0%
Topic
Review Topic
0
0
N/A
N/A
Questions
1 1
0
0
Topic
Snapshot
  • A 22-year-old woman presents to the emergency department for worsening right upper quadrant abdominal pain. She states that her symptoms have slowly progressed since the past 2 days. On physical exam, you note an athletic female with well-developed muscles. Her current medications include only oral contraceptives. Suddenly, the patient's blood pressure drops to 90/30 mmHg and her pulse is 145/min.
Introduction
  • Overview
    • benign epithelial tumors arising in the liver
      • typically arising in the right hepatic lobe and are usually solitary masses
        • multiple adenomas can be seen in
          • prolonged contraceptic use
          • glycogen storage disorders
          • hepatic adenomatosis
  • Epidemiology
    • demographic
      • young women
    • risk factors
      • oral contraceptives
      • anabolic androgens
      • glycogen storage disorders type I and III
      • pregnancy
Introduction
  • Symptoms
    • abdominal pain 
      • may be localized in the epigastrum or in the right upper quadrant
      • sudden, severe abdominal pain with hypotension suggests rupture of the hepatic adenoma into the peritoneum
  • Physical examination
    • abdominal mass
      • can be seen in ~30% of cases
Imaging
  • Abdominal ultrasound
    • indication
      • typically assesses adenomas of the liver; however, findings are typically nonspecific
    • findings
      • large and often a right lobe lesion
      • typically a hyperechoic mass
  • CT abdomen with and without contrast
    • indication
      • another imaging modality to better characterize liver lesions
    • findings
      • may have changes consistent with hemorrhage
  • MRI of the abdomen with and without contrast
    • indication
      • another imaging modality to better characterize liver lesions
    • findings
      • may show arterial enhancement
Studies
  • Histopathology
    • gross
      • soft, smooth, tanned masses containing prominent blood vessels
    • histology
      • adenoma cells that contains glycogen and lipids
Differential
  • Hepatocellular carcinoma
    • differentiating factor
      • increased α-fetoprotein
      • hypervascular tumor on CT 
Treatment
  • Lifestyle
    • discontinuation of the oral contraceptives or steroids
      • indication
        • in asymptomatic patients
          • some physicians may prefer resection
  • Surgical
    • resection
      • indication
        • in symptomatic and large adenomas
Complications
  • Malignant transformation
  • Spontaneous rupture and hemorrhage
 
Topic Rating

Please rate topic.

Average 5.0 of 1 Ratings

 

Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Topic COMMENTS (0)
Private Note