The document discusses various cystic diseases of the liver including pyogenic liver abscess, amebic liver abscess, hydatid cysts, simple hepatic cysts, polycystic liver disease, cystadenoma, and cystadenocarcinoma. It provides details on the presentation, imaging, and management of these conditions with a focus on pyogenic liver abscess including risk factors, complications, and surgical versus non-surgical treatment approaches.
This slides gives you the Facts & Salient features of Liver Cysts / Interesting Case Reports covering Main Departments of Clinical side with Recent Advances made in the treatment of Liver cyst & Key points.
This slides gives you the Facts & Salient features of Liver Cysts / Interesting Case Reports covering Main Departments of Clinical side with Recent Advances made in the treatment of Liver cyst & Key points.
Gall bladder carcinoma seen in Indian popluation most common in women and presents at a very late stage .Survival is in months hence palliative treatment is being preferred .
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
Gall bladder carcinoma seen in Indian popluation most common in women and presents at a very late stage .Survival is in months hence palliative treatment is being preferred .
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. Cystic Diseases of Liver
Dr Anang Pangeni
Dr Anang Pangeni
Department Of Surgery
BPKIHS JR
2. Introduction
• Frequency : not known
• Estimated to occur in 5% of the population.
• Usually found as an incidental finding on imaging
or at the time of laparotomy
• Most series in the literature are relatively
small, reporting fewer than 50 patients each.
3. Introduction
A number of different cystic lesions may affect the liver,
Pyogenic Liver Abscess
Infectious
Amebic Liver Abscess
Hydatid Liver Cysts
Simple hepatic cysts
Congenital
Polycystic liver disease
Cystadenoma
Neoplastic
Cystadenocarcinoma
Traumatic
4. Pyogenic Liver Abscess
• Hippocrates 400BC , and we still debating on what’s the
best form of treatment.
• Open surgical drainage
– recommended treatment for many years.
• 1953, McFadzean and associates
• advocated closed aspiration and antibiotics for solitary abscess;
• however, did not gain widespread acceptance
• 1980s, greater acceptance : widespread advancements in Imaging
allowing for precise localization and a percutaneous approach to
treatment.
• Current treatment includes antibiotics, usually with a
percutaneous drainage procedure.
5. Pyogenic Liver Abscess
“Appendicitis” as a cause, overwhelmingly described in
literature, has now been shifting to other etiologies in
modern era.
1. Bile ducts, causing ascending cholangitis;
2. Portal vein, causing pylephlebitis from appendicitis
or diverticulitis;
3. Direct extension from a contiguous disease;
4. Trauma due to blunt or penetrating injuries;
5. Hepatic artery, due to septicemia; and
6. Cryptogenic
## 40% of pyogenic liver abscesses of biliary origin are
related to an underlying malignancy
8. Pyogenic Liver Abscess Pathology
• Number and Size
– solitary and large,
• portal,
• traumatic, and
• cryptogenic hepatic abscesses
– multiple and small (and these are usually bilobar!!! Also remember Fungal abscesses)
• biliary origin
• arterial abscesses
• Site
– Right lobe : 2/3rd (63%)
– Left lobe : 14%
– Both lobes : 22%
• Organisms
– Most common are Gram negative aerobes (50-70%), positive aerobes (55%) and
anaerobes.
• Biliary : E. cooli , Klebsiella
• GIT : klebsiella , E. coli, enterococcus and anerobes
• Cryptogenic : anaerobes
• AIDS related : Mycobacterium
9. Pyogenic Liver Abscess Presentation
– Subacute and nonspecific
• Fever
• Malaise
• Weight loss , anorexia , nausea vomiting
• Chest symptoms when diaphragm is involved
• Right upper Quadrant tenderness
• Hepatomegaly
• Jaundice
• Pleural effusion
– Acute
• Rupture resulting in peritonitis
• Septic shock
10. Pyogenic Liver Abscess Imaging
• Ultrasonography and computed tomography
(CT) scans - modalities of choice
• USG:
– Sensitivity : 85% and 90%
– Specificity : far less
• Aspiration for diagnosis and microbiologic testing
usually done.
– Troublesome in
• morbidly obese
• Inhomogenous liver
11. Pyogenic Liver Abscess
Imaging
• CT scan
– Sensitivity : 95% -100%
– better than USG (not limited by air / ribs )
– Hypoattenuated than liver
– Wall enhaces on contrast
12. Pyogenic Liver Abscess Imaging
• Plain films
– Right lung (33%)
• basilar atelectasis or
• pleural effusion.
– Right diaphragm elevated and less mobile than
the left.
– Abdomen
• usually normal or show only hepatomegaly.
• Air-fluid level
14. Pyogenic Liver Abscess Management
• Goals
– Treat the abscess
– Treat the source
• Steps IV antibiotics
• Multiple small abscesses
Radiological confirmation
Drainage
• Aspiration and Percutaneous
• Surgical
15. Pyogenic Liver Abscess Management
• Antibiotics Alone
– Multiple abscesses <1.5cm (Biliary source?)
– No concurrent surgical disease
• Antibiotics (preferably 6 wk; 2wk may suffice)
– Empirical (multidrug)
• Aminoglycosides( or Fluoroquinolones) , clindamycin (or
Metronidazole)and Ampicillin or Vancomycin
– Empirical (single agent)
• Ticarcillin-clavulanate
• Imipenem-cilastin
• Pipercillin – tazobactam
– Selective
• As per culture reports
16. Pyogenic Liver Abscess
Non –surgical Management
• Aspiration alone Vs percutaneous drainage
– Higher recurrence (more with biliary source!)
