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Gastrointestinal > Focal Liver Lesions and Hepatomegaly > Flashcards

Focal Liver Lesions and Hepatomegaly Flashcards

1
Q

describe liver lesions in the elderly

A

more likely to be malignant - metastases more common than primary liver cancer in absence of liver disease

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2
Q

describe liver lesions in chronic liver disease

A

more likely to be a primary liver cancer than metastases or benign tumours

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3
Q

describe liver tumours in non-cirrhotic patients

A

most common tumour is haemangioma

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4
Q

bengin liver lesions

A

haemangioma
focal nodular hyperplasia
adenoma
liver cysts

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5
Q

malignant liver lesions

A

primary liver cancers

metastaes

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6
Q

primary liver cancers

A 
hepatocellular carcinoma (HCC)
cholangiocarcinoma
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7
Q

types of cholangiocarcinoma

A

fibrolamella carcinoma

hepatoblastoma

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8
Q

types of hepatoblastoma

A

angiosarcoma

haemangioendothelioma

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9
Q

epidemiology of haemangioma

A

most common liver tumour

female

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10
Q

pathology of haemangioma

A

hyper vascular tumour (attached to lots of blood vessels)
single and small
well demarcated capsule

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11
Q

symptoms of haemangioma

A

asymptomatic

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12
Q

complications of haemangioma

A

bleeding (due to hypervascularity)

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13
Q

tests for haemangioma

A

ultrasound
CT
MRI

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14
Q

treatment for haemangioma

A

none

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15
Q

pathology of focal nodular hyperplasia (FNH)

A

nodule formation
congenital vascular anomaly (associated with Osler-Weber-Rendu and liver haemangioma)
central scar containing a large artery, radiating branches to the periphery
Hyperplastic response to abnormal arterial flow

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16
Q

epidemiology of FNH

A

young and middle aged woman - no relation with sex hormones

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17
Q

symptoms of FNH

A

asymptomatic

minimal pain

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18
Q

histology of FNH

A

sinusoid
bile ductules
kupffer cells

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19
Q

tests for FNH

A

ultrasound
CT
MRI
fine needle aspiration (FNA)

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20
Q

treatment for FNH

A

none

no change in pregnancy or hormones

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21
Q

pathology of hepatic adenoma

A

neoplasm composed of normal hepatocytes, no portal tract, central veins or bile ducts
solitary fat containing lesions
hypervascular
usually right lobe

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22
Q

epidemiology of hepatic adenoma

A

female
contraceptive hormones
androgenic steroids
malignant transformation risk is higher in males

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23
Q

symptoms of hepatic adenoma

A

asymptomatic

right upper quadrant pain

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24
Q

rare signs of hepatic adenoma

A

size related;
rupture
haemorrhage
malignant transformation

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25
Q

what is multiple adenomas

A

rare conditions associated with glycogen storage disease

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26
Q

tests for hepatic adenoma

A

ultrasound
CT
MRI
FNA

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27
Q

treatment for hepatic adenoma

A

stop hormones
weight loss
males - surgical excision
females - imaging in 6 months, surgical incision then dependent on size (>5 cm - remove)

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28
Q

types of cystic lesions

A 
simple 
hydatid 
atypical 
polycystic lesion 
pyogenic or amoebic abscesses
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29
Q

pathology of simple cyst

A

liquid collection lined by epithelium
no biliary tree communication
solitary and uniloculated

30
Q

symptoms of simple cyst

A

asymptomatic

symptoms due to complications

31
Q

complications of simple cyst

A

intracystic haemorrhage
infeciton
rupture (rare)
compression

32
Q

treatment for simple cyst

A

no follow up necessary
if doubt - imaging 3-6 months
surgical intervention - symptomatic or uncertain diagnosis

33
Q

pathology of hydatid cyst

A

echinoccocus granulosus (Cestoda)

34
Q

signs of hydatid cyst

A

disseminated disease
erosion of cysts into adjacent structures and vessels (IVC)
detection of anti-echinococcus antibodies

35
Q

treatment for hydatid cyst

A

surgery
drug - albendazole
percutaneous drainage

36
Q

pathology of polycystic liver disease (PLD)

A

embryonic ductal plate malformation of the intrahepatic biliary tree
numerous cysts throughout liver parenchyma

