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<\/p>\nThis is a patient information booklet providing\u00a0specific practical information about liver cysts in\u00a0brief. Its aim is to provide the patient & his or her
\nfamily with useful information on this particular\u00a0liver problem, the procedures and tests you may\u00a0need to undergo, treatment approaches, risks
\ninvolved, duration, expenses and helpful advice\u00a0on coping successfully with the problem. If you\u00a0require more information, Dr. D.R.Kulkarni or
\nyour doctor will be able to provide more\u00a0information.<\/p>\n
<\/p>\n
The human liver is a reddish brown organ\u00a0normally weighing approximately 1.5% of body\u00a0weight. It is the largest internal organ. It is\u00a0located in the right upper part of the abdominal\u00a0cavity, resting just below the diaphragm under\u00a0the protection of rib cage. Liver is broadly\u00a0divided into a large right\u00a0 and a relatively small\u00a0left lobe. Additionally there is a small lobe called\u00a0caudate lobe. The right and left lobes are further\u00a0subdivided into segments. These subdivisions\u00a0help in planning liver surgery when a patient\u00a0needs removal of a portion of liver.<\/p>\n
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Apart from a patch where it connects to the\u00a0diaphragm the liver is covered entirely by\u00a0peritoneum, a thin, double-layered membrane\u00a0that reduces friction against other organs. The\u00a0peritoneum folds back on itself to form the\u00a0falciform ligament and the right and left\u00a0triangular ligaments. These “ligaments” are in no\u00a0way related to the true anatomic ligaments in\u00a0joints, and have essentially no functional\u00a0importance. An exception to this is the falciform\u00a0ligament, which attaches the liver to the anterior\u00a0body wall from within.<\/p>\n
Liver is supplied by two large blood vessels, one\u00a0called the hepatic artery and one called the portal\u00a0vein. The hepatic artery carries blood from the
\naorta, whereas the portal vein carries blood\u00a0containing digested nutrients from the entire\u00a0gastrointestinal tract and also from the spleen and\u00a0pancreas. The hepatic portal vein supplies\u00a0approximately 75% of the liver’s blood supply,\u00a0the hepatic artery accounting for the remainder of\u00a0its blood flow. Oxygen is provided from both\u00a0sources.<\/p>\n
Before entering the liver the portal vein and\u00a0hepatic artery divide into right and left branch for\u00a0each of the lobes. They further subdivide within the liver tissue to supply each segment in total 9\u00a0in number.\u00a0Blood flows through channels called\u00a0sinusoids and empties into the central vein of\u00a0each\u00a0 lobule. (Each lobule is made up of millions\u00a0of hepatic cells, which are the basic metabolic\u00a0cells.).\u00a0There are 3 main\u00a0hepatic veins that drain blood from liver into a\u00a0large vein (inferior vena cava), which carries\u00a0blood from lower portion of body to heart. Apart\u00a0from the 3 main Hepatic Veins there are many\u00a0smaller draining veins, which enlarge if any or all\u00a0of the 3 veins are blocked due to diseases like\u00a0cirrhosis or hepatic vein thrombosis or\u00a0 venoocclusive\u00a0disorders.<\/p>\n
The caudate lobe is a separate structure, which\u00a0receives blood flow from both the right- and leftsided\u00a0vascular branches and then drains through
\nsmall veins directly into the vena cava.<\/p>\n
The caudate lobe is a separate structure, which\u00a0receives blood flow from both the right- and leftsided\u00a0vascular branches and then drains through
\nsmall veins directly into the vena cava.<\/p>\n
canaliculi, which merge to form bile ducts. Bile ducts are tube like structures carrying bile\u00a0produced within liver to the intestine. Within the liver, these ducts are called intrahepatic (within\u00a0the liver) bile ducts, and once they exit the liver they are considered extrahepatic (outside the\u00a0liver). The intrahepatic ducts eventually drain into the right and left hepatic ducts, which merge\u00a0to form the common hepatic duct. The term biliary tree is derived from the arboreal branches\u00a0of the bile ducts. The cystic duct draining the gallbladder joins with the common hepatic duct\u00a0to form the common bile duct. Bile can either drain directly into the duodenum via the common\u00a0bile duct, or be temporarily stored in the gallbladder via the cystic duct. The common bile\u00a0duct and the pancreatic duct enter the second part of the duodenum together at the ampulla of\u00a0Vater.<\/p>\n
