wk 6 3 Focal Lesions in Liver

Question 1

solid liver lesions in elderly more likely to be

Answer 1

malignant

with metastases more common than primary liver cancer in the absence of liver disease

Question 2

solid liver lesions in chronic liver disease is more likely to be primary liver cancer t./f

Answer 2

true

cirrhossi/hepB

Question 3

if non cirrhotic, what is the most commmon solid liver tumour

Answer 3

haemangioma

Question 4

other than haemangioma, what else can be benign 3

Answer 4

focal nodular hyperplasia
adenoma
liver cysts

Question 5

haemangioma more lkely in males than females t/f

Answer 5

false

Question 6

how is haemangioma typically diagnosed

Answer 6

US (echogenic spot, well demarcated)
CT - venous enhancement from periphery to center
MRI - high intense area
no need for biopsy

Question 7

treatment for haemangioma

Answer 7

none

Question 8

name given for benign nodule formation of normal liver tissue

Answer 8

Focal Nodular Hyperplasia (FNH)

Question 9

classical clinical feature of FNH

Answer 9

central scar contaooning a large artery, radiatin branches to periphery

Question 10

FNH is usually symptomatic, however what may be a symtpom

Answer 10

ab pain

Question 11

FNH diagnosed through ultrasound t.f

Answer 11

true

Question 12

benign neoplasm composed of normal hepatocytes (no portal tract, central veins or bile ducts)

Answer 12

Hepatic Adenoma

Question 13

Hepatic adenoma is associated with contraceptive pill t/f

Answer 13

true

10:1 ratio female - male

Question 14

hepatic adenoma diagnosed by

Answer 14

US (filling defect)

Ct nd MRI used also

Question 15

t/f biopsy required for hepatic adenoma

Answer 15

true

rule out malignancy

Question 16

treatment for males for hepatic adenoma

Answer 16

surgical excision (higher risk of malignancy) 
q

Question 17

treatment for woman for hepatic adenoma

Answer 17

stop hormones, weight loss
<5 - annual MRI
>5 - surgical excision

Question 18

differences between adenomaa and FNH

Answer 18

only hepatocytes, FNH contains all liver structre (bile ducts ect)
adenoma - may lead to malignancy

Question 19

5 types of cysts

Answer 19

simple 
hydatid 
atypical 
polycystic lesion 
Pyogenic/ amoebic abscess

Question 20

most common cyst

Answer 20

simple cyst

Question 21

how does a simple cyst appear

Answer 21

liquid collection lined by epithelium

Question 22

associated symptoms of simple cyst

Answer 22

intracystic haemorrhage
infection
rupture (rare)
compression

Question 23

t/f no follo up required for simple cyst

Answer 23

true unless doubt (imaging 3-6months)

sympomatic - surgical

Question 24

hydatid cyst is echinococcus granulosus, how is it diagnosed

Answer 24

history appearance

detection of anti-echinococcus antibodies

Question 25

management of hydatid cyst

Answer 25

surgery 
-open cystectomy
pericystectomy/lobectomy 
may be given albendazole
drainage

Question 26

define polycystic liver disease

Answer 26

embryonic ductal plate malformation of intrahepatic biliary tree
numerous cyts
3 typess - von meyenburg complexes, PLD, autosomal dominant poolycystic kidney disease

Question 27

t/f VMC are benign cysts

Answer 27

true

Cystic bile duct malformations, originating from the peripheral biliary tree

Question 28

PCLD more likely to cause liver failure than ADPKD

Answer 28

false

Question 29

symptoms of PCLD

Answer 29

ab pain

ab distension

Question 30

t/f for polcystic liver dieeases, invasive procedures are unlikely

Answer 30

true, only in slect with liver failure

conservative treatment to allow ab decompresion/ alleviate symptoms

Question 31

which drug is given for PLD

Answer 31

somatostatin

Question 32

clinical features of liver absces

Answer 32

high fever
leukocytosis
ab pain
complex liver lesion

likely to come from an ab/biliary infection or dental procedur

Question 33

how is liver abscess treate

Answer 33

initial empiric broad spectrum antibiotics
drainage
eechocardiogram
operation if no improvement
4 weeks antibiotic therapy with repeat imagin

Question 34

HCC is carcinoma of liver, risk factors of it 5

Answer 34

(cirrhosis from any cause) 
/hep B
hep C
alcohol 
aflatoxin
other

Question 35

clinical features of HCC

Answer 35

wt loss and RUQ pain
worsening/pre-existing chronic liver diease
acute liver failure

signs of cirrhosis
hard enlarged RUQ mass
liver bruit (rare)

Question 36

what is AFP, what does it indicate

Answer 36

Alfa fetoprotein

HCC tumour marker (>100 indicates)

Question 37

mri may be used for HCC t/f

Answer 37

true

if <1cm/ difficult to diagnose

Question 38

HCC is dependant on the Child-Purgh score, broken into stage0, stage A-C and Stage D, what is each

Answer 38

0 - very early, single tumour <2cm, resection if portal pressure is normal

A - single tumour/3nodules, <3cm, management depends on underlying liver disease
B - multinodular - transarterial chemoemolisation reqd

C - advanced, portal invasion (N1,M1)
sorafenib used

D - symptomatic treatment

Question 39

TACE

Answer 39

trans arterial chemoembolisation

inject chemo then embolic agent, only in early cirrhosis

Question 40

sorafenib is

Answer 40

multikinase inhibitor - reduces tumour growth

Question 41

fibro-lamellar carcinoma more likely in young patients t/f

Answer 41

true
TACE - unresectable
surgical resection/transplant is standard