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Flashcards in Liver Lesions Deck (24)
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1
Q

What types of Primary Liver Lesions are benign? malignant?

A
  • Benign
    • Hemangioma
    • Focal Nodular Hyperplasia (FNH)
    • Adenoma
  • Malignant
    • Hepatocellular Carcinoma (HCC)
    • Cholangiocarcinoma (CCA)
2
Q

What do the following history findings suggest in terms of the type of liver lesion?

Oral contraceptives:

A history of extrahepatic malignancy:

Underlying liver disease:

History of primary sclerosing cholangitis:

A
  • Oral contraceptives:
    • Hepatic adenoma
  • A history of extrahepatic malignancy:
    • Metastatic disease
  • Underlying liver disease:
    • Hepatocellular carcinoma
  • History of primary sclerosing cholangitis:
    • Cholangiocarcinoma
3
Q

Most lesions in non-cirrhotic livers originate from which two organs?

A

The GI tract (45%) and the lungs (24%)

4
Q

77% of lesions in a cirrhotic liver are due to…

A

Hepatocellular carcinoma

5
Q

How does a hemangioma (normally painless) lead to pain?

A

Glissm’s capsule surrounds the liver and has nerve endings

Expansion of liver and subsequent stretch of the capsule leads to pain and is an indication for surgery

6
Q

What is the most common benign liver lesion and what type of liver is it associated with (Cirrhotic/Non-cirrhotic)?

A

Hemangioma found in Non-cirrhotic liver

7
Q
  • What is a hemangioma?
  • Age of diagnosis?
  • Range in size and number?
  • Malignant potential?
A
  • What is a hemangioma?: congenital vascular malformations
  • Age of diagnosis: third to fifth decade
  • Range in size and number: 1-20cm (multiple in 30%)
  • Malignant potential: None
8
Q

What is the second most common benign liver lesion and what type of liver is associated with it?

A

Focal Nodular Hyperplasia in Non-cirrhotic livers

9
Q

What is a Focal Nodular Hyperplasia?
Gender and age and of diagnosis?
Range in size and number?
Malignant potential?

A
  • What is a FCH: A reaction to intrahepatic amolous artery leading to hyperperfusion
  • Gender and age and of diagnosis: Women (20-50yrs)
  • Range in size and number: <5cm (Rarely > 10cm)
  • Malignant potential: None
10
Q

What is the third most common benign liver lesion what type of liver is it associated with?

A

Hepatic adenoma found in non-cirrhotic liver

11
Q

Hepatic adenoma is a proliferation of ______

What other disorders is it associated with?

A

Hepatic adenoma is a proliferation of hepatocytes

  • Associated with contraceptive use
  • Multiple adenomas also seen with
    • Glycogen storage disease
    • Diabete Mellitus
12
Q

In what population are hepatic adenomas usually found?

What are its symptoms?

A

Majority in women of childbearing age

Usually asymptomatic

13
Q

Hepatic adenoma differs from hemangiomas and FNH because there its risk for _______ and _________ ________

A

Hepatic adenoma differs from hemangiomas and FNH because there its risk for Hemorrhage and Malignant Transformation

14
Q

What treatment is used for Hepatic Adenoma?

A
  • Contraceptives should be discontinued
  • Avoid pregnancy
  • Surgical resection is recommended to avoid the risk of cancer and tumor rupture
15
Q

What is the leading cause of hepatocellular carcinoma worldwide? In the US?

A

Worldwide: Hepatitis B

US: Hepatitis C cirrhosis

16
Q

What is the most rapidly rising carcinoma in the US?

A

Hepatocellular carcinoma

17
Q

Why is there an recent increase in prevalence of HCV infection?

A

Patients who were infected 20 years ago (before current treatment capabilities) are now starting to have cirrhosis so levels appear to be increasing

18
Q

What is the most frequent cause of HCC in non-Asians?

In Asians?

A

HCV

HBV

19
Q

What happens to arterial flow and portal blood flow as HCC progresses?

A

Portal blood flow decreases and Arterial blood flow increases

20
Q

What is “washout” in a radiograph of HCC?

A

Contrast in the radiograph will show early arterial enhancement followed by “washout” of venous flow (decreased presence of contrast)

21
Q

What protein is elevated in 60%-70% of patients with HCC?

A

Alpha Fetoprotein (AFP) - normally produced by the fetal liver and the placenta

22
Q

AFP levels greater than _____ ng/ml in conjunction with ______ _____ on imaging is consistant with HCC

A

200ng/ml; liver lesion

23
Q

How is HCC prevented?

A

HBV vaccination

Treatment of viral hepatitis

Coffee

24
Q

What are the primary sites of metastatic carcinoma?

A
  • Gastrointestinal
  • Lung
  • Urogenital
  • Breast
  • Melanoma