The liver has a “capsule” around it, which contains nerve endings, accounting for pain when\u00a0the liver enlarges and stretches its capsule. The\u00a0damaged liver has an amazing ability to\u00a0regenerate itself. The body needs only about\u00a020% of the liver to live, and if a piece is cut out\u00a0or injured, it can grow back. Sometimes,\u00a0however, the liver gets chronic diseases, which\u00a0impair its ability to regenerate. It can become\u00a0infiltrated with fat (“steatosis”), shrink from
\nchronic alcohol or viral exposure (“cirrhosis”)\u00a0or grow large from infection or a blocked blood\u00a0drainage (“hepatomegly”). Any inflammation of\u00a0the liver, whether caused by germs, drugs, or\u00a0radiation, is called hepatitis. A damaged liver\u00a0may heal, or may slowly fail and require liver\u00a0transplant to save the patient’s life.<\/p>\n
The liver is an astounding laboratory sustaining\u00a0metabolism. Liver’s main job is to filter the blood\u00a0coming from the digestive tract, before passing it
\nto the rest of the body. The liver detoxifies\u00a0chemicals and metabolizes drugs. As it does so,\u00a0the liver also secretes bile that ends up back in
\nthe intestines. Bile contains bile salts, which are\u00a0responsible for digestion and absorption of food\u00a0material. The liver is responsible for\u00a0carbohydrate, fats & protein metabolism and also\u00a0makes albumin, proteins important for blood\u00a0clotting and other functions. It also produces\u00a0various clotting factors, stores glucose, fats,\u00a0vitamins like A, D3, B12 & minerals like iron &\u00a0copper. This myriad of functions makes clear\u00a0why the liver is essential to life.<\/p>\n
The diagnosis of liver function is made by blood\u00a0tests. Liver function tests can readily pinpoint the\u00a0extent of liver damage. Usually in liver diseases
\npatient can have a combination of raised\u00a0bilirubin, increase in liver enzymes, drop in blood\u00a0albumin levels, alteration in clotting test results,\u00a0depending on the type of liver disease.<\/p>\n
If liver function is altered then other tests are\u00a0asked depending on clinical picture and lab\u00a0results. If hepatitis is suspected, then tests to\u00a0detect cause of hepatitis are done. Sometimes,\u00a0one may require an ultrasound or a CT scan or\u00a0MRI to produce images of the liver and diagnose\u00a0liver tumors, abscess, and other pathologies.<\/p>\n
Physical examination of the liver is not accurate\u00a0in determining the extent of liver damage. It can\u00a0only reveal presence of tenderness or the size of
\nliver, but in most cases, some type of radiological\u00a0study is required to examine it. In patients with\u00a0chronic liver disease noninvasive tests like\u00a0Phytate liver scan (nuclear scan) and Ultrasound\u00a0elastography of liver (Fibroscan) are done to\u00a0assess the liver status.<\/p>\n
However, the ideal way to determine damage to\u00a0the liver is with a biopsy. A biopsy is not\u00a0required in all cases, but may be necessary when\u00a0the cause or extent of damage is unknown. A\u00a0needle is inserted into the skin just below the rib\u00a0cage and a biopsy is obtained. The tissue is sent\u00a0to the laboratory, where it is analyzed under a\u00a0microscope. Sometimes, a radiologist may assist\u00a0the physician performing a liver biopsy by\u00a0providing ultrasound\u00a0 guidance.<\/p>\n
A cyst is a collection of fluid bound by defined\u00a0wall either of surrounding tissue or a lining.\u00a0When the cyst has a lining from within also\u00a0called epithelium, it is known as true cyst in\u00a0medical terms and if there is no lining it is known\u00a0as false or pseudo cyst.<\/p>\n
