Liver cysts Flashcards
What are simple liver cysts?
simple fluid filled epithelial lined sacs within the liver
What lobe are liver cysts usually in?
Right lobe
What causes simple liver cysts?
Congenitally malformed bile duct cells fail to connect to the extrahepatic ducts which leads to dilatation filled with bile like fluid
What are the symptoms of simple liver cysts?
Normally asymptomatic but may have abdominal pain, nausea, and early satiety
What investigations can be done for simple liver cysts?
LFTs are usually normal but may have raised GGT, CEA and CA19-9 may be elevated, ultrasound
On ultrasound how will simple liver cysts look?
anechoic, well defined, thin walled, oval spherical lesions, no rotations and strong posterior wall acoustic enhancement
What is the management for simple liver cysts?
most require no intervention but should be monitored by ultrasound. if symptomatic then ultrasound guided aspiration or laparoscopic deroofing
What colour are simple liver cysts in laparoscopy?
Blue hue
What is polycystic liver disease?
presence of more than 20 cysts within the liver parenchyma which are all more than 1cm in size
What two conditions causes polycystic liver disease?
Autosomal dominant polycystic kidney disease and autosomal dominant polycystic liver disease
What do ADPLD and ADPKD mutations in genes cause?
aberrant ductal plate configurations during liver embryogenesis
Why do polycystic liver disease cysts not drain?
They are not connected to intrahepatic bile ducts, do they dont drain, and this leads to dilatation and eventual cyst formation as they fill with bile like fluid
What are the symptoms of polycystic liver disease?
mainly asymptomatic, but may have abdominal pain as the cysts grow inside, hepatomegaly, renal and urinary symptoms, lier cirrhosis, portal hypertension
How is polycystic liver disease diagnosed?
ultrasound imaging which has more than 20 cysts with the same characteristics with simple cysts
What is the management for polycystic liver disease?
if asymptomatic then just monitor, and then give somatostatin analogues to give symptomatic relief as it reduces the cysts volume
Why would surgery be done for polycystic liver disease?
Intractable symptoms, inability to rule out malignancy on imaging alone, prevent malignancy
What surgery can be done for polycystic liver disease?
US guided aspiration, laparoscopic de-roofing of cysts
What are cystic neoplasms usually?
Cystadeomas which are non-invasive mutinous cystic neoplasms, which are pre malignant lesions
What are the symptoms of cystic neoplasms?
asymptomatic, but if symptoms then abdominal pain, anorexia and nausea, fullness and bloating
What are the investigations for cystic neoplasms?
LFTs usually normal, but ALP, CEA and CA19-9 may become mildly elevated, Ultrasound scan, CT imaging with contrast,
Why should aspiration and biopsy be avoiding in cystic neoplasms?
potential peritoneal seeding
Why would you think something is malignant on imaging?
sections, wall enhancement and nodules
Why would you think something is an abscess on imaging?
debris within the lesion, loculation
Why would you suspect a hydatid cyst on imaging?
calcification, daughter cysts around the lesion
What is the management for liver cystic neoplasms?
liver lobe resection
What is a hydatid cysts?
echinococco cysts that result from infection by tape worm
How are tapeworm eggs passed on?
Faaeco-oral transmission
How do tapeworm eggs pass into the liver?
via the hepatic portal system
What are the symptoms of hydatid cysts?
asymptomatic for years and undetected, vague abdominal pain, jaundice, cholangitis, vomiting, dyspepsia, early satiety, anaphylaxis
What will hydatid cysts show on FBC?
Eosinophilia
What will an ultrasound of hydatid cysts show?
Calcified, spherical lesion with multiple separations
What is the management for hydatid cysts?
aspiration is not recommended as may cause rupture and cause an anaphylactic reaction
What is the primary treatment for hydatid cysts?
cyst deroofing, radiological drainage and injection of scolecidal agent, anti-microbials
