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Y1 - Gatrointestinal > Liver Lesions > Flashcards

Liver Lesions Flashcards

1
Q

What are the types of benign hepatic tumours?

A

Haemangioma
Focal nodular hyplasia
Adenoma
Liver cysts

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2
Q

What is the most common liver tumour?

A

Haemangioma

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3
Q

What is a haemangioma?

A 
Hypervascular tumour (blood filled)
Small mass contained within capsule with clear borders
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4
Q

How does haemangioma present?

A

Asymptomatic and incidental finding

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5
Q

How does haemangioma present on imaging?

A

US - echogenic spot that is well demarcated
CT - venous enhancement from periphery to centre
MRI - high intensity area

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6
Q

What is the management for haemangiomas?

A

None

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7
Q

What is focal nodular hyperplasia?

A

Benign nodule on liver

Congenital vascular abnormality causes hyperplasia because of abnormal arterial flow

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8
Q

What is the classical description of focal nodular hyperplasia?

A

Central scar containing a large artery radiating branches to the periphery

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9
Q

How does focal nodular hyperplasia present?

A

Usually asymptomatic but may cause pain if compressing on structures

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10
Q

Who is focal nodular hyperplasia most common in?

A

Middle aged women

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11
Q

What is seen on histology in focal nodular hyperplasia?

A

Kupffer cells, bile ductules, all the liver’s ultra-structure

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12
Q

How does focal nodular hyperplasia present on imaging?

A

US - nodule with varying echogenity
CT - hypervascular mass with a central scar
MRI - iso/hypo intense
FNA - normal hepatocytes and Kupffer cells

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13
Q

What is the management for focal nodular hyperplasia?

A

None as no malignant potential

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14
Q

What is a hepatic adenoma?

A

Benign neoplasm composed of normal hepatocytes

No portal tract, central vein or bile duct involvement

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15
Q

Who is hepatic adenoma more common in?

A

Women

Associated with contraceptive pill use and anabolic steroids

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16
Q

How does hepatic adenoma present?

A

Usually asymptomatic but can be RUQ pain

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17
Q

What complications can occur in hepatic adenomas?

A

Rupture causing haemorrhage

Malignant transformation

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18
Q

How does hepatic adenoma present on imaging?

A

US - filling defect
CT - dissuse arterial enhancement
MRI - hypo-hyper intense lesion
FNA may be required

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19
Q

What is the management for hepatic adenoma?

A

Stop taking oral contraceptives/hormones/anabolic steroids
In males surgical excision irrespective of size
In females annual MRI if <5cm or reducing in size or surgical excision if >5cm or increasing in size

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20
Q

Which are more common in the liver, primary or secondary tumours?

A

Secondary

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21
Q

What is the most common primary liver tumour?

A

Hepatocellular carcinoma

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22
Q

What are the risk factors for hepatocellular carcinoma?

A

Cirrhosis
HBV, HCV
Male sex

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23
Q

What is the pathology of hepatocellular carcinomas?

A

Usually single nodule
Consists of cells resembling hepatocytes
Metastasis can be to bones, lungs, lymph nodes

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24
Q

What are the clinical features of hepatocellular carcinomas?

A 
Weight loss, malaise, fever, anorexia
Ache in RUQ
Worsening of pre-existing chronic liver disease
Ascites
Rapid progression of these
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25
Q

What are examination findings that are suggestive of hepatocellular carcinoma?

A

Signs of cirrhosis
Hard enlarged RUQ mass
Liver bruit

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26
Q

What investigations can be done for hepatocellular carcinoma?

A

Serum alpha-fetoprotein is HCC marker but is normal in 1/3 of cases
US
CT (MRI needed if <1cm)
Tumour biopsies are less frequent

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27
Q

What is the characteristic appearance of a hepatocellular carcinoma?

A

Hypervascularity of the nodule and a lack of portal vein washout

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28
Q

What scoring system is used to determine prognosis of hepatocellular carcinoma?

A

Child-Pugh score

29
Q

What is the first choice treatment for hepatocellular carcinomas, and when can this be done?

A

Resection
Small lesions with preserved liver function
No jaundice or pulmonary hypertension

30
Q

What is the second choice treatment for hepatocellular carcinomas, and when can this be done?

A

Liver transplantation

If there is one nodule <5cm or up to three, all <3cm

31
Q

What treatment is done if you can’t get liver transplant?

A

Local ablation - temporary measure

32
Q

What is TACE?

A

Transarterial chemoembolisation
Chemotherapy is selectively injected into the hepatic artery
Then an embolic agent is injected
Given to patients with early cirrhosis

33
Q

What is sorafenib?

A

Used in hepatocellular carcinoma if there are no other options
Kinase inhibitor
Gives a few extra months

34
Q

Who is fibre-lamellar carcinoma more common in?

A

Younger patients

35
Q

Which primary liver cancer is not associated with cirrhosis?

A

Fibro-lamellar carcinoma

36
Q

What investigations are done for fibre-lamellar carcinoma, and what does it show?

