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1st Year - Gastroenterology > Liver, etc. 9 - Focal Liver Lesions > Flashcards

Liver, etc. 9 - Focal Liver Lesions Flashcards

1
Q

What are solid liver lesions in older patients most likely to be?

A

Malignant - usually metastases if the patient does not have liver disease (then it is more likely to be a primary liver cancer)

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2
Q

What is the most common solid liver tumour in non cirrhotic patients?

A

Haemangioma

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3
Q

What are the causes of a benign focal liver lesions? (4)

A

HaemangiomaFocal nodular hyperplasiaAdenomaLiver cysts

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4
Q

What are the 2 causes of malignant focal lesions of the liver?

A

Primary liver cancersMetastases

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5
Q

What are the types of primary liver cancers? (6)

A

Hepatocellular carcinomaCholangiocarcinomaFibrolamellar carcinomaHepatoblastomaAngiosarcomaHaemangioendothelioma

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6
Q

Clinical features of haemangioma:-more common in M or F?- blood supply?- size/ number of them?- border?- symptoms?

A

FemalesHypervascular tumourUsually single and smallWell demarcated capsuleusually asymptomatic

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7
Q

Diagnosis of haemangioma?

A

US: echogenic spot, well demarcatedCT: venous enhancement from periphery centreMRI: high intensity areaNo need for FNA

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8
Q

Treatment for haemangioma?

A

No need for treatment

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9
Q

What is a focal nodular hyperplasia?

A

Benign nodule formation of normal liver tissue (hyper plastic growth of normal hepatocytes)

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10
Q

What is usually the cause of a focal nodular hyperplasia?What 2 other conditions is FNH therefore associated with?

A

Congenital vascular anomaly - hyperplastic response to abnormal arterial flowOsler-Weber-RenduLiver haemangioma

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11
Q

What is the classical appearance of a focal nodular hyperplasia?

A

Central scar containing a large artery, radiating branches to the periphery (Hub and spoke) - not always

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12
Q

What 3 things are present on histology focal nodular hyperplasia?

A

SinusoidsBile ductulesKupffer cells

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13
Q

What age groups and gender are focal nodular hyperplasia more common in?

A

Young and middle age women (no relation with sex hormones)

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14
Q

Symptoms of focal nodular hyperplasia?

A

Usually asymptomatic, amy cause minimal pain

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15
Q

Diagnosis of focal nodular hyperplasia?

A

US: nodule with varying echogenicityCT: hypervascular scar with central scarMRI: Iso or hypo intenseFNA: normal hepatocytes and cupful cells with central core

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16
Q

Treatment of focal nodular hyperplasia?

A

No treatment necessary(no change required regarding pregnancy and hormones - some older texts give mixed message)

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17
Q

What is a hepatic adenoma?

A

Benign neoplasm composed of normal hepatocytes - most are solitary fat containing lesionsNo portal tract, central veins or bile ducts

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18
Q

Clinical features of hepatic adenoma:Which sex is it more common in?What is it commonly associated with?Symptoms?What can it rarely present with?

A

FemalesContraceptive hormonesUsually asymptomatic but may have RUQ pain - symptoms are size relatedMay present with rupture, haemorrhage or malignant transformation (very rare)

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19
Q

What lobe of the liver are hepatic adenomas commonly found in?

A

The right lobe

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20
Q

What is multiple adenomas called?What is this associated with?

A

AdenomatosisGlycogen storage diseases

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21
Q

What has been identified within adenomas that confer malignant risk?

A

Identifiable oncogene mutations

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22
Q

How are hepatic adenomas related to Oral Contraceptive?

A

Related to duration of OC use (>2 years) and oestrogen component, but adenomas have been described with even 6 months of OS use

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23
Q

What can happen do hepatic adenomas after discontinuation of Oral contraceptives?

A

Regression

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24
Q

Diagnosis of hepatic adenoma?

A

US: filling defectCT: diffuse arterial enhancementMRI: hypo or hyper intense lesionFNA: may be needed

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25
Q

Treatment for a hepatic adenoma?

A

Stop hormonesObserve every 6m for 2yif no regression then surgical excisionNew guidelines suggest that male patients should have them removed straight away as they are more prone to developing a malignant transformation

26
Q

Difference between an adenoma and focal nodular hyperplasia appearance?

A

Adenoma = purely a hepatocyte tumour which is cold on nuclear sulfur colloid scanFocal nodular hyperplasia = contains all the liver ultrastructure including ES and bile ductules (isointense on sulfur colloid scan) - central scar

27
Q

Malignant risk with adenoma and focal nodular hyperplasia?

A

Adenoma = malignant degenerationFocal nodular hyperplasia = no malignant risk

28
Q

Type of cystic lesions of the liver? (5)

A

SimpleHydatidAtypicalPolycystic lesionPyogenic or amoebic abcess

29
Q

Clinical features of a simple cyst:-Appearance-Biliary tree communication?-Symptoms?