37
Q

types of PLD

A

von meyenburg complexes (VMC)
polycystic liver disease (PCLD)
autosomal dominant polycystic kidney disease (ADPKD)

38
Q

pathology of VMC

A

benign cystic nodules throughout liver
cystic duct malformation originating from peripheral biliary treee
remnants develop into small hepatic cysts and remain asymptomatic

39
Q

aetiology of VMC

A

not germline genetically driven

incidental finding

40
Q

aetiology of PCLD

A

mutation in PCLD gene - PRKCSH and SEC63

41
Q

pathology of PCLD

A

liver function preserved

renal failure is rare

42
Q

symptoms of PCLD

A

dependent on size of cysts;
abdominal pain
abdominal distension
atypical symptoms

43
Q

pathology of ADPKD

A

renal failure due to polycystic kidneys
non-renal extra hepatic features
potential massive hepatic enlargement

44
Q

aetiology of ADPKD

A

mutation in ADPKD genes - PKD1 and PKD2

45
Q

treatment of polycystic liver disease

A

conservative
invasive (only in those with advanced PCLD, ADPKD or liver failure) - defenestration/aspiration, liver transplantation
somatostatin

46
Q

action of somatostatin in polycystic liver disease management

A

symptom relief

liver volume reduction

47
Q

symptoms/signs of liver abscess

A

high fever
leukocytosis
abdominal pain
complex liver lesion

48
Q

aetiology of liver abscess

A

abdominal or biliary infection

dental procedure

49
Q

treatment of liver abscess

A

empiric broad spectrum antibiotics
aspiration/drianinage
surgery (no improvement)
4 weeks antibiotic therapy with repeat imaging

50
Q

epidemiology of HCC

A

men

51
Q

risk factors for HCC

A 
cirrhosis from any cause;
HBV (integrates DNA)
HCV
alcohol 
aflatoxin 
other
52
Q

symptoms/signs of HCC

A 
weight loss
right upper quadrant pain 
asymptomatic 
worsening of pre-existing chronic liver disease 
acute liver failure
53
Q

signs of HCC

A

signs of cirrhosis
hard enlarged right upper quadrant mass
liver bruit (rare)
elevated alfa fetoprotein (AFP)

54
Q

metastases of HCC

A 
rest of the liver
portal vein 
lymph nodes
lung 
bone 
brain
55
Q

describe AFP

A

HCC tumour marker

>100ng/ml - high probability of HCC

56
Q

tests for HCC

A 
AFP
ultrasound 
triphasic CT
MRI
biopsy
57
Q

treatment for HCC

A 
liver transplantation 
resection 
local ablation 
chemoembolization - TACE
systemic therapies
58
Q

describe local ablation treatment in HCC

A

ethanol injection

radiofrequency ablation

59
Q

liver transplantaiton in HCC

A

low recurrence rate

60
Q

resection in HCC

A

small tumours with preserved liver function, high recurrence rate

61
Q

local ablation in HCC

A

non resectable tumour

62
Q

TACE in HCC

A

inject chemotherapy selectively in hepatic artery
then inject embolic agent
only in patients with early cirrhosis

63
Q

systemic therapies in HCC

A

sorafenib

64
Q

action of sorafenib

A

multikinase inhibitor of vascular endothelial gf receptor, platelet derived gf receptor and Raf
common side effects but increased survival

65
Q

epidemiology fibro-lamellar carcinoma

A

young patients

not related to cirrhosis

66
Q

pathology of fibro-lamellar carcinoma

A

AFP normal

stellate scar with radial septa showing persistent enhancement

67
Q

treatment for fibro-lamellar carcinoma

A

surgical resection
transplantation
TACE - unresectable tumour

68
Q

describe secondary liver metastases

A

most common site for blood born metastases

69
Q

common primaries for secondary liver metastases

A 
colon
breast
lung 
stomach 
pancreas
melanoma
70
Q

pathology of secondary liver metastases

A

mild evaluated ALP

preserved liver function

71
Q

tests for secondary liver metastases

A

ultrasound
CT
MRI
FNA

72
Q

treatment for secondary liver metastases

A

dependent on primary cancer

resection or TACE may be possible

Gastrointestinal (71 decks)

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