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Gastrointestinal Conditions (JBR) > Liver Lesions > Flashcards

Liver Lesions Flashcards

1
Q

What is a hepatocellular adenoma?

A

Benign neoplasm composed of normal hepatocytes

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2
Q

Hepatocellular adenomas are more common in?

A

Females

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3
Q

Hepatocellular adenomas are associated with?

A

Contraceptive hormones and anabolic steroids

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4
Q

Hepatocellular adenomas may increase in size, and there is a risk of?

A

Rupture of bleed

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5
Q

Where are hepatocellular adenomas usually found?

A

Right lobe

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6
Q

Multiple adenomas is known as?

A

Adenomatosis

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7
Q

What is adenomatosis?

A

Rare condition associated with Glycogen storage disease

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8
Q

How do hepatocellular adenomas present?

A

Most asymptomatic
may have RUQ pain
May present with rupture, haemorrhage or malignant transformation

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9
Q

How do you investigate hepatocellular adenomas?

A

USS (filling defect)
CT (diffuse atrial enhancement)
MRI (hypo-/hyper-intense lesions)
+/- FNA

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10
Q

What does FNA stand for?

A

Fine needle aspiration

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11
Q

How do you treat hepatocellular adenomas?

A

Stop hormones
Weight loss
Males - surgical excision
Females - surgical excision if >5cm (otherwise annual imaging)

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12
Q

What is the most common primary liver cancer?

A

Hepatocellular carcinoma (HCC)?

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13
Q

HCC is associated with?

A

HBV, HCV, and cirrhosis

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14
Q

On diagnosis HCC is usually _____ unless incidental finding?

A

advanced

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15
Q

What are the histopathological types of HCC?

A

hepatocytic

Cholangiocytic

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16
Q

What are risk factors for HCC?

A

Cirrhosis of any origin

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17
Q

HCC metastasises to the?

A 
Liver
Portal vein
Lymph nodes
Lung 
Bone 
Brain
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18
Q

How does a HCC present?

A

Usually as a mass, pain, obstruction
Weight loss
Worsening pre-existing liver disease
Acute liver failure

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19
Q

What would be found on examination for HCC?

A

Signs of cirrhosis, hard enlarged RUQ

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20
Q

How do you investigate HCC?

A

AFP
USS
Triphasic CT

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21
Q

What is AFP?

A

Alfa-feroprotein

HCC tumour marker

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22
Q

How do you treat?

A 
Transplant 
Resection
Local ablation
Ethanol injection, chemoembolisation
Systemic therapies
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23
Q

What are systemic therapies for HCC?

A

Sorafenib (multikinase inhibitor - side effects common)

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24
Q

When do you chose transplant as a possible treatment option for HCC?

A

If tumour <5 cm

or more than 3 <3cm lesions

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25
Q

Fibrolamellar Carcinoma presents in?

A

Young patients

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26
Q

Fibrolamellar carcinoma is not related to?

A

Cirrhosis

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27
Q

In fibrolamellar carcinoma the AFP is?

A

Normal

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28
Q

What does the CT show for fibrolamellar carcinoma?

A

typical stellate scar with radial septa showing persistent enhancement

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29
Q

What is the standard care for fibrolamellar carcinoma?

A

Surgical resection

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30
Q

If un-resectable how do you treat fibrolamellar carcinoma?

A

TACT (trans arterial chemoembolisation)

31
Q

What is a hepatoblastoma?

A

Rare malignant liver cancer occurring in infants and children

32
Q

A hepatoblastoma is composed of?

A

Tissue resembling foetal liver cells

33
Q

Hepatoblastoma presents with?

A

Abdominal mass and increased AFP

34
Q

What is a haemangioma?

A

Commonest benign liver tumour of mesenchymal origin

35
Q

What do haemangiomas looks like?

A

Usually small

Well distinguished capsule

36
Q

Haemangiomas have a risk of?

A

Malignant degeneration

37
Q

How does a haemangioma present?

A

Asymptomatic

38
Q

How do you investigate haemangiomas?

