Liver cyst Flashcards
What are the 4 types of liver cyst?
- Simple cyst
- Polycystic liver disease
- Cystic neoplasm
- Hydatid cyst
What is a simple liver cyst?
- fluid-filled epithelial-lined sac within liver
Where does simple liver cyst commonly occur?
Right lobe
What is the pathophysiology of a simple liver cyst?
- congenitally malformed bile duct cells
- fail to connect to extrahepatic ducts
- local dilation filled with bile like fluid
4.
What are the clinical features of simple liver cyst?
- Asymptomatic (most common)
- Symptomatic (15%)
- abdominal pain
- nausea
- early satiety
What Ix would you order for liver cyst?
- LFT
- Normal
- +/- raised GGT
- Tumour markers
- CEA
- CA19-9
- USS (image modality of choice)
What are the USS features of simple liver cyst?
- anechoic
- well-defined
- thin-walled
- oval lesions c no septation
- strong posterior wall acoustic enhancement
How would you manage simple cyst?
- Majority: no intervention
- >4cm: follow up USS
- symptomatic: USGA / laparoscopic deroofing
What is polycystic liver disease?
- presence of 20 or more cysts within liver, each 1 or more cm in size
What causes polycystic liver disease?
- Autosomal Dominant Polycystic Kidney Disease (ADPKD)
- mutations in PKD 1 (chromosome 16) & 2 (chromosome 4) genes
- Autosomal DOminant Polycystic Liver Disease (ADPLD)
- mutations in PRKCSH (c19) and SEC63 (c6)
- no renal involvement
What is the Px of polycystic liver disease?
- Genetic mutation
- aberrant ductal plate configuration during liver embryogenesis
- Structures not connected to intrahepatic bile ducts
- Dilation and cyst formation
What are the clinical features of polycystic liver disease?
- Asymptomatic (majority)
- Abdominal pain
- Urinary tract sx
- Portal hypertension
- Liver cirrhosis
What Ix would you order for polycystic liver disease?
- LFT
- +/- raised ALP
- USS - definitive diagnosis
- multiple cyst
How would you Mx polycystic liver disease?
- Asymptomatic: left alone
- Symptomatic relief: somatostatin analogue
- Surgery
- USGA
- laparoscopic deroofing
What are the indications for surgery in polycystic liver disease?
- intolerable symptoms
- inability to rule out malignancy on imaging
- prevention of malignancy
What is the most common subtype of cystic neopllasm?
- Cystadenomas
What is Cystadenoma?
- Non-invasive mucinous cystic neoplasm
- abnormal proliferation of biliary epithelium
What are the clinical features of cystic neoplasm?
- Asymptomatic (Majority)
- Symptomatic
- abdominal pain
- anorexia
- nausea
- fullness
What Ix would you order for cystic neoplasm?
- LFT
- ALP +/- raise
- Tumour markers
- CEA, CA19-9 raise
- USS
- CT c contrast - check evidence of mets
What special test should be avoided in cystic neoplasm and why?
- Aspiration
- Avoid peritoneal seeding
How would you Mx cystic neoplasm?
- Liver lobe resection
What is Hydatid cyst?
- infection by tapeworm Echinococcus Granulosus
What is the Px of hydatid cyst?
- Infected dog(common) pass stool
- Transmitted to host via fecal-oral transmission
- Larvae invade GI tract
- Travels to liver via hepatic portal system
- Grow and form cyst
Which places are prevalent for hydatid cyst?
- South america
- North africa
- central asia
What are the clinical features of Hydatid Cyst?
- Asymptomatic
- vague abdominal pain
- jaundice
- vomiting
- dyspepsia
- early satiety
What Ix would you order for Hydatid cyst?
- FBC - eosinophilia
- LFT
- Echinococcal antibody
- USS
- calcified
- spherical lesion
- multiple septations
- CT c contrast
How would you Mx hydatid cyst?
- Asymptomatic: monitor
- Laparoscopic deroofing
- Radiological drainage
- Injection of scolecidal agent
- Drug tx
What drug combination is given for hydatid cyst?
- albendazole
- mebendazole
- praziquantel
Why aspiration is not indicated for hydatid cyst?
- rupture can cause anaphylactic reaction