A

-liquid collection lined by an epithelium - solitary and uniloculated- no biliary tree communicationMost of the time asymptomatic but symptoms can be experienced in relation to:-intracsytic haemorrhage-infection-rupture (rare)-compression

30
Q

Management of a simple cyst?

A

No follow up necessaryif in doubt, image in 3-6 monthsIf symptomatic or uncertain of diagnosis (complex cystic lesion), then consider surigcal intervention

31
Q

What organism causes hydatid cysts?

A

Echinoccus granulosus

32
Q

Where are endemic regions for hydatid cysts?

A

Eastern europe central americasouth americamiddle eastnorth africa

33
Q

How can patients with hydatid cysts present?

A

Disseminated diseaseerosion of cysts into adjacent structures and vessels (IVC)

34
Q

How is a hydatid cyst diagnosed?

A

Based on history, appearance and serologic testing-detection of anti-echinococcus antibodies

35
Q

Possible management for hydatid cysts? (3)

A

Surgery - most common form of treatment medicalprecutaneous drainage

36
Q

What are the 2 types of treatment that can be given for a hydatid cyst?

A

ConservativeRadical

37
Q

Types of conservative surgery for hydatid cyst? (2)

A

Open cystectomyMarsupialization (slit cut in cyst to allow it to continually drain)

38
Q

Types of radical surgery for a hydatid cyst?

A

PericystecomyLobectomy

39
Q

Risks of surgery for a hydatid cyst?

A

Operative morbidityAnaphylacisDissemination of infection

40
Q

Medical treatment for a hydatid cyst?

A

Albendazole

41
Q

What does PAIR stand for (percutaneous drainage)?

A

PunctureAspirationInjectionRespiration

42
Q

What causes polycystic liver disease?

A

Embryonic ductal plate malformation of the intrahepatic biliary tree - numerous cysts throughout liver parenchyma

43
Q

What are the causes of numbers cysts throughout the liver parenchyma?

A

Von meyenburg complexesPolycystic liver diseaseAutosomal dominant polycystic kidney disease

44
Q

What is von memenburg complexes?

A

Microhamartomas - benign cystic nodules throughout the liver - cystic bile duct malformations, originating from the peripheral biliary tree - remnants develop into small hepatic cysts and usually remain silent during life - incidental finding

45
Q

Difference between polycystic liver disease and autosomal dominant polycystic kidney disease?

A

Liver function is preserved and renal failure rare in polycystic liver disease where as renal failures common in polycystic kidney disease often with extra-kidney manifestations

46
Q

Treatment of polycystic liver disease with symptoms due to volume of tumours?

A

Conservative treatment to half cyst growth - invasive procedures are only required in severe cases (aspiration/ liver transplant)

47
Q

What type of pharmacological therapy leads to a beneficial outcome in polycystic liver disease by relieving symptoms and reducing liver volume?

A

Somatostatin analogues

48
Q

Clinical features of a liver access?

A

High feverLeukocytosisAbdominal painComplex liver lesionHistory of abdo or biliary infection or dental procedure

49
Q

Management of liver abscess?

A

Initial empiric broad spectrum antibioticsAspiration/ drainage percutaneouslyEchocardiogramOperation if no clinical improvement (open drainage/ resection)4 week antibiotic therapy with repeat imaging

50
Q

What is the most common primary liver cancer?

A

Hepatocellular carcinoma

51
Q

Most important risk factor for hepatocellular carcinoma?

A

Cirrhosis of any cause

52
Q

Most common symptoms of HCC?

A

Weight loss and RUQ pain (can be asymptomatic)

53
Q

What is a tumour marker for HCC?

A

Alfa fetoprotein - values greater than 100ng/ml = highly susceptive of HCC

54
Q

Treatment of HCC if a small tumour with no evidence of raised portal pressure?

A

Resection

55
Q

Treatment of HCC if single tumour less than 5cm or less than 3 tumour less than 3cm each?

A

Liver transplant

56
Q

Treatment of HCC if multiple tumour and evidence of dissemination?

A

Palliative, local ablation, chemoembolisaiton

57
Q

Treatment of a non-resectable patient e.g. advanced liver cirrhosis?

A

Local ablation - alcohol injection, radio frequency ablation - temporary measure only

58
Q

What is chemoembolisation?

A

TransArterial ChemoEmbolisation = inject chemo selectively into hepatic artery then inject an embolic agent (only for patients with early cirrhosis

59
Q

What systemic therapy can be given for advanced HCC?

A

Sorafenib - multikinase inhibitor of vast endothelial gf receptor

60
Q

What is the type of lung cancer that is often seen in young patients (5-35) and is not related to cirrhosis - also causes a normal AFP?

A

Firbo-Lamellar carcinoma

61
Q

What is the standard treatment for Fibre-Lamellar carcinoma?

A

Surgical resection or transplantation

1st Year - Gastroenterology (37 decks)

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