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Y3M - HPB Surgery > Liver Cysts > Flashcards

Liver Cysts Flashcards

1
Q

How are liver cysts commonly found?

A

Incidentally on routine imaging

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2
Q

Explain simple liver cyst

A

Fluid-filled epithelial-lined sacs

They are most commonly found in the right lobe

Are quite common and increasing incidence with age.

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3
Q

Cause of simple cysts

A

Congenitally malformed bile duct cells that fail to connect to the extrahepatic ducts.

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4
Q

Clinical features of simple cysts.

A

Asymptomatic

Usually discovered incidentally.

10-15% may experience symptoms…
Abdo pain, nausea and early satiety.

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5
Q

Lab tests in simple cysts

A

LFTs usually normal

Some patients might have raised GGT

CEA and CA19-9 tumour markers may also be elevated in some cases

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6
Q

Imaging modality of choice in simple cysts

A

USS

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7
Q

USS findings in simple cysts

A

Anechoic

Well-defined

Thin-walled

Oval/spherical lesions with no septations

Strong posterior wall acoustic enhancement

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8
Q

General management of simple cysts.

A

Usually no management is needed.

> 4cm in size should have follow-up USS at 3, 6 and 12 months

If the size of the cyst remains unchanged after 2-3 years no further scans are needed

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9
Q

Managment in symptomatic patients with simple cysts.

A

Ultrasound-guided aspiration or laparoscopic de-roofing (cysts have blue hue on this)

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10
Q

Define polycystic liver disease

A

Presence of 20 or more cysts within the liver parenchyma each of which is 1 cm or more in size.

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11
Q

Caused by usually one of the two following conditions…

A

Autosomal dominant polycystic kidney disease (ADPKD)

Autosomal dominant polycystic liver disease (ADPLD)

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12
Q

Explain ADPKD

A

Caused by mutations in the PKD1 and PKD2 genes

10-60% patients will develop liver cysts as well as it is a common extra-renal manifestation

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13
Q

Explain ADPLD

A

Mutation in the PRKCSH or SEC63 gene

There will be no renal involvement in ADPLD

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14
Q

Pathophysiology of polycystic liver disease

A

The mutations in the genes lead to aberrant ductal plate configuration during liver embryogenesis.

This means that the structures are not connected to the intrahepatic bile duct

This means that they cannot drain -> dilatation and cyst formation of bile-like fluid.

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15
Q

Clinical features polycystic liver disease

A

Majority are asymptomatic

Abdominal pain can arise as the cysts grow in size

Hepatomegaly

Concurrent renal disease with urinary tract symptoms

Liver cirrhosis and portal HTN

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16
Q

Lab tests in polycystic liver disease

A

Usually normal LFTs

ALP can be raised sometimes

Renal function should also be assessed

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17
Q

Definitive diagnosis of polycystic liver disease

A

Ultrasound imaging with multiple of cysts (>20)

18
Q

Management of asymptomatic patients of polycystic liver disease

A

Can be left alone and monitored

Many patients will eventually require some sort of intervention as they are progressive diseases.

Short-term benefit for somatostatin analogues in symptomatic relief might be trialled
This is because it acts to reduce cyst volume

19
Q

Indications for surgery polycystic liver disease

A

Intractable symptoms

Inability to rule out malignancy on imaging alone

Prevention of malignancy

20
Q

Surgical approach polycystic liver disease

A

US-guided aspiration

Laparoscopic de-roofing of cysts

21
Q

Explain US guided aspiration in polycystic liver disease

A

Provides temporary relief

It is not routinely perfored as fluid usually accumulates again

22
Q

Explain laparoscopic de-roofing of cysts in polycystic liver disease

A

Preferred technique

Where there are particular liver segments that are heavily affected resection may be preferred

Extreme cases transplantation might even be preferred

23
Q

Explain cystic neoplasms of the liver

A

Quite rare and account for <5% of liver cysts

Most of them are cystadenomaswhich arepremalignant lesionsthat can lead tocystadenocarcinomas in around 10% of cases

24
Q

Clinical features of cystic neoplasms

A

Most commonly asymptomatic

Since the neoplasms grow slowly, symptoms may present slowly as well.

Abdo pain, anorexia

Nausea, fullness and bloating

25
Q

Lab tests cystic neoplasms

A

LFTs usually normal

ALP, CEA and CA19-9 can all be elevated

26
Q

Imaging of cystic neoplasms

A

USS can distinguish between simple cysts and cystic neoplasms

CT imaging with contrast should be performed in all patients where cystic neoplasms is suspected

CT for staging as well

27
Q

When should you do an aspiration or biopsy of cystic neoplasms

A

Should be avoided

This is because it can result in potential peritoneal seeding of malignancy

28
Q

Imaging features suggestive of malignancy

A

Septations

Wall enhancement

Nodularity

29
Q

Imaging features suggestive of abscess

A

Debris within lesion

Loculation (can also suggest malignancy)

30
Q

Imaging features suggestive of hydatid cyst.

A

Calcification

Daughter cysts around main lesion

31
Q

Management of cystic neoplasms

A

Liver lobe resection for both cystadenomas and cystadenocarcinomas

Samples are sent for histopathology as well to confirm diagnosis

32
Q

Explain hydatid cysts

A

Result from infection by the tapeworm Echinococcus granulosus.

33
Q

Explain pathophysiology of hydatid cysts

A

Eggs from tapeworm are passed by faeco-oral route.

The larvae invade their hosts’ GI tract and then pass via hepatic portal to liver where it starts to grow.

34
Q

Epidemiology of hydatid cysts

A

Global distribution

Highest prevalence in South america, north africa and central asia

35
Q

Clinical features of hydatid cysts

A

Only grow a few millimetres per year

This means they may remain asymptomatic and undetected for many years

Most common presentation is vague abdo pain caused by mass effect on surrounding structures or due to rupture

Jaundice, cholangitis, vomiting, dyspepsia and early satiety can also happen

Rarely anaphylaxis can happen if a cyst ruptures into thorax or intraperitoneally.

36
Q

Lab tests of hydatid cysts

A

LFTs are often normal unless there is also associated cholangitis

FBC = Eosinophilia

Echinococcal antibody titres +ve

37
Q

Imaging of hydatid cysts

A

USS

CT with contrast can be done as well

38
Q

USS findings hydatid cysts

A

Calcified spherical lesions with multiple septations

Anechoic or snow-flake like inclusions

39
Q

CT imaging findings hydatid cysts

A

Similar to USS with calcified spherical lesions with mutiple septations

Daughter lesions can be found near main lesion as well

40
Q

Primary treatment of hydatid cysts

A

Surgical by cyst de-roofing

41
Q

What other surgical intervention might be done in hydatid cysts

A

Radiological drainage and injection of scolecidal agent

Aspiration is not recommended due to risk of rupture and anaphylactic reaction

42
Q

Medical management of hydatid cysts

A

If the cysts are asymptomatic and inactive monitoring might be done.

Medical management is used as an adjunct to surgical therapy

Especially in those with widely disseminated hydatid disease or if unfit for surgery

Albendazole, mebendazole and/or praziquantel is normally given

Y3M - HPB Surgery (14 decks)

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