Liver Cysts and abscess

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Liver cysts[edit | edit source]

Liver with cysts caused by coccidia

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

Congenital cysts[edit | edit source]

File:Polycystóza jater.jpg
CT of liver with polycystosis

They occur either as solitary or as polycystosis.

Solitary[edit | edit source]

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[edit | edit source]

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[edit | edit source]

The causes include e.g. Echinococcosis 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[edit | edit source]

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[edit | edit source]

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

Therapy[edit | edit source]

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[edit | edit source]

Liver with abscess caused by amoebae

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[edit | edit source]

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[edit | edit source]

High temperatures are common in bacterial abscesses, but not in fungal abscesses. Abdominal pressure pain, nausea, feeling sick, phrenic nerve symptom.

File:Absces jater před drenáží.jpg
CT – liver abscess before drainage
File:Absces jater po drenáži.jpg
CT – liver abscess after drainage

Examination[edit | edit source]

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

Therapy[edit | edit source]

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[edit | edit source]

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

Links[edit | edit source]

Related Articles[edit | edit source]

Bibliography[edit | edit source]

  • ZEMAN, Miroslav, et al. Speciální chirurgie. 2. edition. Praha : Galén, 2006. ISBN 80-7262-260-9.

Sources[edit | edit source]