A

CT - stellate scar with a radial spot showing persistent enhancement

37
Q

What is the treatment for fibre-lamellar carcinoma?

A

Surgical resection or transplant if possible

TACE if not

38
Q

What is a cyst?

A

A liquid collection lined by epithelium

39
Q

What is a simple cyst?

A

A solitary cyst that doesn’t involve the biliary tree

40
Q

How do simple cysts present?

A

Usually asymptomatic but may cause RUQ pain from compression or fever if infection or rupture

41
Q

What investigation is used for simple cysts?

A

US

If any doubt follow up

42
Q

What is the treatment for simple cysts?

A

If asymptomatic then none

If symptomatic/uncertain diagnosis then surgical removal

43
Q

What is a hydatid cyst caused by?

A

The tape worm echinococcus granulosus

44
Q

Who presents with hydatid cysts?

A

Faming communities as a result of contact with livestock

45
Q

How do hydatid cysts present?

A

Often asymptomatic but can cause dull ache and swelling in right hypochondrium due to erosion into adjacent structures and vessels

46
Q

What is the investigation for hydatid cysts?

A

AXR - cyst calcificatin
US/CT - diagnostic
Anti-echinococcus antibodies

47
Q

What is a diagnostic sign of hydatid cysts?

A

The presence of daughter cysts

48
Q

What is the treatment for hydatid cysts?

A

Surgery
Albendazole to reduce size
Can be drained using PAIR

49
Q

What does PAIR stand for?

A

Puncture
Aspiration
Injection
Re-aspiration

50
Q

What is polycystic liver disease caused by?

A

Embryonic ductal plate malformation
Causes malformed bile ducts
This leads to the formation of numerous cysts throughout the liver

51
Q

What are the three types of polycystic liver disease?

A

Von Meyenburg complex
Polycystic liver disease
Autosomal dominant polycystic kidney disease

52
Q

What is von meyenburg complex?

A

Benign cystic nodules throughout the liver
Originate in the peripheral biliary tree as a result of the ductal plate malformation
Incidental finding and asymptomatic

53
Q

What is polycystic liver disease?

A

The presence of cysts in the liver
Liver function preserved and kidneys functioning normally
Symptoms depend on the size of the cyst and may cause RUQ pain and distension

54
Q

What is autosomal dominant polycystic kidney

disease?

A

Polycystic disease in the kidneys which can cause hepatic manifestation
Reduction in kidney function but liver function should be preserved
Liver maybe massively enlarged

55
Q

What is the clinical presentation of polycystic liver disease?

A

Abdominal pain
Abdominal distension
May be atypical symptoms due to many cysts compressing surrounding tissues
Liver failure if disease is very severe

56
Q

What investigation is done for polycystic liver disease?

A

Gene studies
CT
Kidney function tests

57
Q

What is the treatment for polycystic liver disease?

A

Surgery - aspiration and liver transplant only in severe disease
Somatostatin analogues to reduce liver volume and provide symptomatic relief

58
Q

What is a clue for a patient having liver abscess?

A

Dental procedure followed by clinical presenation

59
Q

What is the clinical presentation for liver abscess?

A 
High fever
Abdominal pain
Nausea and vomiting
Jaundice (+ maybe  pleural rub in right lower chest)
Malaise for several months
60
Q

What is the investigation for liver abscess?

A 
Check for leukocytosis
CXR - raised right  semi-diaphragm
US - diagnosis
CT - complex and multiple lesions
Echocardiogram
61
Q

What is the treatment for liver abscess?

A

Initial empiric broad spectrum antibiotics (amoxicillin, metronidazole, gentamycin) all IV
Aspiration/drainage
Operation if no improvement
Post-op 4 weeks of antibiotic therapy

62
Q

What is haemochromatosis?

A

Autosomal recessive inherited disease characterised by excess iron deposition in the liver and other organs

63
Q

What are the clinical features of haemochromatosis?

A

‘Bronzed diabetic’ (bronze or grey skin pigmentation, hepatomegaly, diabetes mellitus)
Cardiac arrhythmias and heart failure in younger patients
Signs of liver fibrosis or failure
Joint pain
Hypogonadism

64
Q

What are the investigations for haemochromatosis?

A

Serum iron >30 in most cases
If normal do genetic testing
LFTs often normal
MRI

65
Q

What is the management for haemochromatosis?

A

Venesecation

Avoid iron rich foods

66
Q

What is Wilson’s disease?

A

Autosomal recessive disorder leading to reduced ceruloplasmin (the major copper transporter), causing a defect in copper transporting and excretion into bile

67
Q

What are the symptoms of Wilson’s disease?

A

Kayser-Fleischer rings around eyes
Signs of liver disease
May show signs of CNS issue

68
Q

What is the investigation for Wilson’s disease?

A

Urinary copper increased

Serum copper and ceruloplasmin usually reduced

69
Q

What is the management for Wilson’s disease?

A

Penicillamine

Y1 - Gatrointestinal (31 decks)

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