Info
🌱 來自: Huppert’s Notes
Other Pathologies Affecting the Liver🚧 施工中
Other Pathologies Affecting the Liver
Hypoperfusion
• Shock liver: Hypotension causes hypoperfusion of the liver; labs are notable for an elevated AST/ALT with relatively normal bilirubin/AlkP. Transaminases should normalize in 1–2 weeks. Treat underlying condition (e.g., treat sepsis to prevent further hypotension)
Hepatic cysts and abscesses
• Hepatic cysts: Usually benign and no follow-up/treatment is required; surgical removal can be considered if the cysts are causing symptoms; if many cysts, consider the diagnosis of autosomal dominant polycystic kidney disease.
• Hydatid liver cysts: The tapeworm Echinococcus granulosus can be transmitted from dogs to humans, and cause cysts in the liver that have “eggshell” calcifications. Treatment: Surgical resection (pre-inject with ethanol prior to surgery to kill the tapeworm first!), then metronidazole or albendazole after surgery.
• Pyogenic liver abscess: Pus-filled area in the liver, often due to a polymicrobial infection (E. coli, Klebsiella, Proteus, Enterococcus, anaerobes). Symptoms: Fever, malaise, anorexia, nausea/vomiting. Diagnosis: RUQ ultrasound or CT abd/pelvis. Treatment: IV antibiotics, drain (percutaneous vs. surgical depending on the number and size).
Benign liver tumors
• Hepatic hemangioma: Most common benign liver tumor. May increase in size with pregnancy or estrogen, but mechanism unknown. No treatment is required.
• Focal nodular hyperplasia (FNH): Second most common benign liver tumor. Predominantly in women of reproductive age. Not associated with OCP use. No treatment required.
• Hepatocellular adenoma: Benign liver tumor that typically affects women and is associated with OCP use; low malignant potential. Treatment: Stop OCPs. Resect tumors >5 cm or if symptomatic.