Hepatic cyst

The hepatic diseases are every number of diseases that affect the liver, like Hepatitis, Cirrhosis, Haemochromatosis, Cancer, Wilson’s disease, Budd-Chiari syndrome and the hepatic cyst disease. The hepatic cyst disease usually stands for simple cysts of the liver, solitary nonparasitic.

The Cystic lesions may include simple cysts or multiple cysts, parasitic or hydatid cysts, abscesses or even cystic tumors.

The origin of the liver cyst is considered to be congenital, but there is not enough medical data to determine it with accuracy. Progressive dilatation of biliary microhamartomas may cause the cysts because this microhamartomas fail to develop normal connections with the biliary tree. Adult polycystic liver disease is closely linked to autosomal dominant polycystic kidney disease (AD-PKD) and it is congenital.

The mutations have been found in PKD1 and PKD2 genes and in some rare cases PCLD have been reported in the absence of polycystic kidney disease (PKD). Also in this case another gene has been found – protein kinase C substrate 80K-H (PRKCSH). Usually for a patient with PKF the kidney cysts precede the liver cysts and most of the time results in renal failure.

True intrahepatic neoplastic cysts are rare and they are often confused with liver cysts. Proliferations of abnormal embryonic analogs of the gallbladder or biliary epithelium are believed to be the causes of cystadenomas and cystadenocarcinomas. Infestation with the parasite Echinococcus granulosus causes Hydatid cysts.

The Echinococcus granulosus is found in areas and cattle farming all over the world and the tapeworm lives in the digestive tract of some animals like dogs and wolves. There eggs are in the stool of these animals and usually are ingested by sheep or even humans, and they represent the intermediate hosts.

The larva enters the bowl wall and the mesenteric vessels, thus allowing access to the liver where they grow and become encysted. This hydatid cyst creates another layer of inflammatory tissue that produces daughter cysts. After carnivores ingest the liver of the intermediate host, sheep or humans, the scolices of the daughter cysts are released in the small intestines. There the larva grows into an adult worm and it completes its life cycle.

There are two forms of hepatic abscess: amebic or bacterial.

The amebic abscess causes the Entamoeba histolytica and it is contracted by ingestion of food which was previously contaminated by the parasite. There have been cases of the parasite invading the mesenteric venules and causing liver abscesses but usually the amebiasis stays in the intestine. Also ascending cholangitis can cause pyogenic abscesses.

Only symptomatic patients need treatment of PCLD because asymptomatic patients have a greater chance of developing complications. These patients should be treated to prevent any growth or rupture of the cyst. Abscesses have to be treated right away and the correct treatment is with percutaneous drainage and antibiotics.

There are contraindications to the treatment of the liver cysts. It relates to underlying comorbid illnesses like congestive heart failure and suggestive of angina.

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