3. INTRODUCTION
• IT IS PARASITIC DISEASE WHICH AFFECT BOTH ANIMALS AND HUMANS.
• CAUSATIVE ORGANISNISM: ECHINOCOCCUS GRANULOSUS
• DEFINITIVE HOST: DOGS ,WOLF FOX
• INTERMEDIATE HOST: SHEEP CATTLE , HUMAN
4.
5.
6. SYMPTOMS AND SIGNS
• USUALLY IT IS ASYMPTOMATIC BUT SOMETIMES THERE IS EPIGASTRIC LUMP IS
FELT IN RELATION TO LIVER DULL ACHING PAIN IN RIGHT UPPER ABDOMEN
• IF GO INTO LUNGS : DYSPNOEA CHEST PAIN HAEMOPTYSIS.
7. • PRESSURE EFFECTS : PRESSURE ON BILE DUCT : OBSTRUCTIVE JAUNDICE
• : PRESSURE ON PORTAL VEIN: PORTAL HYPERTENSION.
• RUPTURE : IT MAY RUPTURE INTO:
• PERITONEAL CAVITY : SYMPTOMS OF GENERALISED PERITONITIS
• INTO INTESTINE OR STOMACH CYST CONTENT MAY BE VOMITTT OUT
• INTO PLEURAL CAVITY: EMPYEMA
• INFECTION AND SUPPURATION : PAIN RIGOR AND FEVER
8. • SIGNS : HEPATOMEGALY,
• CAMELLOTTE SIGN : FOLLOWING INTRABILLIARY RUPTURE GAS MAY ENTER INTO
CYST LEADING TO PARTIAL COLLAPSE OF CYST WALL.
9. INVESTIGATIONS
• ROUTINE BLOOD INVESTIGATION: 25% EOSINOPHILLIA
• ELISA( ANTI ECHINOCOCCUS IGG ANTIBODY
• CHEST X- RAY
• USG
• CT ( WHEN THERE IS MULTIPLE HYATID CYST)
• MRI( CYSTIC LESION IN LIVER)
10. IMMUNOLOGICAL TESTS
• CASONIS TEST:
• DONE BY INJECTING STERILIZED CRUDE HYATID FLUID POSTIVE REACTION IS
INDICATED BY WHEAL AND FLARE AT SITE OF INJECTION
• IT IS POSITIVE AFTER EXCISION OF CYST
12. USG
• FINDINGS:
• A) SOLITARY CYST:FEATURES SUGGESTIVE OF DEPENDENT DEBRIS(HYATID
SAND)MOVE FREELY WITH CHNGE IN POSITION
• B) WATER LILY SIGN:SEPARATION OF MEMBRANES DUE TO COLLAPSE OF
TERMINAL LAYER.
• C) DAUGHTER CYST: CYST WITH IN CYST( HONEYCOMB APPERANCE)
16. MEDICAL TREATMENT
ALBENDAZOLE IS GIVEN 10- 15MG/KG/D FOR (3-6MONTHS)
IT ALSO HAS ROLE IN SURGERY IT IS GIVEN 4DAYS BEFORE SURGERY AND 4WEEKS
AFTER SURGERY.
20. PROCEDURE
• FIRSTLY WE PUNCTURE THE CYST
• UNDER USG GUIDANCE THERE IS PERCUTANEOUS ASPIRATION OF CYST
• INSTALLATION OF SCOLIDICAL AGENTS: 95%ALOCHOL, BETADINE,HYPERTONIC
SALINE,3%H2O2.
• THE CONTENT IS THEN REASPIRATED AFTER 10 MINUTES.
21. SURGICAL TREATMENT
• CONSERVATIVE: CYSTECTOMY AND EVACUATION, CAPITONNAGE, PARTIAL
PERICYSTECTOMY OMENTOPLASTY, PERICYSTOJEJUNOSTOMY.
• RADICAL : CYSTOPERICYSTOMY
• WEDGE RESECTION OF LIVER , MAJOR LIVER RESECTION
22. SURGICAL TREATMENT
• INDICATIONS:
• LARGE LOVER CYST WITH MULTIPLE DAUGHTER CYST
• LIVER CYST WITH BILLIARY TREE COMMUNICATION
• INFECTED CYSTS
• CYST IN BRAIN LUNG KIDNEY.
23. CONTRAINDICATIONS
• CYSTS THAT ARE DIFFICULT TO ACCESS
• MULTIPLE CYSTS IN MULTIPLE ORGANS
• DEAD CYSTS CALCIFIES CYST OR VERY SMALL CYSTS.
24. CYSTECTOMY
• OLDER PATIENT WITH SMALL ASYMPTOMATIC DENSELY CALCIFIED CYST :
CONSERVATIVE MX.
• SURGERY IS TREATMENT OF CHOICE
• ANESTHOLOGISY IS REQUIRED FOR EPINEPHRINE STEROIDS ( ANAPHYLACTIC
REACTION)
• IN GENERAL ABDOMEN IS EXPLORED LIVER IS MOBILIZED CYST IS EXPOSED
.PACKING OFF ABDOMEN IS IMPTT BECAUSE RUPTURE MAY LEADS TO
ANAPHYLAXIS.
• THE FLUID IN CYST IS ASPIRATED BY SYRINGE THEN IT IS FILLED WITH
SCOLICIDAL AGENTS AND WAIT FOR 5MINUTES
25. • SCOLICIDAL SOLUTION IS ASPIRATED BACK
• AN INCISION IS MADE OVER TINNED OUT LIVER TISSUE UPTO THE PERICYST
• LAMINATING MEMBRANE IS GRASPED WITH SPONGE HOLDING FORCEPS AND
CAN BE REMOVED INTACT.
• THINNED OUT LIVER PARENCHYMA FORMING PERICYST IS PARTIALLY EXCISED
AND HEMOSTATSIS IS ACHIEVED WITH ELECTROCAUTERY OR SUTURE.
• ALSO LOOK FOR ANY BILE LEAKAGE IN THE HYATID CYST CAVITY IF MINOR
LEAKAGE IS FOUND
26. • IT MAY BE UNDER RUN WITH SUTURE .
• IF MAJOR BILLIARY COMMUNICATION IS FOUND A DRAINAGE PROCEDURE LIKE
ROU EN Y CYSTOJEJUNOSTOMY WILL BE REQUIRED.
