Liver Cysts and abscess

Liver cysts
We divide them into congenital, parenchymal, bile, acquired, neoplastic and traumatic.

Congenital cysts
They occur either as solitary or as polycystosis.

Solitary
They are most often in the right lobe, they are caused by a disorder in the development of the bile ducts. Smaller cysts are monitored with USG či CT, they are rarely symptomatic and almost do not grow. Larger cysts must be surgically removed - cystectomy and suture. We must histologically examine each removed cyst to see whether it is cystadenocarcinoma.

Polycystosis
Congenital polycystosis manifests itself in infants. It is often associated with cystosis of other organs (kidneys, pankreas). Severe forms are an indication for transplantation.

Acquired cysts
The causes include e.g. echinokokózy caused by the parasite Echinococcus granulosus (large cysts filled with fluid) or Echinococcus multilocularis (thin-walled cysts s surrounding infiltration). The so-calledechinococcal cyst.

Clinical presentation
Indefinite difficulties with a feeling of fullness of the abdomen, sometimes a palpable tumor. It is less often ikterus present from pressure on the bile ducts, cholangitis when fistula into the bile ducts, bleeding into the GIT from pressure on the blood vessels.

Diagnostics
Main methods are USG, CT, serology, skin tests and monitoring eosinophilia. Puncture is contraindicated when parasitic origin is suspected.

Therapy
Instillation of 20% NaCl, 50% glucose or 0.5% argentitrate (prevention of shock when the contents of the cyst spill over the peritoneum) and then surgically removed. cystectomy and pericystectomy are performed, or resection with part of the liver. The procedure is covered by mebendazole. Recurrence threatens if the abdominal cavity is contaminated.

Liver abscess
They are either  solitary  (60%) or  multiple  (40%). They are most often located in the right lobe. The causative agents include bacteria, amobea or fungi.

Etiology
They most often occur secondarily as a result of surgery, trauma, cholangitis or pseudocyst infection, eg by hematological spread through the v. portae or arterially in sepsis sepsis. We Cultivate E.coli, Klebsiella, Enterobakter, anaerobes (Bacteroides). It often arises as a 'cryptogenic abscess'', where there is a direct transfer from the environment (most often from the gallbladder). Recently, the number of abscesses after bile duct endoscopies has been increasing.

Clinical presentation
High temperatures are common in bacterial abscesses, but not in fungal abscesses. Abdominal pressure pain, nausea, feeling sick, frenikový příznak.

Examination

 * palpation – fullness and tenderness in the right epigastrium
 * RTG – high diaphragm, unilateral fluidothorax
 * potvrzení diagnózy – USG, CT, targeted puncture
 * in KO – leukocytosis, anemia, increased ALP, hyperalbuminemia
 * blood culture may not be positive!

Therapy
Abscesses should be drained, either puncture under USG or CT control or openly. Aspirate the cavity and rinse the solutions antibiotik. Antibiotics are provided in general

Prognosis
Solitary abscess has good prognosis. Multilocular can be cured.

Související články

 * Cysty
 * Absces