liver diseases and tumors

Question 1

What are the causes of hepatic abscess?

Answer 1

Pyogenic (bacterial), amebic, and fungal (rare).

Question 2

What are the routes of entry for a hepatic abscess?

Answer 2

• Direct spread (biliary tract infection, portal spread, trauma)
• Systemic spread (hematogenous)

Question 3

What are common organisms causing pyogenic liver abscesses?

Answer 3

Polymicrobial, E. coli, Proteus, Klebsiella (Gram-negative)

Question 4

What are the common sources of pyogenic liver abscesses?

Answer 4

Ascending cholangitis (most common)
• Portal vein spread (e.g., diverticulitis, appendicitis)
• Sepsis

Question 5

What clinical features suggest pyogenic liver abscess?

Answer 5

• Signs of toxemia (fever, chills, septic-like picture)
• RUQ pain and jaundice
• Pleural effusion signs (SOB, stony dullness)
• Tender hepatomegaly on exam

Question 6

What lab investigations help diagnose hepatic abscess?

Answer 6

• CBC: Leukocytosis
• CRP & ESR: Elevated
• LFTs: Elevated
• Hepatitis serology: Rule out viral hepatitis
• Urinalysis & culture: Rule out kidney problems

Question 7

What imaging techniques are used for pyogenic liver abscess?

Answer 7

RUQ Ultrasound: Examines liver & kidney, detects abscess (often small and multiple)
• CT abdomen & chest: Shows abscess and possible right-sided pleural effusion

Question 8

What is the first-line management of pyogenic hepatic abscess?

Answer 8

• IV broad-spectrum antibiotics: Ceftriaxone + Metronidazole (4–6 weeks)

Question 9

When is CT/US guided percutaneous drainage used for hepatic abscess?

Answer 9

When drainage is needed; the sample is sent for culture & sensitivity, and antibiotics are adjusted accordingly.

Question 10

When is operative drainage considered for hepatic abscess?

Answer 10

If there are multiple abscesses or if the infection is refractory to treatment.

Question 11

What is the usual side of the liver affected by hepatic abscess?

Answer 11

Right lobe (more commonly affected than the left).

Question 12

What can a hepatic abscess on the left lobe lead to?

Answer 12

Risk of rupture into the peritoneum.

Question 13

What are the potential effects of any hepatic abscess on the lungs?

Answer 13

Right-sided pleural effusion and respiratory symptoms like dyspnea and dullness.

Question 14

What causes an amebic liver abscess?

Answer 14

Entamoeba histolytica

Question 15

What is the source and path of infection for amebic liver abscess?

Answer 15

Feco-oral route; E. histolytica causes flask-shaped ulcers in intestines and spreads via portal circulation.

Question 16

What are risk factors for amebic liver abscess?

Answer 16

• Immigrants
• Male homosexuals
• Traveling to endemic areas (e.g., India, Africa)

Question 17

What are the clinical features of amebic liver abscess?

Answer 17

• Mild fever (no chills)
• RUQ pain
• +/- Bloody diarrhea history
• Tender hepatomegaly on exam

Question 18

What is the drug of choice (DOC) for treating amebic liver abscess?

Answer 18

IV Metronidazole.

Question 19

When is CT/US guided percutaneous drainage done for amebic abscess?

Answer 19

• If refractory to metronidazole
• Risk of peritoneal rupture
• Co-infection present

Question 20

What organism causes hydatid cysts?

Answer 20

Echinococcus granulosus or multilocularis (tapeworms).

Question 21

What is the source of Echinococcus infection in humans?

Answer 21

• Ingesting infected vegetables contaminated with infected animal feces (feco-oral route)
• Dogs are definitive hosts (eggs in stool)
• Sheep are intermediate hosts
• Humans are accidental hosts

Question 22

Why can daughter cysts of Echinococcus not infect others?

Answer 22

They reproduce asexually and need the egg to infect others.

Question 23

What are risk factors for hydatid cysts?

Answer 23

Exposure to infected animals and being an immigrant from endemic areas.

Question 24

What is the most common location of a hydatid cyst in the liver?

Answer 24

Right lobe periphery.

Question 25

What are clinical features of hydatid cysts?

Answer 25

• May be asymptomatic • RUQ pain (liver symptoms) • Respiratory symptoms (alveolar cysts) • CNS symptoms (brain cysts) • Hepatomegaly with palpable hydatid thrill (pathognomonic)

Question 26

What are complications of liver hydatid cysts?

Answer 26

• Rupture (risk of fatal anaphylaxis) • Cholangitis (cyst obstruction) • Secondary infections

Question 27

What labs help diagnose hydatid disease?

Answer 27

• CBC: Eosinophilia • LFTs: Liver function assessment • Serology: Anti-echinococcus IgG antibodies

Question 28

What liver ultrasound findings are virtually diagnostic of hydatid cysts?

