Liver cysts

Question 1

What are simple cysts??

Answer 1

fluid-dilled epithelial-lined sacs

Question 2

what symptoms are associated with simple cysts?

Answer 2

typically asymptomatic however may experience:
pain
early satiety
nausea

Question 3

What investigations are performed with simple cysts and what are the findings?

Answer 3

LFTs - usually normal
tumor marker CEA may be raised
USS - well defined, thin-walled and no septation

Question 4

what is the management for simple cysts

Answer 4

Most require no intervention
>4cm follow-up USS recommended at 3,6 and 12 months
for symptomatic: USS aspiration

Question 5

What two conditions are associated with polycystic liver disease?

Answer 5

autosomal dominant polycystic kidney disease (ADPKD)

autosomal dominant polycystic liver disease (ADPLD)

Question 6

Why do cysts in polycystic liver disease not drain??

Answer 6

they are not connected to the intrahepatic bile ducts

Question 7

what are the clinical features of polycystic liver disease??

Answer 7

usually asymptomatic 
in those who are symptomatic:
- hepatomegaly with Abdo pain 
- concurrent renal disease ADPKD 
- significant disease can cause cirrhosis and portal hypertension

Question 8

what are the findings on investigation of polycystic disease??

Answer 8

typically no abnormal LFTs
may have disrupted U&E in ADPKD
USS- 20+ cysts with the appearance of simple cysts

Question 9

what are the indications for surgery in polycystic liver disease??
what are the surgeries that can be performed

Answer 9

intractable symptoms
inability to rule out malignancy on imaging
prevention of malignancy

surgeries:
USS-guided aspiration and laparoscopic de-roofing of cysts.
if particular segments are grossly affected then resection may be preferred

Question 10

what is the most common subtype of cystic neoplasms?

describe these lesions.

Answer 10

cystadenomas:
pre-malignant lesions that develop as a result of perforated biliary epithelium –> have potential to develop into cystadenocarcinoma

Question 11

what are the clinical features of cystic neoplasms??

Answer 11

usually asymptomatic 
may however present with:
- pain 
- anorexia
- vague symptoms of fullness, nausea and bloating

Question 12

what investigations are performed for cystic neoplasms and what are the findings?

Answer 12

ALP, CEA may be elevated
USS - typically can differentiate between simple and abnormal cysts
CT imaging with contrast - delineation and evidence of metasteses
*aspiration and biopsy avoided to reduce risk of peritoneal seeding

Question 13

what are the suspicous features on imaging liver cysts?

Answer 13

malignancy : septations, wall enhancemnt and nodularity
abscess: debris within
hydatid cyst: calcification, ‘daughter cysts’ around teh main cyst

Question 14

what is the management for cystadenomas and cystadenocarcinomas??

Answer 14

liver lobe resection with histological samples acquired after removal

Question 15

describe how hydatid cysts develop.

Answer 15

result from infection by tapeworm: Echinococcus granulosus - transmitted faeco-orally from carnivores e.g. dogs

larvae invade GI tract –> hepatic portal vein –> grow in liver and form cysts

Question 16

what are the clinical features of hydatid cysts??

Answer 16

can remain asymptomatic for a long time 
most common complaint:
- vague abdo pain (rupture/mass effect)
less commonly:
- vomiting, dyspepsia and early satiety 
- anaphylactic reaction if ruptured

Question 17

what investigations are performed with hydatid cysts and what are the findings?

Answer 17

LFTs usualy normal unless associated with cholangtis
FBC - eosinophilia
Echinococcal Ab titres +ve
USS - calcified, spherical lesion + multiple septations
CT with contrast

Question 18

what is the management of Hydatid cysts?

Answer 18

potentially just monitor if asymptomatic
surgically : cyst deroofing/ complete excision
medical (alongside surgical) - albendazole. mebendazol +/- praziquantel

*aspiration not recommended as rupture may cause an anaphylactic reaction –> anaphylactic shock