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Cysts by Dr. Syed Alam Zeb

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Cysts by Dr. Syed Alam Zeb

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

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