Cyst can be present anywhere in the body\u00a0whether in brain, lung, liver, kidney, pancreas,\u00a0spleen, abdominal cavity, ovary, and neck\u00a0etcetera. Pseudo cysts however are specifically\u00a0seen originating from pancreas or as a result of\u00a0pancreatic inflammation.<\/p>\n
A cyst can form in the liver due to various\u00a0causes. They can be due to congenitally\u00a0obstructed small biliary channels within liver and\u00a0have lost communication with others. These are\u00a0Simple Liver Cysts (SLC) and are by far the\u00a0commonest of liver cysts. They are never\u00a0inherited. SLC might be single or many scattered\u00a0cysts<\/strong>.<\/p>\n Sometimes a cyst forms due to parasitic\u00a0infections (ecchinococcus or tapeworms) and is\u00a0known as hydatid cysts. Occasionally a cyst is\u00a0actually a\u00a0 benign tumor called biliary cystadenoma\u00a0or a cancer called cystadeno- carcinoma\u00a0the cause of cystadenomas<\/strong> and cystadenocarcinomas<\/strong>\u00a0is unknown. It\u00a0 is important to know\u00a0that Cystadenoma is a premalignant lesion & can\u00a0transform to cyst- adenocarcinoma. Sometimes a\u00a0liver cancer with central\u00a0 destruction can also give\u00a0appearance of a cyst.<\/p>\n Rarely multiple cysts are result of congenital\u00a0malformation of bile ducts (choledocal cyst &\u00a0caroli disease) or residual collection following an\u00a0abscess or trauma.<\/p>\n Less commonly liver cyst can be part of\u00a0hereditary diseases like polycystic disease\u00a0wherein multiple cysts occur in organs like\u00a0kidney, liver, pancreas.\u00a0 Adult polycystic liver\u00a0disease (AD-PCLD) is congenital & inherited\u00a0disorder and is usually associated with autosomal\u00a0dominant polycystic kidney\u00a0 disease<\/strong> (AD-PKD). Mutations in these patients have been identified\u00a0in PKD1 and PKD2 genes. Occasionally, PCLD\u00a0has been reported in the absence of polycystic\u00a0kidney disease<\/strong> (PKD). In these patients, a third\u00a0gene, protein kinase C substrate 80K-H\u00a0(PRKCSH), has been identified.<\/p>\n Despite these differences in genes, patients with\u00a0PCLD are similar in clinical presentation. In\u00a0patients with PKD, the kidney cysts usually\u00a0precede the\u00a0 liver cysts. PKD often results in renal\u00a0failure, whereas liver cysts only rarely are\u00a0associated with hepatic fibrosis<\/strong> and liver failure<\/strong>.<\/p>\n In an autosomal dominant inherited disease there\u00a0is 50% chance of disease occurring in the child if\u00a0one parent is having the disease. If both parents Liver cysts tend to occur in 5% of the population.\u00a0No more than 10-15% of these patients have\u00a0symptoms. Hepatic cysts are usually found as an Liver Cyst especially simple liver cyst generally\u00a0causes no symptoms and is usually picked up\u00a0when an abdominal ultrasonography is performed A liver cyst of any etiology causes complaints\u00a0only when it is large in size, causes pressure on\u00a0surrounding organs or develops complications\u00a0like\u00a0 bleeding, infection rupture or cancer.<\/p>\n Cyst may produce dull right sided abdominal\u00a0pain, bloating and early satiety if large in size.\u00a0Occasionally, a cyst is large enough to produce a\u00a0palpable\u00a0 abdominal mass. Jaundice caused by\u00a0bile duct obstruction is rare. Patient may develop\u00a0secondary infection, leading to a presentation\u00a0similar to a hepatic abscess with abdominal pain\u00a0& fever. Free rupture in the abdomen or within\u00a0the biliary system or bleeding inside the cyst\u00a0causes acute severe\u00a0 abdominal pain.<\/p>\n Most liver cysts will not cause liver failure.\u00a0Rarely patients with PCLD present with\u00a0symptoms of portal hypertension & liver failure\u00a0like hematemesis (blood vomiting), ascites\u00a0(accumulation of water in the abdomen),\u00a0encephalopathy (loss of consciousness).<\/p>\n Cysts can usually be distinguished on the basis of\u00a0the patient’s symptoms, the radiographic\u00a0appearance of the lesion, certain blood tests and\u00a0analysis of the cyst fluid. It is important to\u00a0identify the exact nature of the cyst.<\/p>\n A simple cyst, a hydatid cyst & cystic tumor in\u00a0its early stage of disease would appear same. A\u00a0practical problem in the evaluation of a patient\u00a0with a cystic hepatic lesion is differentiating\u00a0cystic neoplasms from simple cysts.<\/p>\n Also it is important to find out whether your\u00a0complaints are due to some other cause, which\u00a0will be the situation most of the times in case of\u00a0simple liver cyst. It is a different situation when a\u00a0patient presents with a complication of liver cyst\u00a0like hemorrhage or infection or when cyst is very\u00a0large (>7cms)\u00a0Therefore evaluation of a patient with a liver cyst\u00a0involves carefully recording patient history and\u00a0performing a physical examination. If\u00a0 necessary\u00a0laboratory investigations including a complete\u00a0blood count, renal function tests like blood urea\u00a0nitrogen & creatinine, liver function tests, In case of small simple liver cyst the diagnosis is\u00a0completed after a routine abdominal\u00a0ultrasonography and no follow up study or\u00a0consultations is necessary. Liver function test\u00a0results, such as transaminases or alkaline\u00a0phosphatase or bilirubin are usually normal in\u00a0case of simple cysts. Liver function test\u00a0abnormalities like raised liver enzymes and\u00a0bilirubin would occur only if cyst is large and\u00a0causes pressure on the bile ducts. Coagulation Abnormalities in LFT can occur more frequently\u00a0in case of PCLD or Hydatid cyst because of\u00a0pressure on the bile ducts or rupture of hydatid\u00a0material in the bile duct. In the presence of\u00a0hydatid cysts, high eosinophil count is noted in\u00a0approximately 40% of patients in routine CBC,\u00a0and echinococcal antibody titers are positive in\u00a0nearly 80% of patients.<\/p>\n As with simple cysts, liver function test results\u00a0are normal with cystic tumors. There may be\u00a0mild abnormalities in some patients.\u00a0Carbohydrate antigen (CA) 19-9 levels are\u00a0elevated in some patients. Cyst fluid can be sent\u00a0for CA 19-9 testing as a marker for cystadenoma\u00a0and cystadenocarcinoma.<\/p>\n In the setting of PCLD, greater abnormalities in\u00a0liver function test results are found, but liver\u00a0failure is uncommon and is usually seen in very Simple liver cyst can be treated with aspiration\u00a0(PAIR) method or surgery. There is no medical\u00a0treatment for simple liver cyst<\/strong>.<\/p>\n Percutaneous aspiration under ultrasound or CT\u00a0guidance is avoided because the recurrence rates\u00a0are nearly 100%. Typically, the fluid within a Sometimes however a large cyst is aspirated just\u00a0to find out if it relieves complaints, in which case\u00a0a definitive treatment can be taken up later if the Aspiration combined with instillation of alcohol\u00a0or other chemical agents is done in some patients.\u00a0This method is known as PAIR (Percutaneous But this method has high failure and recurrence\u00a0rates. Successful sclerosis depends on complete\u00a0decompression of the cyst, complete destruction Percutaneous catheters should not be placed to\u00a0drain simple cysts because the cavity becomes\u00a0contaminated, leading to the development of Surgical treatment of simple liver cysts involves\u00a0“unroofing” the cyst by excising a portion of the\u00a0wall that extends above the surface of the liver. Yes, cyst deroofing can be successfully\u00a0performed laparoscopically. The laparoscopic\u00a0approach is currently considered the standard of\u00a0care. When compared to laparotomy, this\u00a0technique is associated with less postoperative\u00a0pain and disability,<\/p>\n Histologic assessment of the excised cyst wall\u00a0should be routinely undertaken to identify the\u00a0presence of an unsuspected neoplasm, such as If cysts on imaging studies show abnormalities\u00a0suggestive of cystic tumors, or are of equivocal\u00a0etiology surgery is indicated. Other surgical\u00a0indications include large cysts at risk of rupture\u00a0and abscesses not anatomically amenable to\u00a0percutaneous treatment.<\/p>\n General anesthesia is the norm. Prophylactic\u00a0antibiotics are not necessary. Sometimes an\u00a0orogastric tube and urinary catheter is necessary<\/p>\n 3 or 4 ports are used for laparoscopic cyst\u00a0surgery.<\/p>\n Excision of the entire cyst wall is neither\u00a0necessary nor desired and, if attempted, carries\u00a0the risk of injury to portal or hepatic venous\u00a0vessels that may be stretched over the cyst wall.<\/p>\n A light diet is offered the evening of surgery, and\u00a0most patients can be discharged home the\u00a0following day.<\/p>\n Generally, recovery is rapid, and most patients\u00a0resume full activity within 1 week. Patients can\u00a0shower with the waterproof dressings in place the Following successful laparoscopic unroofing of a\u00a0simple liver cyst, the patient is seen at a followup\u00a0visit within 2 weeks and again 6 weeks after Routine radiographic studies are not obtained\u00a0unless symptoms recur.<\/p>\n Complications of laparoscopic unroofing of\u00a0simple liver cysts are uncommon. Trocar site\u00a0infection is a rare occurrence. Unexpected\u00a0leakage of bile from the cut edges of the cyst can\u00a0lead to a subhepatic or subphrenic fluid collection\u00a0or, rarely, bile ascites.<\/p>\n In patients with PCLD, unroofing and\u00a0fenestration procedures can cause injury to biliary\u00a0or vascular structures in the compressed hepatic In patients with hydatid cysts, spillage of cyst\u00a0contents into the peritoneal cavity may cause\u00a0anaphylaxis. This can even give rise to\u00a0disseminated hydatid disease in peritoneum.<\/p>\n Treatment of PCLD is indicated only in\u00a0symptomatic patients. Asymptomatic patients do\u00a0not require therapy because the risk of\u00a0developing complications related to the lesion is\u00a0lower than the risk associated with treatment.<\/p>\n No options are available for the medical\u00a0treatment of PCLD. In AD-PCLD, enlargement\u00a0of the liver occurs slowly and only rarely\u00a0compromises liver function. Only patient with\u00a0clearly disabling pain is considered for surgery\u00a0and as much of the cystic liver as possible is\u00a0decompressed. This is accomplished by a\u00a0combination of unroofing and fenestration\u00a0(drilling holes) or, in selected patients, by\u00a0resection of the involved portion of the liver. Laparoscopic unroofing of simple hepatic cysts\u00a0have reported cure rates of 90% or higher. In\u00a0patients with simple liver cysts, the general\u00a0agreement is that laparoscopic unroofing offers\u00a0the best balance between efficacy and safety.<\/p>\n Patients with PCLD have lower cure rates. How\u00a0patients with PCLD should be treated remains\u00a0less clear because the failure rates for\u00a0laparoscopic\u00a0 unroofing and fenestration are high.\u00a0Liver resection, though more effective, carries\u00a0higher risks.<\/p>\n Cystadenoma and cystadenocarcinoma always\u00a0need surgery as the treatment. Quite often these\u00a0pathologies are diagnosed on histopathology after Fenestration and complete fulguration have also\u00a0been implemented, although, in this method,\u00a0complete ablation cannot be confirmed by\u00a0pathology.<\/p>\n Hydatid cysts are caused by parasite\u00a0Echinococcus granulosus. Which is a tapeworm.\u00a0This parasite is found worldwide, but it is\u00a0particularly common in areas of sheep and cattle\u00a0farming.<\/p>\n The adult tapeworm lives in the digestive tract of\u00a0carnivores, such as dogs or wolves. Eggs are\u00a0released into the stool and are inadvertently\u00a0ingested by the intermediate hosts, such as sheep,\u00a0cattle, or humans. The egg larvae invade the\u00a0bowel wall and mesenteric vessels of the\u00a0intermediate host,\u00a0 allowing circulation to the\u00a0liver. In the liver, the larvae grow and become\u00a0encysted. This is the hydatid cyst. The hydatid\u00a0cyst develops an outer layer of inflammatory\u00a0tissue and an inner germinal membrane that\u00a0produces daughter cysts. When carnivores ingest\u00a0the liver of the intermediate host, the\u00a0 scolices of\u00a0the daughter cysts are released in the small\u00a0intestines and grow into adult worms, thus\u00a0completing the life cycle of the worm.<\/p>\n Patients with hydatid cysts, similar to patients\u00a0with simple cysts, are most often asymptomatic,\u00a0but pain may develop as the cyst grows. Larger Cyst rupture is the most serious complication of\u00a0hydatid cyst. Cysts may rupture into the biliary\u00a0tree, through the diaphragm into the chest, or\u00a0freely into the peritoneal cavity. Rupture into the\u00a0biliary tree may result in jaundice or cholangitis.