wk 6 3 Focal Lesions in Liver Flashcards
solid liver lesions in elderly more likely to be
malignant
with metastases more common than primary liver cancer in the absence of liver disease
solid liver lesions in chronic liver disease is more likely to be primary liver cancer t./f
true
cirrhossi/hepB
if non cirrhotic, what is the most commmon solid liver tumour
haemangioma
other than haemangioma, what else can be benign 3
focal nodular hyperplasia
adenoma
liver cysts
haemangioma more lkely in males than females t/f
false
how is haemangioma typically diagnosed
US (echogenic spot, well demarcated)
CT - venous enhancement from periphery to center
MRI - high intense area
no need for biopsy
treatment for haemangioma
none
name given for benign nodule formation of normal liver tissue
Focal Nodular Hyperplasia (FNH)
classical clinical feature of FNH
central scar contaooning a large artery, radiatin branches to periphery
FNH is usually symptomatic, however what may be a symtpom
ab pain
FNH diagnosed through ultrasound t.f
true
benign neoplasm composed of normal hepatocytes (no portal tract, central veins or bile ducts)
Hepatic Adenoma
Hepatic adenoma is associated with contraceptive pill t/f
true
10:1 ratio female - male
hepatic adenoma diagnosed by
US (filling defect)
Ct nd MRI used also
t/f biopsy required for hepatic adenoma
true
rule out malignancy
treatment for males for hepatic adenoma
surgical excision (higher risk of malignancy) q
treatment for woman for hepatic adenoma
stop hormones, weight loss
<5 - annual MRI
>5 - surgical excision
differences between adenomaa and FNH
only hepatocytes, FNH contains all liver structre (bile ducts ect)
adenoma - may lead to malignancy
5 types of cysts
simple hydatid atypical polycystic lesion Pyogenic/ amoebic abscess
most common cyst
simple cyst
how does a simple cyst appear
liquid collection lined by epithelium
associated symptoms of simple cyst
intracystic haemorrhage
infection
rupture (rare)
compression
t/f no follo up required for simple cyst
true unless doubt (imaging 3-6months)
sympomatic - surgical
hydatid cyst is echinococcus granulosus, how is it diagnosed
history appearance
detection of anti-echinococcus antibodies
management of hydatid cyst
surgery -open cystectomy pericystectomy/lobectomy may be given albendazole drainage
define polycystic liver disease
embryonic ductal plate malformation of intrahepatic biliary tree
numerous cyts
3 typess - von meyenburg complexes, PLD, autosomal dominant poolycystic kidney disease
t/f VMC are benign cysts
true
Cystic bile duct malformations, originating from the peripheral biliary tree
PCLD more likely to cause liver failure than ADPKD
false
symptoms of PCLD
ab pain
ab distension
t/f for polcystic liver dieeases, invasive procedures are unlikely
true, only in slect with liver failure
conservative treatment to allow ab decompresion/ alleviate symptoms
which drug is given for PLD
somatostatin
clinical features of liver absces
high fever
leukocytosis
ab pain
complex liver lesion
likely to come from an ab/biliary infection or dental procedur
how is liver abscess treate
initial empiric broad spectrum antibiotics
drainage
eechocardiogram
operation if no improvement
4 weeks antibiotic therapy with repeat imagin
HCC is carcinoma of liver, risk factors of it 5
(cirrhosis from any cause) /hep B hep C alcohol aflatoxin other
clinical features of HCC
wt loss and RUQ pain
worsening/pre-existing chronic liver diease
acute liver failure
signs of cirrhosis
hard enlarged RUQ mass
liver bruit (rare)
what is AFP, what does it indicate
Alfa fetoprotein
HCC tumour marker (>100 indicates)
mri may be used for HCC t/f
true
if <1cm/ difficult to diagnose
HCC is dependant on the Child-Purgh score, broken into stage0, stage A-C and Stage D, what is each
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
TACE
trans arterial chemoembolisation
inject chemo then embolic agent, only in early cirrhosis
sorafenib is
multikinase inhibitor - reduces tumour growth
fibro-lamellar carcinoma more likely in young patients t/f
true
TACE - unresectable
surgical resection/transplant is standard
