Liver nodule Flashcards
incidental liver nodule <1 cm - what to do?
repeat ultrasound at 3 months
Incidental liver nodule >1 cm
4 phase MDCT or MRI with contrast
What are suspicious features on advanced imaging (CT or MRI) of an >1 cm liver nodule?
arterial hypervascularity AND venous delayed phase washout
What to do after positive CT or MRI findings?
biopsy
HCC surveillance
U/S q6m and AFB not routinely checked due to high false positive rates
Is there risk for bleeding and tumor seeding via needle track with percutaneous liver biopsy?
Yes and only recommended when initial imaging study is not clear diagnosis
what is sorafenib?
oral tyrosine kinase and vascular endothelial growth factor used to tx advanced and unresectable HCC and advanced RCC.
pyogenic liver abscess management
meropenem
surgical intervention if abscess is >5 cm or larger, complex abscesses, presence of gas forming organisms, hemodynamic instability, biliary fistulization presenceof a foreign body.
asymptomatic liver hepatic adenoma smaller than 5 cm needs to
stop OCP
follow up imaging for every 6 months for two years
heptocellular adenomas are associated with women because
dependent on estrogen for growth
heptocellular adenomas in men can have
higher risk for malignant transformation
- seen with anabolic steroid use, obesity and metabolic syndrome
solitary and range from 1 to 30 cm long
most are asymptomatic
hepatic adenomas can increase in size due to
estrogen
pregnancy.
if there is one >2cm in female who is pregnant or getting pregnant can treat with radiofrequency ablation
surgical resection for hepatic adenoma is for those who:
symptomatic - abdominal pain
adenomas >5 cm
adenoma in a male
failure to regress after stopping OCP
may need to check alpha feto protein
