nodules throughout the liver

30
Q

where do cystic bile duct malformations originate in von meyenburg complexes?

A

from the peripheral biliary tree

31
Q

which genes are involved in Polycystic liver disease?

A

PCLD gene – PRKCSH and SEC63

32
Q

which genes are involved in Dominant Polycystic Kidney disease?

A

ADPKD genes – PKD1 and PKD2

33
Q

what are the clinical features of liver abscesses?

A

High fever
Leukocytosis - increased number of white cells
Abdominal Pain
Complex liver lesion

34
Q

what is important in the history for liver abscesses?

A

abdominal/biliary infection or recent dental treatment

35
Q

what is the initial treatment for liver abscesses?

A

Empire broad spectrum antibiotics

36
Q

what are the surgical options for liver abscess treatment?

A

aspiration/drainage percutaneously
open drainage
resection

37
Q

what is the most common primary liver cancer?

A

Hepatocellular carcinoma

38
Q

what are the risk factors for hepatocellular carcinoma?

A

Cirrhosis of any cause:
Hep B or C
Alcohol
Aflatoxin

39
Q

what are the clinical features of hepatocellular carcinomas?

A

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

40
Q

where are hepatocellular carcinomas likely to metastasise to?

A

portal vein, lymph nodes, lung, bone, brain

41
Q

what is Alfa Fetoprotein

A

AFP is an HCC tumour marker

42
Q

what values of AFP suggests HCC as a likely diagnosis?

A

100ng/ml or greater

43
Q

what investigations are used in the diagnosis of hepatocellular carcinoma?

A

Ultrasound
CT scan
MRI
Biopsy

44
Q

what is the criteria for liver transplant in hepatocellular carcinoma?

A

Single tumour less than 5cm or 3 tumours less than 3cm each

45
Q

when can resection be used?

A

For small tumours with preserved liver function

46
Q

when can local ablation be used?

A

when resection can’t - those who have advanced liver cirrhosis

47
Q

what are the two forms of ablation used in HCC?

A

Alcohol injection

Radiofrequency ablation

48
Q

what does TACE stand for?

A

Transarterial Chemoablation

49
Q

for which patients can TACE be used?

A

In patients with early cirrhosis

50
Q

In which patients does Fibre-Lamellar Carcinoma present?

A

Young patients

51
Q

What would a CT show in Fibre-Lamellar Carcinoma?

A

stellate scar with radial septal showing persistent enhancement

52
Q

what is the treatment for Fibre-Lamellar Carcinoma?

A

resection or transplantation - TACE if unresectable

53
Q

What are the common primary sites for secondary liver metastases?

A

colon, breast, lung, stomach, pancreas and melanoma

Gastroenterology (Own) (18 decks)

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