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34 Cards in this Set
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- Back
- 3rd side (hint)
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Cutaneous hemangiomas in children may be a marker for what?
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Hepatic hemangiomas
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how do hemangiomas usually present? when do you need to tx hemangiomas?
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asymptomatically
tx when the hemangioma is > 5cm |
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what are the two types of benign hepatic neoplasms?
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hepatic adenoma and hemangioma
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what is the most prevalent benign mesenchymal liver tumor?
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hemangiomas
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which hepatic neoplasm is associated w/ estrogen and OCP use? what happens to this neoplasm during pregnancy? what is the other concern with pts taking an OCP?
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hepatic adenoma which may enlarge during pregnancy (which may hemorrhage causing pain, shock & requiring surgical resection) and is more numerous, larger & more likely to bleed in pts taking an OCP.
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what are the 3 diagnostic tools used to confirm hepatic adenomas? how do you tx it? what is the associated potential malignancy?
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CT, MRI & US
tx: discontinue OCP and if symptomatic, resect. <12% potential malignancy |
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which hepatic neoplasm has been associated w/ steroid use?
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hepatic adenomas
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what are the 3 groups of hepatic neoplasms?
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Benign, hepatocellular carcinoma, tumor metastases to the liver
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what is the MC sx of hepatocellular CA? what are the other 7 sxs?
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MC- abdominal pain
others: abdominal mass, weight loss, dec liver fxn, blood ascites (portal thrombosis or bleeding from the tumor), jaundice & weakness. |
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what is a tumor marker for hepatocellular CA? what other diagnostic test are used to rule in/ out hepatocellular CA?
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alpha fetoprotein level >400 (esp in a pt w/ cirrhosis, chronic viral hepatitis)
others: US, CT, MRI, Biopsy |
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what two screening tests are specifically used in pts w/ cirrhosis to watch for hepatocellular CA?
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AFP & US
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how do you tx hepatocellular CA? when would you do these txs?
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surgical: surgical resection or liver transplantation
Nonsurgical: ethanol injection (use tumors <2cm), arterial chemoembolization, radiofrequency ablation (Tumors 2-4 cm) liver transplantation: is appropriate for all unresectable tumors in pts w/ advanced cirrhosis |
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in what countries is hepatocellular CA very common? who is mc afflicted w/ HC CA? what percentage does heptocellular CA account for CAs in the US?
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Asia & africa; Men. 2.5%
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what type of liver usually leads to heptocellular ca? what chronic illnesses are associated w/ hepatocellular CA??
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--cirrhotic liver
CHRONIC HBV, HCV. HCV =80% of cases in the US of hepatocellular CA. |
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what are some etiologic factors for heptocellular CA besides cirrhotic liver?
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aflatoxins, alcohol, hemochromatosis & anabolic steroids
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what are the 5 main tumors that metastasize to the liver in order of frequency?
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Lung
colon pancreas breast stomach |
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what is the main sx of simple cysts? how do you dx?
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asymptomatic
dx: US--- best study to determine presence of fluid |
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which hepatic neoplasm is usually congenital and benign?
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Simple cysts
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what hepatic neoplasm causes mortality from rupture of contents resulting in infection anaphylaxia or biliary obstruction & jaundice?
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hydatic cysts
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what are the best diagnostic tools for a hydatic cyst?
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US, CT
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what is the DOC for txing hydatic cysts? what is the causative agent for hydatic cysts?
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albendazole; dog POOP.
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DM pt presents w/ fever, right upper quadrant pain, juandice, malaise and anorexia. what is the diagnosis? how do you confirm it? tx?
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pyogenic liver abscess
dx: CT scan w/ contrast followed by aspiration & culture of the abscess (which you will see ring enhancing lesions!!) US imaging studies (cannot distinguish from amebic abscess) blood cultures tx: drainage (>5 cm abscess)--- drainage catheters should remain in place until drainage is minimal & broad-spectrum antibiotics |
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T/F
only a few of the pyogenic liver abscesses are polymicrobial. |
FALSE
Most pyogenic liver abscesses are polymicrobial. |
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what is the MC identifiable cause of pyogenic liver abscesses in the US?
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ascending cholangitis resulting from biliary obstruction (d/t stone, stricture or neoplasm)
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what are the sxs associated w/ amebic liver abscess?
amebic liver abscess may involve what three other organs? |
sxs: (most asymptomatic) others: fever, malaise, weight loss, RUQ pain, diarrhea (33%)
organs: heart, lung, brain |
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what can a rupture of amebic liver abscess lead to?
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peritonitis
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how do you dx amebic liver abscesses? what is a key diagnostic feature? tx?
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CT, US, or MRI.
key-Leukocytosis w/o eosinophilia. tx: metronidazole |
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what is the main cause of amebic liver abscess? who is at risk for this?
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protozoan infection: entamoeba histolytica. (starts in the cecum and moves into the liver).
risk: travelers & inhabitants of endemic areas. |
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what do hepatic adenomas consist of histologically?
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sheets of normal hepatocytes w/o portal tracts & kupffer cells.
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A 51 yr. old Asian male comes to your office c/o abdominal pain for 1 week, wt. loss over 2 months, abdominal distention, and ? Jaundice , No vomiting. No fevers. PMH: Cirrhosis PE: VSS. Mild Jaundice and Ascites. Diagnosis?
Simple cyst Hepatic adenoma Hemangioma Choleocholithiasis Hepatocellular CA |
hepatocellular CA
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what does injecting the hydatid cyst with 10% formalin & remove it w/n 5 minutes do for the pt?
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will prevent anaphylactic shock that may come secondary.
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Which of the following may be a indicator of a Hepatic Hemangioma?
Fever Jaundice Cutaneous Hemangioma Alpha Fetoprotein elevation Oral contraceptives |
cutaneous hemangioma
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what are the risk factors associated with pyogenic liver abscess?
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diabetes,
underlying hepatobiliary dz pancreatic malignancy, cirrhosis liver transplant. |
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A 30 yr. old female presents with ruq abdominal pain. Denies any fevers or recent illness. She has no history of cirrhosis nor Hepatitis B or C. PMH= None Meds: OCP. PE= VSS. Ruq tenderness to palpation. No G/r/r. Most likely diagnosis?
Hepatocellular CA Hemangioma Hepatic Adenoma Amebic Abscess Pyogenic Abscess |
hepatic adenoma
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