Should I have liver imaging performed during pregnancy?

Imaging of liver lesions during pregnancy requires careful discussion with your doctor.  Ultrasound (US) is the preferred imaging modality as it is very safe and readably available.  US may not provide sufficient information, or be limited by bowel gas or patients body habitus. In this situation if further information is required, magnetic resonance imaging (MRI) may be indicated.   MRI is more sensitive and provides better spatial resolution that US. In addition, there are no proven risks of MRI to either the mother or unborn baby, however administration of gadolinium contrast is avoided if possible.   The use of computered tomography (CT) is avoided as it exposes the mother and unborn baby to ionizing radiation.  

Are liver lesions common in pregnancy?

It is common for patients to be found to have liver lesions during pregnancy.  They are often identified incidentally during obstetric ultrasound examinations.  Almost all liver lesions in young pregnant patients are benign.  For this reason, definitive characterisation of the liver lesion can be delayed until after delivery of the baby.  If there is any concern, then interval imaging throughout the pregnancy can be performed looking for interval change in the liver lesion.  Alternatively cross-sectional imaging with MRI may be indicated.  It is rare that a biopsy will be required.

Should I be concerned about liver lesions during pregnancy?

Most liver lesions in young pregnant patients are benign and do not require any surveillance.  Hepatic adenomas can increase in size or bleed during pregnancy due to the effect of high estrogen levels.  For this reason, patients with hepatic adenoma require surveillance throughout pregnancy either by US or non-contrast MRI.  It is extremely rare that any intervention is needed, especially in adenoma that are < 5cm in size.

If I have a liver lesion should I be worried about my children?

Liver lesions are common and the majority occur sporadically, and do not run in families.  If the liver lesion is the result of a disease that can run in families then your specialist will discuss the role of undertaking surveillance of family members.  Once the nature of your liver lesion is established through investigations, your specialist will be able to inform you whether your family members need to be concerned.  

Should I be worried if I have a cyst in my liver?

Liver cysts are common.  Whilst some may be related to a genetic predisposition, the majority are sporadic.  If they are said to be simple then they can often be left alone.  Occasionally if they are causing pain, or pressure, then removal of the cyst is indicated.

If I have a liver lesion, should I avoid alcohol?

It is unlikely that alcohol, if consumed within the healthy recommended limits, is a cause of liver lesions.  Patients who develop cirrhosis of the liver should avoid alcohol as it can be deleterious to their liver.  If you have no evidence of chronic liver disease, then there is no reason that you should abstain from alcohol. 

Should I keep to the liver cleansing diet if I am found to have a liver lesion?

There is no evidence that the liver cleansing diet provides any benefit to the liver.  It is recommended that you eat a healthy diet and keep active.  There is no specific diet that has been shown to cleanse the liver.

Are all liver lesions tumours?

A liver lesion is a group of abnormal cells or tissues within the liver.  They are also referred to as a liver mass or tumour.  The majority are benign, only rarely are they can be left alone.  In order to determine the nature of the liver lesion you will need to have a number of different investigations including imaging, blood tests and possibly biopsy.

Can liver lesions be removed?

Depending on the size, number, location and nature of the liver lesion(s) will determine whether removal of the liver lesion is indicated. Removal of part of the liver or biliary system is possible, but needs to be considered carefully, and your specialist will outline the associated risks and benefits. 

Is the gallbladder part of the liver?

The gallbladder is a small pear-shaped organ that is attached to the underside of the liver.  The gallbladder is part of the biliary system that drains bile from within the liver into the first part of the small bowel, the duodenum.  The gallbladder is a vestigial organ that stores bile to facilitate absorption of fat.  Removal of the gallbladder is referred to a cholecystectomy, and can be done by dissecting it off the liver.

Are there specialists who look after patients with liver lesions?

Yes there are surgeons who have sub-speciality training in liver surgery, called HPB surgeons.  They work with physicians who also look after patients with liver lesions, called hepatologists.  

Is it true that the liver regenerates following surgery?

The liver can regenerate.  Following removal of part of the liver (hepatic resection) the liver grows back over a period of 2-3 months, to 100% of the normal size. The function of the liver returns within days and weeks.