Hydatid Cyst and RPC Flashcards
Who is the Host
occurs primarily in sheep-grazing areas of the world but is common worldwide because the dog is a definitive host
There are three species that cause hydatid disease
Echinococcus granulosus is the most common
and Echinococcus multilocularis and Echinococcus ligartus
MC Locations
Echinococcosis is endemic in Mediterranean countries, the Middle East, Far East, South America, Australia, New Zealand, and east Africa.
how does the cyst developes?
In the human duodenum > releases an oncosphere containing hooklets that penetrate the mucosa > to the bloodstream > liver (most commonly) or lungs
what character the cyst has ?
The cyst wall itself has two layers,
an outer gelatinous membrane (ectocyst)
an inner germinal membrane (endocyst)
What other Features happen in the cyst ?
- Freed brood capsules and scoleces are found in the hydatid fluid > hydatid sand
- Daughter cysts are true replicas of the mother cyst.
- Hydatid cysts can die > development of cystic vacuoles, and calcification of the wall.
Calcification of a hydatid cyst, however, does not always imply that the cyst is dead.
the most frequent sign in hydated cyst ?
The most frequent sign is hepatomegaly.
Free ruptures can result in ?
can result in disseminated echinococcosis or a potentially fatal anaphylactic reaction
appearance on US ?
- well circumscribed
- budding signs on the cyst membrane and may contain free-floating hyperechogenic hydatid sand
- A rosette appearance is seen when daughter cysts are present.
- The cyst can be filled with an amorphous mass, which can be diagnostically misleading.
- Calcifications in the wall of the cyst are highly suggestive of hydatid disease and can be helpful in the diagnosis
What preparation should you tell anesthesia to have?
anesthesiologist should have epinephrine and steroids available in case of an anaphylactic reaction.
during surgery what should you do to control seeding or rupture if happens ?
Packing off the abdomen
what are the steps in surgery ?
- Packing off the abdomen
- aspiration of the Cyst ( closed suction system )
- Flushed with a scolicidal agent, such as hypertonic saline
- The cyst is then unroofed
- followed by :
1- pericystectomy/Excision
2- marsupialization procedures
3- leaving the cyst open
4- drainage of the cyst
5- omentoplasty
6- partial hepatectomy
Can you leave the cyst intact and do the surgery ?
Yes
Total pericystectomy or formal partial hepatectomy
What if There is a communication with the Biliary System
Simple suture repair is often sufficient
but major biliary repairs :
approaches through the common bile duct
or postoperative ERCP may be necessary
What are the Tx methods?
1- Surgery the Tx of Choice
2- PAIR
3- albendazole or mebendazole is effective at shrinking cysts and decrease the risk of spillage
When to consider only medical Tx ?
Medical therapy without definitive resection or drainage should be considered only for widely disseminated disease or poor surgical candidates.
Recurrent Pyogenic Cholangitis? Oriental cholangiohepatitis or hepatolithiasis ?
- secondary to biliary stones and strictures that involve the extrahepatic and intrahepatic ducts.
The disease is almost exclusively found in??
Asians and Asian medical centers.
What is the cause ?
The cause of RPC is unknown but is related to recurrent infection of biliary radicals with gut bacteria.
Ultimately, stones and strictures develop in the biliary tree, but it is not known which occurs first.
The stones are bilirubinate stones
An association between RPC and which organism noted ?
Clonorchis sinensis
Ascaris lumbricoides infection
Strictures Mc found where ?
Strictures can be found anywhere in the biliary tree but usually involve the intrahepatic main hepatic ducts
most often the left hepatic duct
What are the Complications ?
- Cirrhosis
- liver failure
- choledochoduodenal fistulas
- acute pancreatitis from common bile duct stones
- cholangiocarcinoma has been noted,
what patient characters have this disease ?
young Asian of a lower socioeconomic background who presents with repeated bouts of cholangitis.
Tx Options
- exploration of the common bile duct with or without hepaticojejunostomy.
- complicated cases > permanent access to the biliary tree for interventional radiologic procedures by extending the end of the Roux-en-Y hepaticojejunostomy to the skin or subcutaneous space
- stricturoplasty and partial hepatectomy.
- Partial hepatectomy is advocated for patients with intrahepatic strictures, hepatic atrophy, liver abscess, or suspicion of cholangiocarcinoma
What percentage have cholangiocarcinoma
cholangiocarcinoma found in approximately 10% of patients
