Liver lesions

Question 1

What are the different benign liver lesions

Answer 1

Solid:
- Haemangioma
- Adenoma

Cystic:
- Infectious: Pyogenic, Amoebic, Hydatid

Question 2

What are the different malignant liver lesions

Answer 2

Primary:
- Heatocellular carcinoma

Metastatic
- Colorectal
- Others: intra-abdominal and extra-abdominal malignancies

Question 3

Explain the presentation of infective benign lesions of the liver

Answer 3

Pyogenic:
- Ill looking, Sweating, Tachycardic, Hypotension
- Spreads from gastro-intestinal tract, haematogenously, biliary spread, abcesses in the git, idiopathic
- Examination: Look sick, may be able to palpate abscess
- FBC, U&E, CRP, CT scan
- Finding: Pseudocapsule, can have subtations
- Management: ICU - broadspectrum antibiotic, aspiration (look for organisms)

Amoebic:
- Dont feel great, Some RUQ pain
- Spreads from stagnant water sources
- Examination:
- Findings: Halo signs,
- Treatment: Metronidazole 10days (tastes like lead, warn patient)

Hydatid:
- Wont know why coming into hospital, feel quite well
- Spread usually from sheep
- Normal clinical exam
- Findings: Water lily signs, Daughter cysts
- Treatment: Albendazole (Causes bone marrow suppression, should always be <4), drain the lesions (LAIR),

Question 4

Explain the non-infective cysts

Answer 4

Simple cysts
Polycystic liver disease - normal liver function despite liver being overtaken by cysts
- Most commonly present with pain if not asymptomatic: Do not operate, will relieve on their own

Question 5

Explain haemangiomas

Answer 5

Most common lesionof the liver
Not pathological

Most accidental finding

Clinically symptomtic:
- Rupture and bleed: Very rare - Resuscitation
- Thrombocytopenia: Casebach something

They dont cause pain

Imaging: They are vascular

Question 6

Explain adenomas

Answer 6

Very common in women associated with oral estrogen contraceptives
Rare in men associated with anabolic steroid use

Women: Change contraceptive and adenoma will dissapear, if not they have to be excised

Man: Adenomas have to be excised

Question 7

Explain hepatocelluar carcinoma

Answer 7

Only cancer that does not need a histological report
Need classical imaging features (hypervascular in arterial phase and washed out in delayed phase) + AFP (apha feto protein) >400

Management: have to look at following 3 categories to determine
- Look at tumour staging
- Liver function: child peu score in cirrhosis patients:
- Ecog score

Question 8

When to biopsy liver tumour

Answer 8

Never - you are making a hole in the liver and that could lead to seeding of the tumour