Answer 28

• Snowflake sign (hydatid sand) • Double-line sign • Calcified outline

Question 29

What does CT show in hydatid disease?

Answer 29

Multiple, multilobulated cysts filled with fluid.

Question 30

What is the medical management for hydatid cyst?

Answer 30

Albendazole: • Given 7 days pre-op and 1 month post-op • Monitor WBCs & LFTs

Question 31

Why should corticosteroids and antihistamines be given before surgery in hydatid disease?

Answer 31

To reduce the risk of hypersensitivity and anaphylactic reactions during cyst manipulation.

Question 32

What precautions should be taken during hydatid cyst surgery?

Answer 32

• Avoid cyst rupture • Use hypertonic saline-soaked gauze • Wear face shield • Good visualization is crucial

Question 33

What is injected into the cyst during surgery to kill daughter cysts?

Answer 33

Scolicidal agent (20% hypertonic saline).

Question 34

What is the major intra-op risk of hydatid cyst surgery?

Answer 34

Spillage causing fatal anaphylaxis or implantation of residual cysts.

Question 35

What is the growth rate of hydatid cysts?

Answer 35

A: Slow: 2–3 cm per year.

Question 36

What is the most common benign liver tumor?

Answer 36

Cavernous hemangioma.

Question 37

What is the most common primary malignant liver tumor?

Answer 37

Hepatocellular carcinoma (HCC).

Question 38

What is the most common liver malignancy overall?

Answer 38

Metastasis from colorectal cancer (followed by lung and breast cancers).

Question 39

What are symptoms of cavernous hemangioma?

Answer 39

Asymptomatic or RUQ pain, bleeding, jaundice.

Question 40

What are signs of cavernous hemangioma?

Answer 40

Hepatomegaly and RUQ bruit (indicative of bloody tumor).

Question 41

What investigations help diagnose cavernous hemangioma?

Answer 41

• Labs: CBC (thrombocytopenia), LFTs • Imaging: Liver US & CT with contrast (homogenous, hyperechoic mass)

Question 42

Why is biopsy contraindicated in cavernous hemangioma?

Answer 42

It may cause fatal hemorrhage.

Question 43

How is cavernous hemangioma managed?

Answer 43

• Asymptomatic: Serial US monitoring • Symptomatic: Surgical resection

Question 44

What is hepatocellular adenoma?

Answer 44

A benign proliferation of hepatocytes without bile ducts.

Question 45

What are risk factors for hepatocellular adenoma?

Answer 45

• OCP use • Anabolic steroids • Glycogen storage diseases • Occurs mostly in women of childbearing age

Question 46

What are symptoms and signs of hepatocellular adenoma?

Answer 46

• Symptoms: RUQ pain, fullness • Signs: RUQ tenderness, palpable mass

Question 47

What investigations help diagnose hepatocellular adenoma?

Answer 47

• Labs: CBC, LFTs • Imaging: Liver US & CT with contrast (solitary, well-demarcated, heterogeneous mass)

Question 48

How is hepatocellular adenoma managed?

Answer 48

• Stop OCPs and anabolic steroids • If asymptomatic & small (<5 cm): Monitoring • If symptomatic or large (>5 cm): Surgical resection

Question 49

What is another name for hepatocellular carcinoma (HCC)?

Answer 49

Hepatoma

Question 50

Who is most commonly affected by HCC?

Answer 50

Males, typically aged 50–60s.

Question 51

What are the major risk factors for HCC?

Answer 51

• Liver cirrhosis (due to HCV, HBV, alcohol) • Genetic diseases: Hemochromatosis, Wilson’s disease • Others: Smoking, carbon tetrachloride, liver flukes (schistosoma), aflatoxins (Aspergillus)

Question 52

What are the symptoms suggestive of liver disease?

Answer 52

RUQ pain, weight loss, and symptoms of polycythemia such as headache and vision disturbances.

Question 53

What are the key signs that suggest liver disease?

Answer 53

• Signs of portal hypertension and liver failure • RUQ bruit (suggesting a high vascular tumor) • Tender hepatomegaly and splenomegaly

Question 54

What laboratory tests are used to investigate suspected liver disease?

Answer 54

CBC, liver function tests (LFTs), and alpha-fetoprotein (AFP).

Question 55

What imaging studies are used for liver disease diagnosis?

Answer 55

Liver ultrasound (US) and CT scan.

Question 56

What is the definitive diagnostic procedure for liver disease?

Answer 56

CT/US-guided liver biopsy

Question 57

What is the management plan for early and non-cirrhotic liver tumors?

Answer 57

Lobectomy with wide margins (either left or right to have the cantlie line).

Question 58

Liver transplant, only in: