8) Cysts of the liver - Hydatid Cyst скачать в хорошем качестве

8) Cysts of the liver - Hydatid Cyst

Cyst of the liver are generally benign –may be unilocular or multi locular- i)Hydatid cyst ii)Retention cyst- a) Solitory Cyst & b)Multiple Cysts ( Polycystic disease) iii)Lymphatic cysts iv)Endothelial cysts v)Blood & degenerative cyst vi)Dermoid cyst vii)Cysto adenomas Mainly classified into 2 major groups- A)Parastic cyst e.g hydatid cyst B)Non- parasitic cyst (other varieties described above) Non –parasitic cysts - Pathology –Single non parasitic cysts are usually situated on the antero inferior surface of Rt. lobe. -cysts contains a clear watery yellowish brown material. Clinical features- -cysts are usually a symptomatic -swelling is only complaint, which is painless Investigations- Ct scan, USG & angiography. Rx- Excision of cyst is Rx of choice. Hydatid cysts Pathology – Condition is caused by a paracite –Eschincoccus Granulosus. -Unilocular cyst is almost always caused by E. Granulosus while alveolar type may be caused by Echinococcus multilocularis. -Dogs are the chief medicators of hydatid cyst. -Eggs of Echinoccus are discharged through the faeces of the dog & this contaminated the grass & grass eaten by animals. -Human being is also affected either – i) by taking uncooked vegetables contaminated with infected canine faeces or ii)by direct handling of the infected dogs. iii)by allowing the dog to feed from the same dish. Morphology –Adult worm is a small type worm measuring 3-6 mm in length. Comprises –i) a head or scolex, ii)neck & iii) strobila – 3 segment- I) immature II) mature III) gravid -Egg is avoid in stape, contains a hexacanth embryo with spairs of hooks Life cycle- Eggs are discharged with the faeces of the definitive hosts. -Swallowed by intermediate hosts & human beings. -In duodenum, the hexacanth embryos are hatched out. -The embryos bore their ways through the intestinal wall & -enter the radicles of the portal vein in about & 8 hoars -arrested in the sinusoidal capillaries (first filter) -some of the embryos may pass through the hepatic capillaries & enter the pulmonary circulation (second filter) -whenever the embryo settles, it forms the hydatid cyst. -Broad capsules with a no. of scolices are develops. -A fully developed scotex is an end product & its presence inside the hydatid cyst is a sign at complete biological development Hydatid Cyst- formed by embryo. Consist 3 layers- i)A dventitia (Fibrous fissue & grey in colour) ii)the laminated membrane (ectocyst)formed by parasitic cells iii)Inner germinal layer (endocyst)-cellcular & no. nuclei embedded in a protoplasmic mass. Compositions of hydafid fluid – -clear & colourless fluid Contains –NACL, Na sulphate, Na phosphate, Na & calcium salts of succinic acid -antigenic & highly toxic –gives rise to anaphylactic symptoms Clinical features- -Remains symptomless for a quite a long time -symptoms occurs when pressure caused to the adjacent organs. -pain fever c chills. Complications – 1)Intra billary rupture –commonest complications. 2)Suppuration- IInd commonest complication, -caused by bacteria from the biliary tract, -turns into a pyogenic abscess with death of the parasites. 3)Intra peritoneal rupture- contamination of peritoneum with hydatid fluid, brood capsule & scolices. 4) Cyst in superior portion of the liver- push into the pleural cavity with formation of empyema & bronchopleural fistula. -Lung is also a primary site of the hydatid cyst. Special investigations- 1) Blood exam – reveal eosinophilia of 20-25% 2) Serological test-Indirect haemagglutination test, casoni’s test & & compliment fixation will be positive. Casoni’s test – Intra dermal inj. Of 0.2 ml of fresh sterile hydatid fluid produces a wheal of 5 cm in diameter within half an hour. 3) Radiographically - calcification of he cyst wall. 4) CT scan 5) USG & arteriography -Differentation is extremely essential as percutaneous needle aspiration, which is Rx of Pyogenic & Amoebic liver abscess, will cause spillage & spread of the cyst to cause disaster . Rx- Primarily Surgical excision. Hepatic cavity remains after excision of hydatid cyst - it should be treated - i)suturing & closure of the cavity, ii)Omentoplasty iii)Marsupialization & drainage . Antiscolicidal solution –Chlorhexidine, 80%onversion of a closd cavity into an open pouch by incise alcohol & 0.5% cetrimide – will destroy 80-90 % of scolices. Marsupialization – Conversion of a closed cavity into an open pouch by incising it and suturing the edges of it’s wall to the edges of the wound .