Liver Lesions Flashcards
What are 3 primary, benign liver lesions?
Hemangioma
Focal nodular Hyperplasia (FNH)
Adenoma
What are 2 maligant liver lesions?
o Hepatocellular Carcinoma (HCC) o Cholangiocarcinoma (CCA)
- Oral contraceptives increase chance of:
- A history of extrahepatic malignancy increase chance of:
Hepatic adenoma
Metastatic disease
Pt with Underlying liver disease is more at risk for:
• History of primary sclerosing cholangitis (PSC) puts you at risk for:
Hepatocellular carcinoma (except Hep B can go right to this)
Cholangiocarcinoma (CCA)
Pt with Non-cirrhotic liver has liver cancer, most likely caused by what?
What if they did have cirrhotic liver?
most likley mets from :GI, LUng, UG, breast
IF cirrhotic liver and cancer 77% its liver cancer
• The most common benign liver lesion
(1% of all autopsies)
• FOUND IN NON-CIRRHOTIC LIVER
NO maligant potential
Hemangioma
When do we see pts with hemangiomas?
- Majority diagnosed in third to fifth decade
- Can range from 1-20 cm (> 10 cm = giant hemangiomas)
Congenital vascular malformations (blood-filled cavities lined by endothelium)
Hemangioma
You see a central stellate scar on a liver, Dx?
Focal nodular hyperplasia
• Second most common benign liver lesion
(Found in 0.3 to 0.6% of all autopsies)
• FOUND IN NON-CIRRHOTIC LIVER
• A reaction to intrahepatic anomolous artery leading to
hyperperfusion
Focal nodular hyperplasia
Who do we see focal nodular hyperplaisa in and where is it located?
- Women between ages of 20 and 50
- Majority < 5cm (rarely exceeds 10 cm)
- Can be multiple in 10%-20% of cases
- NO MALIGNANT POTENTIAL
What do hemangiomas and focal nodular hyperplasia have in common?
both benign with no malignant hyperplasia
- Third most common benign liver lesion
- FOUND IN NON-CIRRHOTIC LIVER
- Benign proliferation of hepatocytes
Hepatic Adenoma
How is hepatic adenoma different and simular to focal nodular hyperplasia and hemangioma?
All three are benign and non-malignant while hepatic andenoma has ability for malignant transformation
What proliferates in hepatic adenoma?
hepatocytes
- Majority in women of childbearing age
- Associated with contraceptives use
- Usually asymptomatic
Hepatic adenoma
• Unlike hemangiomas and FNH, there is a risk
of HEMORRHAGE and MALIGNANT TRANSFORMATION
Growth and rupture of adenoma can occur during
pregnancy
Hepatic adenoma
Treatement for hepatic adenoma
• Treatment
Contraceptives should be discontinued
Avoid pregnancy
Surgical resection is recommended to avoid the risk of cancer and tumor rupture.
What trends are we seeing with HCC?
Fastest growthing death rate in the US, survival rates are better then they used to be but still pretty bad with survial of 12%; Dt HIV and HCV in the 70/80s are now getting maligant tranformaiton
RAtes of Viral hepatits in the US
HCV and HBV are big cuase of HCC
- HBV most frequent in Asians
- HCV most frequent in nonAsians
What happens to the blood flow pattern in HCC? How can we use this knowledge to Dx HCC?
See decreaesed portal flow and increased arterial flow from hepatic artery
this allows us to target the cancer
Can see HCC in the “Washout” during venous phase
• Produced by fetal liver and placenta
• Elevated in 60%-70% of patients with HCC
can be elevated with hepatic inflammation in the absence of HCC
can be elevated in cirrhosis in the absence of HCC
Alpha Fetoprotein (AFP)
Can AFP levels give us dx of HCC?
NO! can be elevated with hepatic inflammation in abscence of HCC like in cirrhosis
Values greater than 200 ng/ml in conjunction
with liver lesion on imaging is consistent with
HCC
How to prevent HCC
- HBV vaccination
- Treatment of viral hepatitis
- ? Coffee
During pregancy, hematocrit, serum urea, uric acid,
albumin, total protein will:
all decrease, substances become diluted
Spiders, plamar erythema, decreased GB contractility (increase stone risk) is seen in:
Pregancy and liver disease
What happens to ALK Phos levels when you are pregnant?
They will increase (from placenta)
Pt is in 1st trimester of pregancy and your pt have continous vomitting adn is severely dehydrated. Her ALT is 3x normal. what could be cause?
HYPEREMESIS GRAVIDARUM
rare; tx symtpoms with fluids and antiemetics
Pt is 7 months along with her 2nd child and has horrible itching that keeps her up at night. Your preceptor suspcects somehting is going on with her liver, what would your Dx be?
Intrahepatic cholestatis of pregancy (IHCP)
uncommon overall
more in 3rd trimester
increase risk for prematurity or perinatal death
You have a pt with Intrahepatic Cholestatis of Pregancy, what would you suspect her labs to be
bilirubin
AST/ALT
serum bile acids
jaundice in 25%, up to 4-fold AST/ALT
increase, serum bile acids increased 30 to 100- fold
Have a pregant pt with the following labs:
jaundice in 25%, up to 4-fold AST/ALT
increase, serum bile acids increased 30 to 100-
fold
IHCP
How do you tx pt with IHCP
cholestyramine-binds bile acids
ursodeoxycholic acid which modifies bile acid
pool, inhibits absorption of more hydrophobic bile
acids
How does cholestyramine work?
Ursodeoxycholic acid:
binds bile acids
modifies bile acid pool, inhibits absorption of more hydrophobic bile acids
PREECLAMPSIA
• Usually occur after ___weeks
• Preeclampsia:
5-7% of pregnancies
AST and ALT elevation ___%
20
hypertension, proteinuria,edema
25-50%
• Eclampsia: preeclampsia + seizures
0.1-0.2% of pregnancies
AST and ALT elevations in____
80-90%
***• Delivery if near term
What is a common overlap between Pre-eclampsia and AFLP?
HELLP
ACUTE FATTY LIVER OF PREGNANCY
(AFLP)
•____ trimester, 1 in 7000-15,000 pregnancies
• Preeclampsia occurs in _____
Third
20-40% of AFLP
• Etiology of Acute fatty liver pregancy:
fatty acid oxidation defects in____
_____: long-chain 3-hydroxyacyl coenzyme
dehydrogenase deficiency in a fetus with a heterozygous mother
Leads to fatty liver in mother
fetus
LCHAD
How can you tell if mom has mild or severe AFLD?
- Mild: liver test abnormalities
- Severe: jaundice, coagulopathy and encephalopathy
- Urgent delivery indicated
What does HELLP syndrome stand for?
• Hemolytic anemia
- *E**levated Liver tests
- L**ow Platelets
Cause or associatesions of HELLP syndrome
• Unclear etiology
• 0.2-0.6 of pregnancies
4-12% of women with preeclampsia/eclampsia
• Urgent delivery indicated