A

US
CT
MRI
Nuclear colloid scna

39
Q

What is seen on USS for haemangioma?

A

Echogenic spot, well demarcated

40
Q

What is seen on CT for heamangioma?

A

venous enhancement from periphery to centre

41
Q

What is seen on MRi for haemangioma?

A

High intense area

42
Q

What is seen on nuclear colloid scan for haemangioma?

A

Cold

43
Q

How do you treat a haemangioma?

A

usually not needed
?radiological follow up
Resection if it causes any problems

44
Q

What is focal nodular hyperplasia?

A

Benign nodular formation of normal liver tissue

45
Q

Focal nodular hyperplasia is believed to be in response to?

A

Underlying congenital atriovenous malformation causing a hpyerplastic response to abnormal blood flow

46
Q

Focal nodular hyperplasia is more common in?

A

Young-middle aged women

47
Q

What is seen on histology for focal nodular hyperplasia?

A

Sinusoids
Bile ductules
Kupffer cells with a central core

48
Q

Focal nodular hyperplasia has ____ malignant risk

A

no

49
Q

How does focal nodular hyperplasia present?

A

typically asymptomatic

may cause minimal pain

50
Q

How do you investigate focal nodular hyperplasia?

A 
US
CT
MRI
FNA 
Sulfur colloid scna
51
Q

What is seen on US for Focal nodular hyperplasia?

A

Nodule with varying echogenicity

52
Q

What is seen on CT for Focal nodular hyperplasia?

A

Hypervascular mass with central scar

53
Q

What is seen on MRI for focal nodular hyperplasia?

A

Iso/hypo intense)

54
Q

What is seen on FNA for focal nodular hyperplasia?

A

Normal hepatocytes + Kupffer cells with central core

55
Q

What is seen on sulfur colloid scan for focal nodular hyperplasia?

A

Isotense

56
Q

How do you treat focal nodular hyperplasia?

A

Treatment not needed

57
Q

What is a simple cystic lesion?

A

Liquid collection lined by epithelium without any biliary tree communication (solitary and uniloculated (single) sac)

58
Q

How does a simple cystic lesion present?

A

usually asymptomatic

Can be related to intracystic haemorrhage, infection, rupture (rare), compression

59
Q

How do you treat a simple cystic lesion?

A

No follow up

Symptomatic/uncertain - consider surgery

60
Q

What causes a Hydatic cyst?

A

parasitic infection tapeworm - Echinocus granuloso)

61
Q

Where is Echinocus granuloso endemic?

A 
Eastern Europe
CA
SA
ME
North Africa
62
Q

patients with hydatid cysts may present with?

A

Disseminated disease or erosion of cysts into adjacent structures and vessels

63
Q

How do you investigate hydatid cysts?

A

Serology to detect anti-echinoccus antibodies

64
Q

How do you treat Hydatid cysts?

A

Surgery

Medical: albendazole or percutaneous drainage

65
Q

What causes polycystic liver disease?

A

Embryonic ductal plate malformation of intrahepatic biliary tree

66
Q

In PCLD the liver function is _____ and renal failure is?

A

preserved

rare

67
Q

What are clinical features of PCLD?

A

Abdominal pain and distension

Atypical symptoms due to voluminous cyst resulting in compression of adjacent tissue or failure of affected organ

68
Q

Clinical features of PCLD are dependent on?

A

Size of cyst

69
Q

How do you treat PCLD?

A

Conservative
Rarely invasive procedures required (only in advanced)
Somatostatin analogues (symptom relief and liver volume reduction

70
Q

What is a liver abscess?

A

Pus-filled mass

71
Q

What are clinical features of liver abscesses?

A 
High fever (continuous or swinging) 
Abdominal pain
History of abdominal biliary infection, dental procedure
72
Q

How do you investigate liver abscesses?

A

Increased WCC
Complex liver lesion
ECHo

73
Q

How do you manage liver abscesses?

A

Broad-spectrum antibiotics (4 weeks with repeat imaging)
Aspiration drainage percutaneously
Surgery if no improvement (open drainage/resection)

Gastrointestinal Conditions (JBR) (33 decks)

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