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Hepatobiliary Surgery (HPB) > Liver cyst > Flashcards

Liver cyst Flashcards

1
Q

What are the 4 types of liver cyst?

A
  • Simple cyst
  • Polycystic liver disease
  • Cystic neoplasm
  • Hydatid cyst
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2
Q

What is a simple liver cyst?

A
  • fluid-filled epithelial-lined sac within liver
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3
Q

Where does simple liver cyst commonly occur?

A

Right lobe

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4
Q

What is the pathophysiology of a simple liver cyst?

A
  1. congenitally malformed bile duct cells
  2. fail to connect to extrahepatic ducts
  3. local dilation filled with bile like fluid
    4.
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5
Q

What are the clinical features of simple liver cyst?

A
  • Asymptomatic (most common)
  • Symptomatic (15%)
    • abdominal pain
    • nausea
    • early satiety
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6
Q

What Ix would you order for liver cyst?

A
  • LFT
    • Normal
    • +/- raised GGT
  • Tumour markers
    • CEA
    • CA19-9
  • USS (image modality of choice)
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7
Q

What are the USS features of simple liver cyst?

A
  • anechoic
  • well-defined
  • thin-walled
  • oval lesions c no septation
  • strong posterior wall acoustic enhancement
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8
Q

How would you manage simple cyst?

A
  • Majority: no intervention
  • >4cm: follow up USS
  • symptomatic: USGA / laparoscopic deroofing
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9
Q

What is polycystic liver disease?

A
  • presence of 20 or more cysts within liver, each 1 or more cm in size
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10
Q

What causes polycystic liver disease?

A
  • 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
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11
Q

What is the Px of polycystic liver disease?

A
  1. Genetic mutation
  2. aberrant ductal plate configuration during liver embryogenesis
  3. Structures not connected to intrahepatic bile ducts
  4. Dilation and cyst formation
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12
Q

What are the clinical features of polycystic liver disease?

A
  • Asymptomatic (majority)
  • Abdominal pain
  • Urinary tract sx
  • Portal hypertension
  • Liver cirrhosis
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13
Q
A
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14
Q

What Ix would you order for polycystic liver disease?

A
  • LFT
    • +/- raised ALP
  • USS - definitive diagnosis
    • multiple cyst
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15
Q

How would you Mx polycystic liver disease?

A
  • Asymptomatic: left alone
  • Symptomatic relief: somatostatin analogue
  • Surgery
    • USGA
    • laparoscopic deroofing
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16
Q

What are the indications for surgery in polycystic liver disease?

A
  • intolerable symptoms
  • inability to rule out malignancy on imaging
  • prevention of malignancy
17
Q

What is the most common subtype of cystic neopllasm?

A
  • Cystadenomas
18
Q

What is Cystadenoma?

A
  • Non-invasive mucinous cystic neoplasm
  • abnormal proliferation of biliary epithelium
19
Q

What are the clinical features of cystic neoplasm?

A
  • Asymptomatic (Majority)
  • Symptomatic
    • abdominal pain
    • anorexia
    • nausea
    • fullness
20
Q

What Ix would you order for cystic neoplasm?

A
  • LFT
    • ALP +/- raise
  • Tumour markers
    • CEA, CA19-9 raise
  • USS
  • CT c contrast - check evidence of mets
21
Q

What special test should be avoided in cystic neoplasm and why?

A
  • Aspiration
  • Avoid peritoneal seeding
22
Q

How would you Mx cystic neoplasm?

A
  • Liver lobe resection
23
Q

What is Hydatid cyst?

A
  • infection by tapeworm Echinococcus Granulosus
24
Q

What is the Px of hydatid cyst?

A
  1. Infected dog(common) pass stool
  2. Transmitted to host via fecal-oral transmission
  3. Larvae invade GI tract
  4. Travels to liver via hepatic portal system
  5. Grow and form cyst
25
Q

Which places are prevalent for hydatid cyst?

A
  • South america
  • North africa
  • central asia
26
Q

What are the clinical features of Hydatid Cyst?

A
  • Asymptomatic
  • vague abdominal pain
  • jaundice
  • vomiting
  • dyspepsia
  • early satiety
27
Q

What Ix would you order for Hydatid cyst?

A
  • FBC - eosinophilia
  • LFT
  • Echinococcal antibody
  • USS
    • calcified
    • spherical lesion
    • multiple septations
  • CT c contrast
28
Q

How would you Mx hydatid cyst?

A
  • Asymptomatic: monitor
  • Laparoscopic deroofing
  • Radiological drainage
  • Injection of scolecidal agent
  • Drug tx
29
Q

What drug combination is given for hydatid cyst?

A
  • albendazole
  • mebendazole
  • praziquantel
30
Q

Why aspiration is not indicated for hydatid cyst?

A
  • rupture can cause anaphylactic reaction

Hepatobiliary Surgery (HPB) (7 decks)

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