Focal Liver Lesions

Question 1

What are solid liver lesions likely to be in older patients

Answer 1

malignant

Question 2

how % of the population have a hepatic focal lesion

Answer 2

5-10%

Question 3

When are liver lesions usually found

Answer 3

During scans for other things

Question 4

What are benign liver lesions

Answer 4

haemangioma
focal nodular hyperplasia
adenoma
lever cysts

Question 5

what are malignant

Answer 5

hepatocelular carcinoma
cholangiocarcinoma
fibrolamellar carcinoma
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Question 6

Most common benign liver tumour

Answer 6

Haemangioma
hyper vascular tumour
Usually single, small
asymptomatic

Question 7

what scans pic ip haemangioma

Answer 7

ultrasound
CT
MRI

Question 8

what treatment is needed for a haemangioma

Answer 8

None - no clinical consequences

Question 9

Clinical features of focal nodular hyperplasia

Answer 9

benign nodule
Congenital vascular anomaly associated with Osler weber Rendu
central scar containing a large artery radiating branches to periphery

Question 10

How to diagnose FNH

Answer 10

US
CT
MRI - iso or hypo intense mass

Question 11

What is the treatment for FNH

Answer 11

no treatment

Question 12

What is a hepatic ademoma

Answer 12

mostly solitary fat containing lesion
increasing incidence
usually in right lobe
symptoms (pain, bleeding) - size related

Question 13

How do you diagnose hepatitic adenoma

Answer 13

link to oral contraception
thought to be due to oestrogen
US -filling defect
CT- diffuse arterial enhancement

Question 14

Treatment for hepatic adenoma

Answer 14

stop oral contraception

surgery

Question 15

types of cystic lesions

Answer 15

fluid containing lesions 
simple 
polycystic 
polygenic or amboetic 
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Question 16

Most common cyst seen on US

Answer 16

simple cyst 
liquid collection lined by an epithelium 
no biliary tree communication 
solitary unallocated 
mostly asymptomatic

Question 17

Hydatid cysts epidemic regions

Answer 17

enchinococcis ganulosus

endemic regions - eaters Europe, central and south america, Middle East North Africa

Question 18

management of hydatid cyst

Answer 18

conservative - open cystectomy
radical- pericystectomy, lobectomy
medical -
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Question 19

Polycystic liver disease

Answer 19

numerous cysts throughout liver 
three types 
-von meyenburg complexes 
-polycystic liver disease 
-autosomon dominant polycystic kidney disease

Question 20

Von meyenburg complexes

Answer 20

being cystic nodules through liver

Question 21

Polycystic liver disease

Answer 21

liver function preserved
renal failure rare
symptoms depend on size of cyst
PDLD gene- PRKCSH

Question 22

Autosomal dominant pc kidney disease

Answer 22

renal failure
hepatic enlargement
PKD1 and PKD2 genes identified

Question 23

Management of PCLD

Answer 23

pc- abdominal pain, distension
conservative treatment - halt cyst growth
invasive procedures - liver transplant, defenestration/aspiration
pharmacological therapy lead to beneficial outcome and size reduction of liver

Question 24

Clinical features of liver abscesses

Answer 24

high fever 
leukocytosis 
abode pain 
complex liver lesion 
history - abdominal or biliary infection 
dental procedure

Question 25

management of liver abscess

Answer 25

initial broad spec antibiotics aspiration echo operation if no clinical improvement - open drainage, resection 4 weeks antibiotic therapy with repeat imaging

Question 26

hepatacellular carcinoma clinical presentation

Answer 26

``` elevated AFP US triohasic CT scan MRI Biopsy ```

Question 27

prognosis for HCC

Answer 27

``` depends on how early tumour detected sixe spread underlying liver disease liver function ```

Question 28

Resection

Answer 28

for small liver tumours no impaired liver function no cirrhosis

Question 29

ethanol injection

Answer 29

inject tumour with ethanol

Question 30

chemoembolization

Answer 30

inject chemo selectively in hepatic artery also inject with embolic aget only in patients with early cirrhosis