liver cysts

Question 1

what is a simple liver cyst and what are their clinical features?

Answer 1

simple fluid-filled epithelial-lined sacs within the liver, most commonly occurring in the right lobe

normally asymptomatic and often detected incidentally on imaging.
Around 10-15% of patients have symptoms e.g abdo pain, nausea, and early satiety

Question 2

what investigations can be done for simple cysts?

Answer 2

• LFTs

- USS, usually well defined, thin walled, oval/spherical lesions

Question 3

how are simple cysts managed?

Answer 3

Most cysts require no intervention, though for cysts >4cm in size, follow-up ultrasound scans are recommended to monitor growth

if patient is symptomatic, can do USS guided aspiration or laparoscopic de roofing

Question 4

what is polycycstic liver disease and what causes it?

Answer 4

presence of ≥20 cysts within the liver parenchyma, each of which are ≥1cm in size.

caused by one of the two following autosomal dominant conditions:

• Autosomal dominant polycystic kidney disease (ADPKD) as an extrarenal manifestation
• Autosomal dominant polycystic liver disease (ADPLD

Question 5

what are the clinical features of PCLD?

Answer 5

majority of patients are asymptomatic, symptoms only arising as a result of localised compression or complications.

symptomatic, patients will often present with abdominal pain as the cysts grow in size and hepatomegaly

Question 6

what is the management for PCLD?

Answer 6

• asymptomatic = leave alone and monitor
• surgery if symptomatic, cant rule out malignancy or cant prevent malignancy.
• can do via US guided aspiration for temporary symptomatic relief, but can get reaccumulation
• laprascopic de roofing of cysts is the prefered technique.

Question 7

what are cystic neoplasms and what are their clinical features?

Answer 7

premalignant lesions

patients are commonly asymptomatic. Cystic neoplasms grow slowly, typically 1-2mm per year and if symptoms do develop, they may do so insidiously.

symptoms include abdominal pain and anorexia, as well as more vague symptoms of nausea, fullness, and bloating.

Question 8

what investigations are done for cystic neoplasms?

Answer 8

• LFT
• CT with contrast
• avoid aspiration or biopsy as can result in potential peritoneal seeding of malignancy