hydatid cyst/ hydatid disease of liver.

1. Learning objectives
• What is Hydatid disease?
• Causative organism
– Life cycle &
– How do humans get infected?
• Pathology
• Course of disease
• Differentials
• Diagnosis & Management

2. What is Hydatid disease?
• Word hydatid means 'dew drop' (Latin).
• In Greek it means 'watery vesicle‘

3. Cause
• Echinococcus granulosus (EG)

4. Life cycle of EG

5. Pathology
• It takes few years to evolve into a complete
hydatid cyst.
• Most commonly involved organ
– Liver
• Segment Vll
• Commonly right lobe-66%; both lobes in 16% and only
left lobe is involved in 17%.
• Other organs involved-
– Lung, muscles, bones
– Rarely: kidneys, brain, spleen, heart

7. Characteristics
• Hydatid fluid:
– Clear
– High specific gravity
– Show hooklets & scolices
• Pressure in the cyst is very high 70 mm of H20
– so leak and anaphylaxis becomes rapid when
punctured.
• Separated laminated membrane fall in the cyst
causing "water lily sign" which is more often
observed in lung hydatid but can be seen in liver
also

9. Course of disease
• The parasite may die and cyst eventually may get
calcified.
• Commonly cyst enlarges and is palpable per
abdomen.
• It may cause complications like jaundice due to
pressure over biliary tree.
• Rupture into the peritoneal cavity causes
anaphylactic reaction
– which may cause life-threatening shock
• Rupture into biliary channels is commonest
• Rupture into bowel, pleural cavity can occur.

10. Course of disease..
• Secondary infection causing suppuration and
septicaemia.
• Secondary cysts in the lung, spleen,
mesentery, retroperitoneum and other organs
can occur.
• Hepatic dysfunction.
• Disseminated abdominal hydatidosis can
occur after silent rupture.

11. Clinical features
• Asymptomatic palpable liver with classical
thrill- m.c.
• Jaundice and Pain
• Features of anaphylaxis
• Discomfort in right upper quadrant area;
dyspepsia; hydatid cachexia in children;
weight loss; fatigue; vomiting.
• Occasionally splenomegaly, pleural effusion,
cholangitis, allergic asthma, fever.

12. Confused with ?
• Hepatoma
• Amoebic liver abscess
• Cystic disease of liver

13. Complications
• Rupture
– Anaphylactic reaction
• Obstructive jaundice
• Infection
• Calcification
• Liver failure
• Sepsis
• Death

14. Diagnosis
• Ultrasound is diagnostic
– rosettes of daughter cysts,
– double contoured membrane of the cyst due to
detachment of the cyst membranes, and
– calcification of cyst wall

18. Diagnosis..
• CECT abdomen:
– more accurate in identifying cyst characteristics-
• cart wheel like- multivesicular rosette like

19. Diagnosis..
• X-ray often shows calcification
• Primary serological tests-
– ELISA; indirect haemagglutination test; latex
agglutination test; immunofluorescence antibody
test; immunoelectrophoresis.
– 80-95% sensitivity for liver hydatid.

20. Diagnosis..
• Secondary lab tests-
– Detection of precipitation line arc 5 in
immunoelectrophoresis is most specific and
virtually diagnostic;
– immunoblotting;
– Polymerase chain reaction (PCR)
• Liver function tests-altered in 20% cases.
• Casoni's test (intradermal test-75% sensitive);
• Complement fixation test

21. Diagnosis..
• MRI when there is jaundice
– to visualise biliary tree and its relation to hydatid
cyst;
– to find out cystobiliary communication;
– biliary hydatids in bile duct and hepatic ducts.
• ERCP can also be done to find out the
communications.
• Other method to find out the cystobiliary
communications is intraoperative
cholangiogram.

22. Treatment..
Medical therapy
• Indications:
– 10 days prior to intervention and to continue it for
1 month to 3 months after the intervention
– Inoperable cysts;
– Multiple or multiorgan cysts
– Recurrent hydatids;
– Surgically unfit patients
– Cysts in lungs

23. Treatment..
Medical therapy
• Contraindications:
– Large cysts;
– Honeycomb cysts (with septae)
– Infected cysts;
– Calcified cysts
– Pregnancy

24. Treatment..
Medical therapy
• Drugs used:
– Albendazole
– Praziquintal
– Mebendazole
• Side effects??

25. Treatment..
• Surgical therapy
– PAIR
– Open /lap surgery

27. Treatment

28. Thank you!
Any questions??