Focal Liver Lesions Flashcards
What are solid liver lesions likely to be in older patients
malignant
how % of the population have a hepatic focal lesion
5-10%
When are liver lesions usually found
During scans for other things
What are benign liver lesions
haemangioma
focal nodular hyperplasia
adenoma
lever cysts
what are malignant
hepatocelular carcinoma
cholangiocarcinoma
fibrolamellar carcinoma
MORE
Most common benign liver tumour
Haemangioma
hyper vascular tumour
Usually single, small
asymptomatic
what scans pic ip haemangioma
ultrasound
CT
MRI
what treatment is needed for a haemangioma
None - no clinical consequences
Clinical features of focal nodular hyperplasia
benign nodule
Congenital vascular anomaly associated with Osler weber Rendu
central scar containing a large artery radiating branches to periphery
How to diagnose FNH
US
CT
MRI - iso or hypo intense mass
What is the treatment for FNH
no treatment
What is a hepatic ademoma
mostly solitary fat containing lesion
increasing incidence
usually in right lobe
symptoms (pain, bleeding) - size related
How do you diagnose hepatitic adenoma
link to oral contraception
thought to be due to oestrogen
US -filling defect
CT- diffuse arterial enhancement
Treatment for hepatic adenoma
stop oral contraception
surgery
types of cystic lesions
fluid containing lesions simple polycystic polygenic or amboetic MORE
Most common cyst seen on US
simple cyst liquid collection lined by an epithelium no biliary tree communication solitary unallocated mostly asymptomatic
Hydatid cysts epidemic regions
enchinococcis ganulosus
endemic regions - eaters Europe, central and south america, Middle East North Africa
management of hydatid cyst
conservative - open cystectomy
radical- pericystectomy, lobectomy
medical -
MORE
Polycystic liver disease
numerous cysts throughout liver three types -von meyenburg complexes -polycystic liver disease -autosomon dominant polycystic kidney disease
Von meyenburg complexes
being cystic nodules through liver
Polycystic liver disease
liver function preserved
renal failure rare
symptoms depend on size of cyst
PDLD gene- PRKCSH
Autosomal dominant pc kidney disease
renal failure
hepatic enlargement
PKD1 and PKD2 genes identified
Management of PCLD
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
Clinical features of liver abscesses
high fever leukocytosis abode pain complex liver lesion history - abdominal or biliary infection dental procedure
management of liver abscess
initial broad spec antibiotics
aspiration
echo
operation if no clinical improvement - open drainage, resection
4 weeks antibiotic therapy with repeat imaging
hepatacellular carcinoma clinical presentation
elevated AFP US triohasic CT scan MRI Biopsy
prognosis for HCC
depends on how early tumour detected sixe spread underlying liver disease liver function
Resection
for small liver tumours
no impaired liver function
no cirrhosis
ethanol injection
inject tumour with ethanol
chemoembolization
inject chemo selectively in hepatic artery
also inject with embolic aget
only in patients with early cirrhosis
