Liver Lesions Flashcards
Which lesions in the liver are benign?
- Haemangioma
- Focal nodular hyperplasia
- Adenoma
- Liver cysts
Which lesions, found in the liver, may be malignant?
- Primary liver cancers e.g. hepatocellular carcinoma
- Metastases
What is the most common liver tumour?
Haemangioma
This is benign
Which gender is affected more often by haemangioma?
Females
How may a haemangioma be diagnosed and what is suitable treatment?
- Ultrasound
- CT
- MRI
No treatment needed
What is focal nodular hyperplasia?
Formation of benign nodes in the liver
Which symptoms are associated with focal nodular hyperplasia?
It is usually an asymptomatic condition
However, minimal pain may be present
Focal nodular hyperplasia is a malignant condition
True or false?
False
It is benign
How is focal nodular hyperplasia diagnosed?
- Ultrasound
- CT
- MRI
- Fine needle aspiration (for cells)
This is a benign condition
What is the treatment for focal nodular hyperplasia?
No treatment
It is a benign condition
Hepatic adenoma is a benign condition, but where may pain be felt?
RUQ
Hepatic adenoma is associated with what?
Contraceptive hormones and anabolic steroids
In patients with hepatic adenoma, how does the treatment vary between males and females?
Males - always surgically removed regardless of size - males have a higher risk of the tumour becoming malignant
Females - if it is <5cm it is not removed, if it is >5cm or increasing in size it is surgically removed
What causes hyatid cysts?
Tapeworms
How is a diagnosis of an hyatid cyst made?
History
Appearance
Serological testing - presence of anti-Echinococcus antibodies (antibodies against the worm)
Which medication is used for patients with hyatid cysts?
Albendazole
(used for many parasitic infections)
As well as albendazole, what other treatment options are available for patients with hyatid cysts?
- Surgery
- Percutaneous drainage
What are the three types of polycystic liver disease?
- Von Meyenburg complexes (VMC)
- Polycystic liver disease
- Autosomal dominant polycystic kidney disease
Which type of polycystic liver disease causes a potentially massive hepatic enlargement?
Autosomal dominant polycystic kidney disease
Which clinical findings would be present for a liver abscess?
- High fever
- Leukocytosis (high WCC)
- Abdominal pain
- Complex liver lesion
A dental procedure may lead to which benign liver condition?
Liver abscess
How can a liver abscess be managed and treated?
Broad spectrum antibiotics initially
Aspiration or drainage
ECG
Operation
4 week antibiotic therapy with repeat imaging to assess progress
What is the most common primary liver cancer?
Hepatocellular carcinoma
What are the risk factors for hepatocellular carcinoma?
Cirrhosis from any cause e.g.
- Hep B/C
- Alcohol
- Aflatoxin
- Others
What are the signs of hepatocellular carcinoma?
Weight loss
RUQ pain
Acute liver failure
Cirrhosis
Hard RUQ mass
Liver bruit (rare)
In order to diagnose hepatocellular carcinoma which is the modality of choice and why?
Imaging
Small lesions may not elevate AFP
In terms of diagnosing hepatocellular carcinoma, AFP elevation is not enough alone, what else is required?
Imaging modality technique
US, CT, MRI
What is the best treatment available for hepatocellular carcinoma?
Liver transplantation
Only done when tumour <5cm or less than 3 tumours <3cm each
When would resection be a viable treatment option for hepatocellular carcinoma?
When there are small tumours and preserve liver function
Reccurence rate is high
When would local ablation be used for patients with hepatocellular carcinoma?
When patients cannot undergo surgery
This is merely palliative and not curative
What is the most common site for blood borne metastases?
Liver
Besides hepatocellular carinoma, what other types of malignant lesions can affect the liver?
- Fibrolamellar carcinoma - young age, no relation to cirrhosis
- Hepatoblastoma
