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eSimpleCysts and Hydatid Cysts of Liver

SimpleCysts

Livercysts occur in approximately 5% of the population. However, onlyabout 5% of these patients ever develop symptoms. In general, cystsare thin-walled structures that contain fluid. Most cysts are single,although some patients may have several.

Thesymptoms associated with liver cysts include upper abdominalfullness, discomfort, or pain.A small number of patients bleed into the cyst, which causes suddenand severe right sided abdomen and shoulderpain.The bleeding stops on its own, and the pain then improves over thenext several days.

Liverfunction tests are usually normal . The cyst(s) are usually foundby ultrasound(US) or computedtomography (CT scan).Simple liver cysts are always benign and usually cause no problems.

Theonly patients who require treatment for a liver cyst(s) are those whodevelop symptoms. Simply removing the fluid from the cyst with aneedle is not effective because the cyst fills up again withinseveral days. The best treatment is to remove a large portion of thecyst wall. This surgical procedure can usually be done throughthe laparoscope,which requires only 2-3 small incisions and an overnight stay in thehospital. Most patients recover fully within 2 weeks. The risk of thecyst recurring is very low.

A verysmall number of patients (0.6% of the general population) havepolycystic liver (PLD) disease, which is characterized by the liverappearing like a cluster of very large grapes. Over the course ofseveral years, patients with PLD may develop massive enlargement ofthe liver, which results in abdominal swelling and discomfort.

Theonly long-term solution for patients with severe PLD is livertransplantation.

HydatidCyst of Liver

HydatidCyst of the Liver is one form of cystic disease of the liveroccurring due to human infection by the dog tapeworm. Briefly E.granuloses is a type of tapeworm found in the intestines of dogs.The eggs of this parasite gets excreted in dog’s faeces and areusually consumed by herbivores like cow or sheep while grazing. Theeggs become larvae and develop into cysts within the organs of these animals. Humans get the infection when they accidentally consumeimproperly cooked food contaminated with the eggs of dog tapeworm

Oncethe eggs are ingested, they hatch into larve and reach various organsof the human body, but they most commonly lodge in the liver, andgradually enlarge over a period of 2 -3 years to form the HydatidCyst.

Symptoms of Hydatid Cyst Liver

• Around half of all infections are asymptomatic

• Symptoms depend on the location and size of the cyst.

• Most cysts causing symptoms are larger than 5 cm in diameter. Symptoms can include vague pains, cough, low-grade pyrexia and abdominal fullness. Later, as the mass presses on surrounding organs, symptoms become more specific.

• In the liver, symptoms of obstructive jaundice and abdominal pain can develop.

• Involvement of the lungs may result in chronic cough, dyspnoea, pleuritic chest pain or haemoptysis. Expectoration of cyst membranes and fluid may be observed with intrabronchial rupture.

• Secondary complications may occur as a result of infection of the cyst or leakage of the cyst.

• Minor leaks can cause increased pain, flushing and generalized itching.

• Major rupture can result in severe anaphylactic reaction, or shock

• Rupture into the biliary tree can lead to obstruction by daughter cysts, resulting in cholangitis.

• Rupture into bronchi can cause expectoration of cyst fluid.

• Infection of the cyst results in a range of symptoms from mild fever to full-blown sepsis.

• Partially or totally calcified cysts are not uncommon.

Diagnosisof hydatid cysts

Bloodtests

Bloodtests will let your doctor know the presence of infection. It willalso detect the presence of antibodies to the parasite .

Imagingtests

Ultrasoundand CT scan abdomen

Thesetests will give a fairly clear information about the size, locationand number of cysts and whether they are active or calcified. Thepresence of associated complications like bile duct involvement orlung involvement can also be made out by these tests.

Treatmentprocedures involved

Basicallythere are three treatment options

Medicaltreatment - Here one istreated with drugs mainly, albendazole and mebendazole. This isusually given in the days prior to surgery and continued for sometime after surgery too. Very rarely, in a few situations patientsare treated with medicines only.

Surgery

Surgeryis usually by laparoscopy these days and here the surgeon removes thecyst completely and carefully without spilling the cyst contents into the abdominal cavity. There are latest developments in the fieldof laparoscopy which help the surgeon to achieve this. Very rarely,based on the location and size of the cyst, a portion of the liverinvolved by the cyst needs to be removed to achieve clearance of thecyst

PAIR(Percutaneous Aspiration Injection and Reaspiration)

Thisis a form of treatment planned for certain types of cysts in specificlocations and is sometimes also performed for patients, who are notfit for surgery or refuse surgery. Here the cyst is punctured andcontents removed and a specific solution (scolicide) is injected intothe cyst to kill the larvae

Thus cysts and their treatment can vary depending on the nature of the cyst and patient symptoms.