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Visceral Surgery > Liver cystic disease > Flashcards

Liver cystic disease Flashcards

1
Q

Cause of benign liver cysts (4)

A

genetic
acquired
infectious
parasitic

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2
Q

majority of liver cysts are (2)

A

non infectious
and
non neoplastic

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3
Q

Most common neoplastic liver cysts

A

cystadenomas

cystadenocarcinomas

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4
Q

Simple cyst

A
  • asymptomatic, may develop symptom with pregnancy
  • well defined, unilocular, low fluid density
  • less than 3cms
  • Hypo in T1, Hyper in T2
  • more common in right lobe of liver
    TTT :
  • none unless symptomatic
  • alcohol sclerotherapy
  • laparoscopic fenestration
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5
Q

Ciliated foregut cyst

A
  • Pain although y 5cm
  • unilocular, subcapsular, single, near falciform in segm IV, 4 layered wall on ultrasound
  • resection if > 4 cm
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6
Q

Polycystic liver disease

A
  • multiple cysts on liver + kidney
  • autosomal dominant
  • open fenestration, liver resection, orthotopic liver transplantation
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7
Q

Amebic abscess

A
  • complext cyst with double target appearance

- metronidazole

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8
Q

Pyogenic liver abscess

A
  • complex cyst with rim enhancment
  • percutaneous drainage and antibiotics
  • surgery if refractory
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9
Q

Traumatic cyst

A
  • variable density and intensity, density layering shifts with movement
  • no treatment unless symptomatic or complications
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10
Q

Cystadenoma

A
  • more common in females
  • complex, multilocular cyst with septations, microcalcification, nodules, contrast enhancement of septations
    TTT :
  • enucleation
  • partial hepatectomy or lobectomy
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11
Q

IPMN-B (Intraductal papillary mucininous neoplasm of the bile ducts)

A
  • complex, multilocular, septation, calcification, biliary communication on ERCP or IOC, bile duct dilatation distal of tumor.
    TTT : partial hepatectomy or lobectomy with IOC +/- extrahepatic biliary resection and portal lymphadenectomy
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12
Q

Cystadenocarcinoma

A
  • more common in females
  • complex, multilocular cyst with septations, microcalcification, nodules, contrast enhancement of septations
    TTT :
  • partial hepatectomy
  • lobectomy
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13
Q

Cystic HCC

A
  • history of HBV, HCV or corrhosis
  • complex hypervascular cystic lesion with portal venous washout
    TTT :
  • RFA
  • TACE (transarterial chemoembolisation)
  • Partial hepatectomy or lobectomy
  • Liver transplantation
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14
Q

Liver tests

A

usually normal unless compressing hepatic structures

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15
Q

Fever (2)

A
  • superinfected cyst

- pyogenic liver ascess

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16
Q

Fever + travel or livestock (2)

A
  • Serology for Echinococcus

- Stool studies for Entamoeba

17
Q

Cyst aspiration (3)

A
  • rarely helps in benign vs neoplastic, no marker
  • avoid if Echinococcus : anaphylaxis
  • if cystadenocarcinoma : peritoneal spread
18
Q

Debris within cysts (3)

A
  • parasitic
  • neoplastic
  • hemorrage in simple cyst
19
Q

Mural calcification or daughter cyst

A

Echinococcal disease (can appear later)

20
Q

Echinococcus (types)

A

alveolar : E. multilocularis - fox (EU, CH, north heimsphere)
cystic = hydatid : E. granulosus - dog (EU, mediteranea, tropical zone)
polycsystic (E. vogeli, E oligarthrus, seldom south america
)

21
Q

Alveolar form (multilocularis)
Survival at 5 years without treatment
At 10 years with treatment

A

40%

80% if inoperable

22
Q

Alveolar Echinococcal Disease

A
  • radical surgery (partial hepatectomy) if possible (30% of cases)
  • liver transplantation
  • if cholangitis or abscess : percutaneous, endoscopic
  • Albendazole
    • for 2 years after surgery
    • lifelong for non operative cases
23
Q

Simple cyst can become symptomatic if:

A
  • size > 5cm (pressure, pain)
  • ruptured
  • hemorrhage
  • infected
24
Q

Rapidly growing simple cyst

A

increased risk of malignancy

25
Q

Imaging for simple cyst

A

Ultrasound should do

if septa, CT

26
Q

Choledocus Cyst

A 
very rare
children
intermittent icterus
complications as adult:
- cholangitis
- pancreatitis
- portal hypertension
- liver abscess
pathophysiology : 
- long common channel theory
- oddi dysfunction
- Oligogangliosis (gallway Hirschsprung)
ttt:
- resection and reconstruction
- OLT
27
Q

Hemangioma Diagnosis

A

US

CT (iris phenomenon, filling from peripher to central)

28
Q

Hemangioma indication for surgery (3)

A

> 15cm
symptomatic
rapid growth
Kasabach-Merritt syndrome (thrombopenia, consummation coagulopathy, hypofibrinogen)

29
Q

FNH Focal Nodular Hyperplasia

  • ranking of non malignant tumor
  • female male ratio
  • age
  • typical morphology
  • size
  • % asymptomatic
A
  • second most common non malignant tumor
  • female (9:1)
  • 20-50 years of age
  • typical vascular anomaly in the the center of the nodule
  • associated with Rendu Osler and therefore likely congenital
  • < 5cm in 90% of cases
  • 75% asymptomatic
30
Q

FNH Diagnosis

A
  • Dx with 4 phase CT or MRI
31
Q

FNH indication

A

> 8cm

unclear if FNH or other

32
Q

Hepatocellular adenoma indication

A

> 5cm (risk of bleeding and malignancy)
No biopsy !!
< 5cm, no absolute indication but surveillance

33
Q

Hepatocellular adenoma

A

associated with estrogen and contrapective pill
can cause pain in 25% of cases
avoidance of hormonal contraception is recommended

Visceral Surgery (32 decks)

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