Liver Neoplasm, Abscesses and Cysts Flashcards
What is the most common liver neoplasm?
Metastatic disease.
Most common primary liver neoplasm is hepatocellular carcinoma.
In 75% of cases neoplasms are multifocal.
List risk factors for the development of primary hepatocellular carcinoma?
90-95% of those that develop hepatocellular carcinoma have cirrhosis.
Hepatitis B and C are important and independent risk factors.
Hepatitis C also causes cirrhosis.
Other causes of cirrhosis are:
Alcoholism.
Genetic haemochromatosis.
Primary biliary cirrhosis.
Describe the presentation of hepatocellular carcinoma?
Usually presents with signs of worsening liver failure:
Jaundice + Pruritus. Hepato splenomegaly. Bleeding oesophageal varices. Weight loss. Confusion and hepatic encephalopathy. Abdominal distension due to ascites. Right upper quadrant abdominal pain.
What are the common primary sites for metastatic tumour to the liver?
Most common: Gastrointestinal via the portal tract: Colorectal Stomach Oesophagus Pancreas
Breast
Lung
Skin
Genitourinary:
Ovaries
Uterus
Renal
Describe the potential management plan of liver neoplasms?
In cirrhotic livers with HCC a handful of patients are suitable for transplantation.
In a non cirrhotic liver tumour resection is the treatment of choice, producing similar survival rates to transplantation.
Image-guided tumour ablation is now a standard treatment option for patients with early-stage HCC. This utilises high radiofrequency US which induces tumour necrosis.
HCC’s are relatively chemoresistant but focussed chemothrapy can be used (chemoembolisation).
This is the delivery of high concentrations of chemotherapy drugs directly to the tumour via the hepatic artery, using embolising agents such as cellulose.
Describe the different cysts which can occur in the liver and what is there clinical significance?
Simple cyst: pathophysiologically they are thought to be congenital. They are of no clinical significance and are often found incidentally.
Polycystic liver disease: genetic disease usually associated with mutations of polycystic kidney disease. Similar to PKD cysts form in the liver. They may cause deranged LFTs and occasionally become infected however they rarely cause liver failure. They are only treated if symptomatic.
Neoplastic cysts: cystoadenomas (pre malignant) and cystoadenocarcinomas (malignant).
How do neoplastic hepatic cysts present?
Vague symptoms including bloating, nausea and fullness can occur. Abdominal pain and biliary obstruction can result as they enlarge.
Treatment is with resection.
What are the common causes of liver abscesses?
Liver abscesses are caused by bacterial, parasitic, or fungal organisms.
In developed countries bacterial infection is the most common cause however worldwide the most common cause is amoeba.
Most are secondary to infection originating in the abdomen:
- cholangitis
- diverticulitis
- appendicitis
- Crohn’s disease
- perforated peptic ulcer
It is more common in immunocompromised patients and those with underlying cirrhosis.
How do liver abscesses present?
Multiple abscesses tend to present more acutely and single ones more indolently.
Liver symptoms:
Right upper quadrant pain, tenderness, hepatomegaly, possible palpable mass.
Generalised infective symptoms: Swinging fever. Night sweats. Nausea and vomiting. Anorexia and weight loss.
How are liver abscesses treated?
US/CT guided drainage of the abscess + abx.
A third generation cephalosporin (ceftriaxone) + an anti-amoebic (metronidazole)
