Liver cysts Flashcards
What could a lesion of the liver be
Simple cysts
Multiple cysts due to polycystic liver disease
Neoplastic cysts: cystadenoma
Hyadatid (echinococcal) cysts
Abscesses
Ductal cysts
Choledochal cysts
Caroli’s disease
Symptoms of benign liver lesions
Abdominal pain (RUQ)
Jaundice
Weight loss
Fatigue
Loss of appetite
Nausea and vomiting
Features of a simple liver cyst
usually congenital and asymptomatic
May require aspiration/catheter drainage/surgical drainage if large
Features of polycystic liver disease
Congenital, associate with ADPKD with mutations in PKD1 and PKD2 genes (kidney cysts occur first)
First notice during puberty
Features of neoplastic cysts
Cystadenoma/cystadenocarcinomas with malignant potential
Usually a solitary multiloculated lesion
Features of Hydatid cysts
Infestation with the parasite echinoococcus granulosus (tapeworm)
Can be asymptomatic for many years or can present with pain and large RUQ mass
Large cysts can rupture into the biliary tree (causing jaundice or cholangitis), through the diaphragm into the chest, or into the peritoneal cavity (causing anaphylactic shock).
Managed via surgical removal (pericystectomy) with mebendazole/albendazole
Features of choledochal cysts
Congenital dilatation of part or whole of the common bile duct
Features of Caroli’s disease
Combination of cystic dilatation of the intrahepatic bile ducts and infantile polycystic kidney disease
Autosomal recessive inheritance
Fever, abdominal pain and recurrent attacks of cholangitis
Features of haemangiomas
Benign blood vessel tumours
Most common benign tumour of mesenchymal origin
Reddish/purple hypervascular lesions, separated from the normal liver by a ring of fibrous tissue
US: hyperechoic
Aetiology of liver abscesses
Often a polymicrobial infection
Most common:
1. E. Coli
2. Klebsiella
3. S. Milleri
Immunocompromised - fungal e.g. candida
Entamoeba histolytica (Central and South America, Africa and Asia)
Hydatid cyst from tapeworm
Complication of untreated or inadequately treated appendicitis, as well as IBD, pancreatitis or diverticulitis
Other associations: DM, Cancer, cirrhosis, prior liver transplant, cardiopulmonary disease, immunocompromise
Recurrent pyogenic cholangitis due to salmonella typhi
Symptoms of liver abscesses
RUQ tenderness
Fevers and chills
Weight loss
Fatigue
Abdominal pain
Nausea and vomiting
Cough, shortness of breath, chest pain
Right shoulder pain (referred pain from diaphragm inflammation)
Jaundice
Management of liver abscesses
Treat underlying cause
Antibiotics or Antifungals (Broad spectrum until sensitivities known)
- Amoebic: Metronidazole + luminal Amoebicide (e.g. Diloxanide furoate)
- Hydatid: mebendazole
Drainage:
If small → Needle aspiration (ultrasound/CT guidance)
If moderate size → Catheter drainage
If large or multi-locular abscesse → Surgical drainage
Complications of liver abscesses/cysts
Septic shock
Allergic sequalae/anaphylaxis from ruptured hydatid cyst
Rupture and dissemination (e.g. into biliary tract causing acute cholangitis, intrathoracic rupture or peritonitis)
Prognosis for liver abscesses
Untreated pyogenic liver abscesses often fatal; complications have high mortality
10% Hydatid cysts recur after surgery Amoebic
Abscesses have a better prognosis and usually have a quick response to therapy
