Liver Neoplasms, Abscess & Cysts Flashcards
What are the three main routes of bacterial infection of the liver?
Ascending spread from cholangitis
Portal spread from abdominal sepsis
Systemic bloodstream spread in septicaemia
What are the three main types of liver abscess?
Pyogenic liver abscess
Amoebic abscess
Hyadit cyst
What are the causes of a pyogenic liver abscess?
Ascending spread -appendicitis -perforation Biliary sepsis Trauma Bacteraemia
What are the most common causative organisms of a pyogenic liver abscess?
E. coli
Strep milleri
Anaerobes
How do patients with a pyogenic liver abscess present?
Long history of malaise but few sx OR Acutely unwell -abdominal sepsis -tender hepatomegaly -right sided pleural effusion
What investigations are appropriate in suspected pyogenic liver abscess?
USS/CT
CXR
What are the management options for a pyogenic liver abscess?
Aspiration under USS guidance
IV antibiotics
Treat underlying cause
What are the causes of an amoebic abscess?
Travel often implicated
Faecal-oral spread of entamoeba histolytica
How do patients w/ an amoebic abscess present?
Acute presentation -asymptomatic OR -profuse/bloody diarrhoea Coalescing microabscesses -swinging high fever -RUQ pain -tenderness
What investigations are appropriate in suspected amoebic abscess?
Stool microscopy
USS/CT
What are the management options for an amoebic abscess?
Metronidazole for 5/7
USS drainage
What are the causes of a hyatid cyst?
Echinococcus granulosus (dog tapeworm)
How do patients w/ a hyatid cyst present?
Asymptomatic OR
Dull ache in RUQ
What investigations are appropriate in suspected hyatid cyst?
Hyatid complement fixation test
AXR
USS/CT
What are the management options for a hyatid cyst?
Albendazole
FNA under USS guidance
What is the most common type of liver neoplasm?
90% 2o mets
What are the common 1o sites of liver mets?
Lung Stomach Colon Breast Uterus
How are 2o liver mets managed?
Investigation to find 1o
Treatment/prognosis vary w/ type of 1o
What is the underlying pathophysiology of hepatocellular carcinoma?
Malignant tumour of hepatocytes
-90% of liver 1o
Common in China/Sub-Saharan Africa
More common in males
What are the causes of hepatocellular carcinoma?
Chronic hepatitis Cirrhosis Metabolic liver disease Aspergillus alfatoxin Parasites Anabolic steroids
What are the presenting sx of hepatocellular carcinoma?
Non-specific fever
Wt loss
Malaise
RUQ pain
What are the presenting signs of hepatocellular carcinoma?
Hepatomegaly (smooth/hard & irregular)
Signs of chronic liver disease/decompensatino
Abdo mass/bruit over liver
Jaundice (late sign c.f. cholangiocarcinoma)
What are the appropriate investigations in suspected hepatocellular carcinoma?
Bloods - FBC, LFTs, clotting, hepatitis serology, AFP
USS/CT
MRI
ERCP/biopsy (?cholangiocarcinoma)
What are the management options for hepatocellular carcinoma?
Surgery -if solitary HCCs <3cm -high risk of recurrence Transplantation -if small tumours due to cirrhosis