\u00a0Free rupture into the peritoneal cavity may cause Patients with hydatid cysts should be treated to\u00a0prevent complications related to cyst growth and\u00a0rupture.<\/p>\n Medical therapy with antihydatid agent\u00a0albendazole is treatment of choice in small cysts.\u00a0Usually these patients will not need any other\u00a0therapy. Patients with larger and complicated\u00a0cysts require surgery. In surgically treated\u00a0patients, albendazole is generally given for few\u00a0weeks pre and postoperatively; continuation is<\/p>\n limited to those who have spillage of cyst fluid at\u00a0the time of operation or to those with cyst\u00a0rupture.<\/p>\n Antihydatid agents are used in conjunction with\u00a0percutaneous treatment. Medical therapy should\u00a0be started 4 days prior to percutaneous treatment PAIR (puncture, aspiration, injection,\u00a0reaspiration) is a percutaneous treatment\u00a0technique for hydatid disease. In this minimally\u00a0invasive method, a needle is introduced into the\u00a0cyst under ultrasound guidance. Cyst fluid is\u00a0aspirated and analyzed. Hypertonic saline or\u00a0ethanol is then injected and reaspirated. PAIRD\u00a0(puncture, aspiration, injection, reaspiration,\u00a0drainage) is similar to PAIR except that a catheter\u00a0is left in place after completion of the procedure.\u00a0PAIRD is most often used for large cysts.<\/p>\n Patients should be followed clinically after PAIR\u00a0treatment. Recurrence is increased in more\u00a0complicated cysts, including those with multiple PAIR is performed only in highly specialized\u00a0centers with appropriately trained and\u00a0experienced staff. In addition, an anesthesiologist\u00a0should be present for monitoring and treatment in\u00a0the event of anaphylactic shock. Surgeons should\u00a0be notified immediately in case of complication.<\/p>\n The World Health Organization currently\u00a0supports PAIR as an effective alternative to\u00a0surgery, although its use is limited.<\/p>\n The World Health Organization guidelines for\u00a0indications and contraindications of PAIR are as\u00a0follows:<\/p>\n Indications for PAIR<\/strong><\/p>\n Contraindications for PAIR<\/strong><\/p>\n More complicated cysts are better managed\u00a0surgically. Treatment of hydatid cysts is\u00a0associated with 2 technical problems: risk of\u00a0anaphylaxis from spillage of cyst fluid containing\u00a0eggs and larvae into the peritoneal cavity and\u00a0recurrence caused by residual eggs in\u00a0incompletely removed germinal membranes.<\/p>\n To prevent these problems, most surgeons use a\u00a0technique in which the cyst contents are aspirated\u00a0and replaced with a hypertonic saline solution to Above information will help you to make an\u00a0informed decision but it cannot replace the\u00a0professional advice and expertise of a doctor\u00a0who is familiar with your condition. You may\u00a0have questions that are not covered; you\u00a0should discuss these with your surgeon. You\u00a0must remember every individual is different.<\/strong><\/p>\n Endoscopist:<\/strong> This may be a gastroenterologist or\u00a0a surgeon who is able to undertake endoscopy\u00a0(examination of the stomach or bowel using a\u00a0flexible telescope). A few endoscopists can also\u00a0perform ERCP and EUS, which are special forms\u00a0of endoscopy that examine the biliary and\u00a0pancreatic ducts and the pancreas.<\/p>\n Gastroenterologist:<\/strong> A physician who is highly\u00a0specialized in \u2018gut\u2019 problems.<\/p>\n General physician:<\/strong> A consultant medical doctor\u00a0who works in a hospital and who is broadly\u00a0specialized including \u2018gut\u2019 problems.<\/p>\n General surgeon:<\/strong> A consultant surgeon who\u00a0works in a hospital and who is broadly\u00a0specialized including \u2018gut\u2019 problems.<\/p>\n HepatoPancreatoBiliary surgeon<\/strong>: A surgeon\u00a0who is highly specialized in pancreato-biliary &\u00a0liver operations.