Cysts by Dr. Syed Alam Zeb
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Cysts by Dr. Syed Alam Zeb

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    Cysts by Dr. Syed Alam Zeb Cysts by Dr. Syed Alam Zeb Presentation Transcript

    • CYSTS BY DR.SYED ALAM ZEB, SURG B KTH DEFINITION CLASSIFICATION
    • Definition
      • Pathological fluid filled sac bounded by a wall.
    • TRUE CYST
      • Sac is lined by cells of epithelial origin. Examples are thyroglossal cyst, Sebaceous cyst, Branchial cysts.
    • FALSE CYSTS
      • They are walled-off fluid collections not lined by epithelium. Examples are: Dental or radicular cysts, encysted pleural effusions, pancreatic pseudocysts.
    • CLASSIFICATION OF CYSTS
      • CONGENITAL: 1. Persistence of normal vestigial remnants like Thyroglossal, Branchial, urachal & hydatid of morgagni.
      • 2. Ectopia of various tissues like dermoid, epidermoid & enterogenous.
      • 3. Failure of connection of tubular elements like polycystic kidneys .
      • 4.Hamartomas like cystic hygromas .
    • Classification cont:
      • Acquired Cysts : 1. Retention like mucous cyst of mouth . 2. Implantation like Epidermoid. 3. Parasitic like Hydatid. 4. Hyperplasic like mammary dysplasia. 5. Degenerative like uterine leiomyoma 6. Traumatic e.g. Haematogenous. 7. Neoplastic e.g. Cyst adenoma, cystic teratoma.
    • CLINICAL FEATURES
      • Depends on the type of cyst, site and size.
      • Pain: due to increase in size, haemorrhage, infection, rupture or torsion.
      • Pressure effect : Haemorrhage in Thyroglossal cyst causes dyspnoea. Pseudocyst of pancreas may compress the CBD, or stomach.
    • CLINICAL FEATURES
      • Fluctuation.
      • Transillumination.
      • Special features like a punctum on sebaceous cyst, typical location of Thyroglossal cyst.
    • INVESTIGATIONS
      • Ultrasound
      • CT scan
      • MRI
      • Lab tests.
    • COMPLICATIONS
      • Infection
      • Haemorrhage
      • Torsion
      • Obstruction
      • Calcification.
    • HYDATID CYST
      • Mostly found in the liver but can reach to any organ in the body.
    • AETIOLOGY
      • Echinococcus Granulosus: microscopic cestode parasites.
    • LIFE CYCLE
      • Dogs infected by adult worms.
      • Man and cattle infected with eggs passed in dogs faeces.
      • Eggs hatch in to larva in the organs…the cysts.
    • HYDATID CYST
      • Ecto-cyst or false capsule
      • Endo-cyst.
      • Laminated membrane.
      • Germinal membrane.
      • Brood capsule.
      • Scolices.
      • Cyst fluid.
      • Hydatid sand.
    • CLINCAL FEATURES
      • Depends on the site:
      • 52-77%----liver 8.5-44%----lungs up to 8.0%----abdomen up to 7.0% ---kidneys 0.2-2.0%----CNS 1-2.0%-----bones
    • HYDATID LIVER DIEASE
      • Patient presents with pain abdomen, mass abdomen, jaundice or fever. On exam. Liver may be enlarged, mass is palpable. Signs of liver failure may be present.
    • OTHER SITES
      • HYDATID LUNG DISEASE : Patient presents with respiratory symptoms like breathlessness, cough etc. There may be signs of consolidation.
      • HYDATID IN THE BRAIN : Patient will present with headache, vomiting or hemiplegia. Signs of focal cerebral defects may be present.
    • DIAGNOSIS
      • Ultrasonography: Investigation of choice for suspected hydatid cysts in the solid organs of the abdomen.
    • CT SCAN
      • Where diagnosis is in doubt, CT scan along with ultrasound is used.
      • Investigation of choice in diagnosing pulmonary, brain, spleen hydatid.
    • CT Scan
      • Hydatid of the spleen –a rare site. One of the indication for splenectomy.
    • CT Scan
      • Ct brain and CT Chest showing hydatid cysts.
    • BLOOD TESTS
      • FBC: There is a rise in the Esinophil count.
      • Agglutination Serological tests: Has high sensitivity and specificity in diagnosing active hydatid disease.
      • Casoni Test: Rarely used these days, was not a reliable test.
    • COMPLICATIONS
      • RUPTURE: Rupture may cause anaphylacsis and dissemination.
      • INFECTION:
      • PRESSURE SYMPTOMS .
    • PROPHYLAXIS
      • Eat clean food and salads.
      • BEWARE your pets can give you hydatid disease.
    • TREATMENT
      • No treatment is required if cyst is calcified and asymptomatic.
      • Anti-helminthes drugs for small cysts.
      • Injection therapy  PAIR---puncture, aspiration, injection and reaspiration.
      • Surgical procedures.
    • SURGICAL PROCEDURES
      • Ultrasound guided or CT guided PAIR.
      • Laparoscopic cystotomy, deroofing, and omentoplasty with helical fasteners
      • Partial resection.
      • Marsupialisation and tube drainage or omentoplasty.
      • Radical surgical resection.
    • SCOLICIDAL AGENTS
      • 20% hypertonic saline.
      • 0.5% silver nitrate.
      • 95% sterile ethanol.
      • Absolute alcohol.
      • Mebendazole
      • There is no place for the use of formaldehyde.
    • Indications for PAIR
      • Refusal of surgery.
      • Inoperable cases.
      • Cysts >5cm in diameter.
      • Multiple cysts.
      • Relapse after surgery.
      • Lack of response to chemotherapy.
    • Complications of PAIR
      • Urticaria.
      • Anaphylaxis.
      • Sub capsular haematoma.
      • Fever.
      • Biliary fistula.
      • Infection.
      • Hypotensive shock.
    • Indications for hepatic surgery
      • Large cysts with suspected multiple daughter cysts.
      • Superficial cysts with risk of rupture.
      • Infected cysts.
      • Cystobiliary communication.
      • Pressure effect on vital organs.