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HPB > Liver cysts > Flashcards

Liver cysts Flashcards

1
Q

What are simple liver cysts?

A

simple fluid filled epithelial lined sacs within the liver

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2
Q

What lobe are liver cysts usually in?

A

Right lobe

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3
Q

What causes simple liver cysts?

A

Congenitally malformed bile duct cells fail to connect to the extrahepatic ducts which leads to dilatation filled with bile like fluid

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4
Q

What are the symptoms of simple liver cysts?

A

Normally asymptomatic but may have abdominal pain, nausea, and early satiety

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5
Q

What investigations can be done for simple liver cysts?

A

LFTs are usually normal but may have raised GGT, CEA and CA19-9 may be elevated, ultrasound

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6
Q

On ultrasound how will simple liver cysts look?

A

anechoic, well defined, thin walled, oval spherical lesions, no rotations and strong posterior wall acoustic enhancement

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7
Q

What is the management for simple liver cysts?

A

most require no intervention but should be monitored by ultrasound. if symptomatic then ultrasound guided aspiration or laparoscopic deroofing

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8
Q

What colour are simple liver cysts in laparoscopy?

A

Blue hue

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9
Q

What is polycystic liver disease?

A

presence of more than 20 cysts within the liver parenchyma which are all more than 1cm in size

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10
Q

What two conditions causes polycystic liver disease?

A

Autosomal dominant polycystic kidney disease and autosomal dominant polycystic liver disease

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11
Q

What do ADPLD and ADPKD mutations in genes cause?

A

aberrant ductal plate configurations during liver embryogenesis

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12
Q

Why do polycystic liver disease cysts not drain?

A

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

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13
Q

What are the symptoms of polycystic liver disease?

A

mainly asymptomatic, but may have abdominal pain as the cysts grow inside, hepatomegaly, renal and urinary symptoms, lier cirrhosis, portal hypertension

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14
Q

How is polycystic liver disease diagnosed?

A

ultrasound imaging which has more than 20 cysts with the same characteristics with simple cysts

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15
Q

What is the management for polycystic liver disease?

A

if asymptomatic then just monitor, and then give somatostatin analogues to give symptomatic relief as it reduces the cysts volume

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16
Q

Why would surgery be done for polycystic liver disease?

A

Intractable symptoms, inability to rule out malignancy on imaging alone, prevent malignancy

17
Q

What surgery can be done for polycystic liver disease?

A

US guided aspiration, laparoscopic de-roofing of cysts

18
Q

What are cystic neoplasms usually?

A

Cystadeomas which are non-invasive mutinous cystic neoplasms, which are pre malignant lesions

19
Q

What are the symptoms of cystic neoplasms?

A

asymptomatic, but if symptoms then abdominal pain, anorexia and nausea, fullness and bloating

20
Q

What are the investigations for cystic neoplasms?

A

LFTs usually normal, but ALP, CEA and CA19-9 may become mildly elevated, Ultrasound scan, CT imaging with contrast,

21
Q

Why should aspiration and biopsy be avoiding in cystic neoplasms?

A

potential peritoneal seeding

22
Q

Why would you think something is malignant on imaging?

A

sections, wall enhancement and nodules

23
Q

Why would you think something is an abscess on imaging?

A

debris within the lesion, loculation

24
Q

Why would you suspect a hydatid cyst on imaging?

A

calcification, daughter cysts around the lesion

25
Q

What is the management for liver cystic neoplasms?

A

liver lobe resection

26
Q

What is a hydatid cysts?

A

echinococco cysts that result from infection by tape worm

27
Q

How are tapeworm eggs passed on?

A

Faaeco-oral transmission

28
Q

How do tapeworm eggs pass into the liver?

A

via the hepatic portal system

29
Q

What are the symptoms of hydatid cysts?

A

asymptomatic for years and undetected, vague abdominal pain, jaundice, cholangitis, vomiting, dyspepsia, early satiety, anaphylaxis

30
Q

What will hydatid cysts show on FBC?

A

Eosinophilia

31
Q

What will an ultrasound of hydatid cysts show?

A

Calcified, spherical lesion with multiple separations

32
Q

What is the management for hydatid cysts?

A

aspiration is not recommended as may cause rupture and cause an anaphylactic reaction

33
Q

What is the primary treatment for hydatid cysts?

A

cyst deroofing, radiological drainage and injection of scolecidal agent, anti-microbials

HPB (13 decks)

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