<\/p>\n MRI — Magnetic Resonance Imaging<\/p>\n A type of scanning performed to diagnose\u00a0problems not picked up by regular investigations<\/p>\n CT SCAN \u2013 Computerized Tomography<\/p>\n A type of scanning performed to diagnose\u00a0problems not picked up by regular investigations<\/p>\n ERCP \u2013 Endoscopic Retrograde<\/p>\n Cholangiography.\u00a0An endoscopic procedure performed to visualize\u00a0bile & pancreatic ducts & treat the disease\u00a0endoscopically whenever possible<\/p>\n EUS – Endoscopic UltraSound.<\/p>\n An endoscopic procedure performed to visualize\u00a0pancreas & biliary tract from very close, diagnose\u00a0problems, obtain biopsies and at times treat the MRCP \u2013 Magnetic Resonance Cholangio-Pancreatography<\/p>\n","protected":false},"excerpt":{"rendered":" What\u2019s Wrong With My Liver? Liver Cyst This is a patient information booklet providing\u00a0specific practical information about liver cysts in\u00a0brief. Its aim is to provide the patient & his or her family with useful information on this particular\u00a0liver problem, the procedures and tests you may\u00a0need to undergo, treatment approaches, risks…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[13,14,15,8,9,12,10,11],"yst_prominent_words":[],"class_list":["post-34","post","type-post","status-publish","format-standard","hentry","category-liver","tag-cause-of-abdominal-pain","tag-hepatic-cysts","tag-hepatic-cysts-treatment","tag-liver","tag-liver-cysts","tag-liver-cysts-causes","tag-liver-cysts-symptoms","tag-liver-cysts-treatment","loop-entry clr boxed"],"_links":{"self":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts\/34","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/comments?post=34"}],"version-history":[{"count":24,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts\/34\/revisions"}],"predecessor-version":[{"id":61,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts\/34\/revisions\/61"}],"wp:attachment":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/media?parent=34"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/categories?post=34"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/tags?post=34"},{"taxonomy":"yst_prominent_words","embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/yst_prominent_words?post=34"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Can Liver Cysts Be Inherited?<\/strong><\/h2>\n
\nhave it the risk increases to 75%. In case of\u00a0autosomal recessive disorder there is only 25%\u00a0risk of child getting the disease only if both the\u00a0parents are having the diseased chromosome.<\/p>\nHow Common Are Liver Cysts?<\/strong><\/h2>\n
\nincidental finding on imaging or at the time of\u00a0laparotomy.<\/p>\nHow Do They Present?<\/strong><\/h2>\n
\nfor abdominal complaints. Imaging studies often\u00a0reveal asymptomatic lesions incidentally. What is\u00a0important to remember is that a malignant liver\u00a0cyst would most of the times present in the same\u00a0way as a simple liver cyst.<\/p>\nCan Liver Cysts Cause Liver Failure?<\/strong><\/h2>\n
How Is A Patient With Liver Cyst Evaluated?<\/strong><\/h2>\n
\nimmunological tests (blood tests) to rule out\u00a0hydatid disease, tumor markers like CA19-9 are\u00a0done. Sometimes cyst fluid is aspirated under
\nutrasonography guidance for analysis to rule out\u00a0a cancer. An imaging study, such as an\u00a0abdominal CT scan or MRI is done if the cyst is\u00a0large, to define the nature & anatomy of the cyst.<\/p>\n
\nprofile is usually within the reference range.\u00a0Percutaneous aspiration is avoided because the\u00a0laboratory and cytologic evaluation of the simple
\ncyst fluid is nondiagnostic, and a small risk exists\u00a0of inducing anaphylaxis from leakage if cyst is a\u00a0hydatid cyst or of causing abscess formation in a
\npreviously sterile cyst.<\/p>\n
\nadvanced disease with liver fully riddled with\u00a0large cysts compressing the bile ducts and blood\u00a0vessels. Renal function test results, including
\nblood urea nitrogen and creatinine levels, are\u00a0often abnormal and should be performed on\u00a0initial evaluation.<\/p>\nWhen Should Liver Cyst Be Treated?<\/strong><\/h2>\n
\n
How Are They Treated?<\/strong><\/h2>\n
