HYDATID CYST DEFINITION Word meaning is ‘dew drop’ (Latin). In Greek it means ‘watery vesicle’. Echinococcus means ‘hedge hog berry’ in Greek. Caused by Echinococcus granulosus (EG), dog tape worm .

1. en love da Homoeopathy
HYDATID CYST

2. HYDATID CYST

3. HYDATIDCYST
DEFINITION
• Word meaning is ‘dew drop’
(Latin).
• In Greek it means ‘watery
vesicle’.
• Echinococcusmeans ‘hedge
hog berry’ in Greek.
• Causedby Echinococcus
granulosus(EG), dog tape
worm .
• A parasite.
• Life cycle: Infected offal of
sheep= Eatenby the dog
(definitive host)

4. LIFE CYCLE
Egg released
↓
develops in the dog’s intestine
↓
intoa parasite of 1 cm long
↓
with a head and three
segments, last of whichcontains
about 500 ova.
↓
Ova expelled fromthe dog’s
intestine to grass and
vegetables
↓
Eggs are ingested by sheep, cattle
or human beings (intermediate
host)
↓
Throughportal vein—liver—
larva form= Hydatid cysts (70%
in liver).
↓
It takes few years to evolveintoa
complete hydatidcyst.
↓
Commonly right lobe

5. PATHOLOGY
It has got 3 layers
1. Adventitia (pseudocyst)
• is an inseparable
fibrous tissue due to
reactionof the liver to
the parasite.
2. Laminatedmembrane
(ectocyst)
• formedof the parasite
itself is whitish, elastic,
containing hydatid
fluid, which can be
peeled off readily from
the adventitia.
3. Germinal epitheliumis the
only living part, lining the cyst
(endocyst).
• This layer secretes
hydatidfluid, brood
capsules with scolices
(heads of futureworms)

6. COURSEOF THE DISEASES
Features of hydatid fluid ™
Clear
↓ ™
Highspecificgravity(1.005–
1.009)™
↓
Shows hooklets and scolices
↓
Once broodcapsules
disintegrate, it grows into
daughter cyst
↓
The parasitemay die and cyst
eventually may get calcified.
↓
Commonlycyst enlarges and is
palpable per abdomen.
↓
It may causecomplications like
jaundicedue to pressureover
biliary tree.
↓
Rupture into the peritoneal
cavity causes anaphylactic
reaction
↓
whichmay cause life-
threatening shock

7. ↓
Rupture into biliary
channels is commonest
↓
Rupture intobowel, pleural
cavity can occur.
↓
Secondaryinfection causing
suppuration and
septicaemia.
↓
Secondary cysts in the lung,
spleen, mesentery,
retroperitoneumand other
organs can occur.
↓
Hepaticdysfunction.
↓
Disseminated abdominal
hydatidosis can occur after
silent rupture.

8. CLINICALFEATURES
• Asymptomatic
palpable liver with
classical thrill
(hydatid thrill) elicited
by three-finger test.
• Jaundice & pain.
• Features of
anaphylaxis.
• Discomfort in right
upper quadrant area
• Dyspepsia
• hydatidcachexia in
children
• weight loss
• Fatigue
• vomiting.
• splenomegaly,
• pleural effusion
• Cholangitis
• allergicasthma
• fever.
• Camellotte sign
• Following intrabiliary
rupture, gas enters into
cyst causing partial
collapse
of thecyst wall.

9. DIFFERENTIAL DIAGNOSIS
• Hepatoma ™
• Amoebicliver abscess ™
• Cysticdisease of the liver
COMPLICATION™
• Anaphylaxis ™
• Rupture ™
Obstructive
jaundice—ERCP
• sphincterotomymay be
needed ™
• Infection™
• Calcification™
• Liver failure
INVESTIGATION
• Ultrasound
• It reveals rosettes of
daughter cysts, double
contouredmembrane of
thecyst due to
detachment of the cyst
membranes, and
calcification of cyst wall.
Intraoperative
ultrasound (IOUS) is
very useful tool.

10. • X-rayoftenshows
calcification.
• CT scan
• abdomenis more
accuratein identifying
cyst characteristics—
cart wheel like—
multivesicular rosette
like.
• Liver functiontests
• Casoni‘s test (intradermal
test
• Primary serological tests––
ELISA
• indirect
haemagglutination
test
• latex agglutination
test
• Secondarylaboratorytests
• Detectionof
precipitation line—
arc 5 in
immunoelectrophores
is is most specificand
virtually diagnosticof
hydatiddisease

11. • MRI
• when there is jaundice
to visualisebiliary tree
and its relationto
hydatidcyst; to find
out cystobiliary
communication
• ERCP to findout
biliary communications
but not as useful as
MRI. MRI is superior to
CT also
TREATMENT
• Drugs Indications for drug
therapy™
10 days prior to
intervention and to continue
it for 1 month(albendazole)
to 3 months (mebendazole)
after the intervention™
Inoperable cysts ™
Multiple or
multiorgancysts ™
Contraindications ™
• Large cysts ™
Honeycomb
cysts(withseptae) ™
• Infectedcysts ™
• Calcifiedcysts ™
• Pregnancy.

12. SURGERY
• Surgeryis still the choice
and gold standard
therapyfor hydatid
disease.
• The abdomenis opened,
and the peritoneal cavity
is packed with mops
• [blackor coloured mops
are usedto identifywhite
scolices clearly so as to
pickup all and prevent
any spillage].
• Fluid fromthe cyst is
aspirated andscolicidal
agents [cetrimide,
chlorohexidine, alcohol,
hypertonic saline (15–20%),
10% povidoneiodineor
H2O2] are injected intothe
cyst cavity (formalinshould
not be used).
• Hypertonicsaline should be
left withinthe cavity for 15–
20 minutes to haveeffective
scolicidal effect.

13. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

14. A
Special Thanks
To A Very
Special Doctor