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54 Cards in this Set
- Front
- Back
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what is the most prevalent benign mesenchymal liver tumor?
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hemangioma
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where is a hepatic hemangioma usually found?
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solitary in the R upper lobe
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how will hepatic hemangioma present?
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sometimes painful
rarely hemorrhage more often than not it's asymptomatic |
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what may be a marker for hepatic hemangioma in children?
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cutaneous hemangioma
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what levels will usually be normal in hepatic hemangioma?
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LFTS
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when will hepatic hemangioma require treatment?
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> 5cm
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what is a hepatic adenoma?
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sheets of normal hepatocytes without portal tracts and kupffer cells
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what is hepatic adenoma associated with?
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contraceptives or estrogen use
(or anabolic steroids in men) |
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when is hepatic adenoma a concern?
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it may hemorrhage during menses or pregnancy, causing pain and shock and requiring surgical resection
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are hepatic adenomas solitary or multiple?
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solitary
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how do you treat hepatic adenoma?
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resect if symptomatic, always discontinue oral contraceptives
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what are frequent malignancies in asia and africa?
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hepatocellular carcinoma
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what is an important cause of mortality in middle aged men?
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hepatocellular carcinoma
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how can hepatocellular carcinoma often arise?
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in a cirrhotic liver from any cause
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what are 3 populations who get hepatocellular carcinoma most often?
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asians
africans men |
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what are 5 risk factors for hepatocellular carcinoma?
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Hep B
Hep C aflatoxins alcohol hemochromatosis |
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what is the MC presentation of hepatocellular carcinoma?
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abdominal pain
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what will bloody ascities suggest in hepatocellular carcinoma?
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portal thrombosis
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when is hepatocellular carcinoma always suspected?
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is a chronic liver patient has a rising afp level
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what can be used to screen for hepatocellular carcinoma in cirrhotic patients?
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afp >4000
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what hepatocellular carcinoma treatment is appropriate for small, unresectable tumors with advanced cirrhosis?
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liver transplant
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how can you treat hepatocellular carcinoma tumors <2cm?
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ethanol injection
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how do you treat tumors 2-4cm in hepatocellular carcinoma?
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radiofrequency ablation
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what is the median survival time for hepatocellular carcinoma?
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less than 6 months
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where will hepatocellular carcinoma metastasize to and how? (5)
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hematogenous spread
lungs colon pancreas breast stomach |
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what liver growths are usually congenital and benign?
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simple cysts
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what can large cysts cayse? (3)
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spontaneous hemorrhage, infection, and compression of the biliary tree
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what is the best study for simple cysts?
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US
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how are simple cysts treated?
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majority do not need treatment but can monitor for 2-3 years or until symptomatic
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what causes hydatid cysts?
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the larval form of echinococcus granulosus which are acquired through the feces of infected dogs
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what will the classic presentation of hydatid cysts include and what is it caused by?
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caused by rupture
jaundice, biliary colic, anaphylaxis |
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what is the most common presentation of hydatid cysts?
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mass effects of enlarging cysts
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what is budd-chiari syndrome and what is it associated with?
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associated with hydatid cysts
caused by the occlusion of hepatic veins and includes a triad of symptoms: abdominal pain ascities hepatomegaly |
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how do you treat hydatid cysts and what should you never do?
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treat by surgically removing but you should never needle aspirate due to risk of tracking or rupture
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what is a pyogenic liver abscess?
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microbial infections that develop following peritonitis
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what is the most common cause of pyogenic liver abscess in the US?
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ascending cholangitis resulting from biliary obstruction
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what will cause pyogenic liver abscess in the immunocompromised? (3)
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candidiasis
tb actinomycosis |
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are most pyogenic liver abscess mono or polymicrobial?
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polymicrobial
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how will pyogenic liver abscess often present?
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insideous
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what for of radiology is good for pyogenic liver abscess?
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CT with contrast
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what will usually be positive in pyogenic liver abscess? (2)
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blood cultures
bilirubin/liver enzymes |
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what pyogenic liver abscess should be drained?
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single abscess >5cm
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what should happen after surgical drainage of pyogenic liver abscess? (2)
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drainage catheters should remain in place until drainage is minimal
broad spectrum antibiotics |
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what will hepatic candidiasis respond to?
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amphotericin B IV
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what type of liver abscesses are associated with mortality rates up to 50%?
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fungal
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what are amebic liver absesses caused by?
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entamoeba histolytics
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who are at risk for amebic liver absesses? (2)
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travelers and inhabitants of endemic areas
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what form of parasite is infective? invasive?
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cysts are infective, trophozoites are invasive
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what will 1/3 of ameobic liver abscesses manifest with?
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diarrhea
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what will the blood profile look like in amebic liver absess?
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leukocytosis without eosinophilia
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what enzyme will be increased in amebic liver absesses?
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alkaline phosphatase
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how do you treat amebic liver absesses?
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metronidazole
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what will enhance recovery in amebic liver absesses refractory to medical therapy?
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percutaneous aspiration
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what should be considered if there's a high risk of rupture in amebic liver absesses?
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therapeutic aspiration
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