\nsimple liver cyst is light yellow in color.\u00a0The cyst\u00a0fluid is continually secreted by the epithelial\u00a0lining of the cyst. For this reason, needle\u00a0aspiration of simple cysts is not curative.<\/p>\n
\ncyst refills.<\/p>\n
\nAspiration Instillation & Reaspiration). These\u00a0chemical agents are called sclerosants and they\u00a0destroy the inner lining of the cyst thereby
\npreventing further secretion of fluid and\u00a0recurrence.<\/p>\n
\nof cyst lining and apposition of the cyst walls.\u00a0This is not possible if the cyst wall is thickened\u00a0or if the cyst is large. Additionally there is risk of
\nthe sclerosing agent slipping down into the bile\u00a0ducts causing permanent damage called\u00a0sclerosing cholangitis.<\/p>\n
\nhepatic abscess. Unlike the typical pyogenic\u00a0hepatic abscess, this problem is difficult to\u00a0resolve with repeated catheter placements\u00a0because of continued secretion from the cyst\u00a0epithelium. This would eventually require\u00a0surgery.<\/p>\nWhat Are The Surgical Options?<\/strong><\/h2>\n
\nExcision of this portion of the cyst wall at the\u00a0liver surface produces a saucer-type appearance\u00a0in the remaining cyst so that any fluid secreted
\nfrom the remaining epithelium leaks into the\u00a0peritoneal cavity where it can be absorbed from a\u00a0much larger surface. Although ablating the\u00a0remaining epithelium with electrocautery or an\u00a0argon beam coagulator is possible, this generally\u00a0is not required because the volume of fluid\u00a0secreted each day can be absorbed by the\u00a0peritoneum without any consequence.\u00a0Additionally it has the risk of damaging\u00a0underlying bile ducts.<\/p>\nCan The Surgery Be Done Laparoscopically?<\/strong><\/h2>\n
\ncystadenoma.<\/p>\nWhich Anesthesia Will Be Used?<\/strong><\/h2>\n
How Many Ports Are Used?<\/strong><\/h2>\n
Will The Cyst Be Removed <\/strong>Completely Or Partially?<\/strong><\/h2>\n
What Will Be The Postoperative\u00a0Course?<\/h2>\n
\nday after surgery. The dressings can be removed\u00a0after 2-3 days.<\/p>\nWhat Is The Follow Up Schedule?<\/h2>\n
\nsurgery to assess symptomatic relief and to\u00a0identify complications, such as wound infection\u00a0or ascites.<\/p>\nWhat Postop Complications Are Possible?<\/strong><\/h2>\n
\nparenchyma between the cysts.<\/p>\nWhat Is Done For Pcld?<\/strong><\/h2>\n
\nRecurrence of symptoms with either procedure is\u00a0high as new cysts replace those that have been\u00a0resected. Small numbers of patients need liver\u00a0transplantation.<\/p>\nWhat Is The Long Term Outcome?<\/strong><\/h2>\n
What Is Done For Cystic Tumors Of Liver?<\/strong><\/h2>\n
\nthe first surgery like deroofing. A second curative\u00a0surgery is then required. Several surgical\u00a0methods for treatment of cystadenoma and
\ncystadenocarcinoma have been described.\u00a0Regardless of surgical technique, all surgical\u00a0options should result in complete ablation of the\u00a0tumor. Enucleation and formal resection have\u00a0been accepted as appropriate treatment options.<\/p>\nHydatid Cysts<\/h2>\n
What Causes Hydatid Cyst?<\/strong><\/h2>\n
How Does The Cyst Form?<\/h2>\n
Are Symptoms Diferrent?<\/h2>\n
\nlesions typically cause pain and are more likely to\u00a0develop complications than simple cysts. At the\u00a0time of presentation, patients generally have a
\npalpable mass in the right upper quadrant.<\/p>\nWhat Are The Complications Of Hydatid Cyst?<\/strong><\/h2>\n
\nanaphylactic shock. Also many more cysts\u00a0would form in the peritoneal cavity. As with\u00a0simple cysts, patients with hydatid cysts may\u00a0develop\u00a0 secondary infection and subsequent\u00a0hepatic abscesses.<\/p>\nWhat Is The Treatment?<\/strong><\/h2>\n
\nand continued either for 1 month (albendazole).<\/p>\n
\ndaughter cysts.<\/p>\n\n
\n
\nkill residual daughter cysts in the germinal\u00a0membrane before unroofing and pericystectomy.\u00a0The goal of the latter procedure is to excise the\u00a0germinal membrane, leaving the inflammatory\u00a0and fibrous components of the cyst wall in situ.\u00a0Excision of the entire cyst wall or formal\u00a0hepatectomy is used selectively.<\/p>\nDoctors Dealing With Liver Disease That You May Meet<\/strong><\/h2>\n
GLOSSARY<\/h2>\n
\ndisease too.<\/p>\n