liver masses Flashcards
Most common benign liver tumor,Hemartomatous outgrowths of endothelium; some express estrogen receptors so accelerated growth is associated with high estrogen states
Cavernous Hemangiomas
how do u diagnose cavernous hemangiomas
Biopsy is contraindicated because of the risk of hemorrhage
• CT and MRI are specific. On contrast CT, hepatic hemangiomas have a characteristic pattern of enhancement, with early peripheral nodular
enhancement, followed by centripetal filling in of the lesion on delayed phases.
Histologically the lesion is composed of abnormal vessels, and cholangial proliferation. normal hepatocytes. Bile ductules are usually found. Kupffer cells
are present.
Focal nodular hyperplasia
Imaging: CT in focak nidular hyperplasia
bright homogeneous arterial contrast enhancement
except for the central scar which remains hypoattenuating
Hormone induced benign liver tumor
Hepatocellular adenoma
risk factors of Hepatocellular adenoma:
OCP and anabolic steroid use
what type of benign tumor where MRI is the best
Hepatocellular adenoma
Histologically, hepatocytes without normal lobular architecture. They are traditionally described as being devoid of bile ducts and Kupffer cells.
Hepatocellular adenoma
where is most common site of mestasis in HEPATOCELLULAR CARCINOMA
lungs
risk factors of HEPATOCELLULAR CARCINOMA
HBV, HCV, cirrhosis, aflatoxins (in peanuts), hemochromatosis, AAT, anabolic steroids, liver flukes, carbon tetrachloride.
diagnosis in HCC
Abnormal LFTs and tumor markers (α-fetoprotein)
tx of hepatocellular adenoma depend on size
o Small <5cm = follow up with imaging; cessation of OCP/steroids
o Large > 5 cm =surgical resection
Histology: degeneration of bile duct epithelium and diffuse infiltration of portal tracts with periductal concentric fibrosis (onion skin appearance)
PRIMARY SCLEROSING CHOLANGITIS
what causes destruction of both intra and extrahepatic bile ducts, 75% of patients have inflammatory bowel disease (usually UC), and Associated with HLA-A1-B8-DR3.
PRIMARY SCLEROSING CHOLANGITIS
what is the antibody in PSC
60% of patients have pANCA antibodies
• 70% of patients are men and average age is 40 years
diagnosis of PSC
High serum ALP, GGT, bilirubin
Chronic disorder w/ progressive destruction of small bile ducts (intrahepatic) leading to cirrhosis.
PRIMARY BILIARY CHOLANGITIS (PBC)
PRIMARY BILIARY CHOLANGITIS (PBC) affects who mostly
Most commonly (90%) affects women aged 40-50 years old; usually in association with other autoimmune disorders ex: SS/RA.
Why Does PBC Happen? (The Root Cause)
• Autoimmune attack → The immune system targets the small bile ducts.
• Bile can’t flow properly, leading to bile acid buildup, which damages liver cells.
• Over time, this leads to scarring (fibrosis) and cirrhosis (severe liver damage).
How is PBC Diagnosed?
- Liver Function Tests (LFTs)
• High Alkaline Phosphatase (ALP) → Most important marker
• High Gamma-GT (GGT), AST, ALT - Anti-Mitochondrial Antibody (AMA) – Key Test
• Positive in 95% of PBC patients → Confirms autoimmune cause - Liver Biopsy (Sometimes Needed)
• Shows bile duct inflammation and scarring
tx of pbc
- Ursodeoxycholic Acid (UDCA) – First-Line Treatment
• Improves bile flow, slows disease progression - Obeticholic Acid (OCA) – For Patients Who Don’t Respond to UDCA
• Helps reduce bile buildup in the liver - Symptom Management
• Itching (Pruritus): Cholestyramine, Rifampin, Antihistamines
what is shown in MRCP in PSC
MRCP (Magnetic Resonance Cholangiopancreatography) shows bile duct strictures (“beaded appearance”)
PSC or PBC have high chance of cancer
PBC has a better prognosis; PSC has a higher risk of bile duct cancer.
INTRAHEPATIC CHOLESTASIS OF PREGNANCY
generally seen in the third trimester.
• Most common liver disease of pregnancy.
• Presents as pruritus, often in the palms and soles, and no rash (although skin changes may be seen due to scratching) • Raised bilirubin
• Complications: increased rate of stillbirth; not generally associated with increased maternal morbidity