– Higher rates of surgical drainage later
– Less invasive
– Less expensive
– Mortality rates similar
• Percutaneous drainage (those tails !)not indicated
– Large multiple abscesses
– Known intrabdominal source
– AUO Thus
– Ascites SURGERY
– Abscess requiring approach Transpleurally
17. Pyogenic Liver Abscess Surgical Drainage
• After Oschner (the man of conservative appendicitis regime !)
– Extraperitoneal (see fig.)
• Now-a-days indicated in
– Failed non operative methods
– Requires surgery for underlying source
– Multiple macroscopic abscesses
– Steroids use
– Ascites
22. Hydatid Cysts
echinococcus , Greek, means hedgehog berry
hudatid, hudatis, Greek, means a drop of water E. Granulosus (black shade)
hydatid ,Latin hydatis, meansdrop of water E. Multilocularis (cross mark)
A recent MEDLINE search showed that 86% of articles published on the subject were
written by surgeons or in association with surgeons, and yet the surgical treatment of
hydatid disease remains controversial!!
27. Clinical picture
• Most commons
Asymptomatic (>70%)
• Pain in the RUQ or epigastrium
• Hepatomegaly and a palpable mass
•Non-specific
•Dyspepsia
•Fever /chills
•Jaundice
•Signs
•RUQ mass
•RUQ tenderness
32. Rare but Described in Literature
Salmonella typhi abscess as a late complication of simple cyst of the liver: A case report
Ismail GOMCEL‹, Ahmet GURER, Mehmet OZDO⁄AN, Nurayd›n OZLEM, Raci AYDIN 1st General Surgery Clinic, Ankara Atatürk Education and Training Hospital, Ankara
Abdominal CT showing an abscess cavity (10x5 cm) at the localization of the previous simple liver cyst.
This case report emphasizes that simple liver cyst could be infected with Salmonella and
progress to a complicated liver abscess, which should respond well to percutaneous
catheter drainage and antibiotherapy.
33. Summary of presentation
• Simple cysts
– no symptoms but may produce dull right upper quadrant pain if large in size. abdominal bloating and early satiety.
– Occasionally, a cyst is large enough to produce a palpable abdominal mass.
– jaundice caused by bile duct obstruction is rare, as is cyst rupture and acute torsion of a mobile cyst.
– Patients with cyst torsion may present with an acute abdomen.
– When simple cysts rupture, patients may develop secondary infection, leading to a presentation similar to a hepatic abscess
with abdominal pain, fever, and leukocytosis.
• Polycystic liver disease
– rarely arises in childhood.
– puberty and increase in adulthood.
– with PKD.
– Women are more commonly affected, and an increase in cyst size and number is correlated with estrogen level. In PCLD,
– hepatomegaly may be prominent, and, occasionally, patients progress to hepatic fibrosis, portal hypertension, and liver
failure.
– Complications, such as rupture, hemorrhage, and infection, are rare. However, patients do present with abdominal pain as
the cysts enlarge.
34. Presentation
• Neoplastic cysts
– Cystadenoma in middle-aged women; cystadenocarcinoma equally affects both men and women.
– Most patients are asymptomatic or have vague abdominal complaints of bloating, nausea, and
fullness.
– These patients, like all those with hepatic cysts, eventually present with abdominal pain.
– Rarely, they present with evidence of biliary obstruction.
• Hydatid cysts
– most often asymptomatic, but pain may develop as the cyst grows.
– Larger lesions typically cause pain and are more likely to develop complications than simple cysts.
– a palpable mass in the right upper quadrant.
– Cyst rupture is the most serious complication of hydatid cysts. Cysts may rupture into the biliary
tree, through the diaphragm into the chest, or freely into the peritoneal cavity. Rupture into the
biliary tree may result in jaundice or cholangitis. Free rupture into the peritoneal cavity may cause
anaphylactic shock.
– secondary infection and subsequent hepatic abscesses.
• Hepatic abscesses
– present with abdominal pain, fever, and leukocytosis
– Those patients with amebiasis can have history of diarrhea and weight loss,
– some may be asymptomatic.
– Pyogenic abscesses often present with cholangitis, abdominal infections, or sepsis.
Rarely, abscesses will rupture, and patients present with peritonitis.
35. labs
• history
• a physical examination
• imaging study, such as an abdominal CT scan, to define the anatomy of the cyst.
– simple hepatic cysts
• require little preoperative laboratory workup.
• Liver function test results, such as transaminases or alkaline phosphatase, may be mildly abnormal, but bilirubin, prothrombin time,
and activated partial thromboplastin times are usually within the reference range.
– PCLD,
• greater abnormalities in liver function test results are found, but liver failure is uncommon.
• Renal function test results, including blood urea nitrogen and creatinine levels, are often abnormal and should be performed on
initial evaluation.
– hydatid cysts,
• eosinophilia is noted in approximately 40% of patients, and echinococcal antibody titers are positive in nearly 80% of patients.
– cystic tumors
• As with simple cysts, liver function test results are normal
• There may be mild abnormalities in some patients.
• Carbohydrate antigen (CA) 19-9 levels are elevated in some patients.
• Cyst fluid can be sent for CA 19-9 testing at the time of surgery as a marker for cystadenoma and cystadenocarcinoma.
– hepatic abscesses
• can usually be easily identified by the clinical presentation.
• Leukocytosis is generally present.
• The enzyme immunoassay (EIA) test detects specific antibodies to E histolytica.
36. imaging
• Before the widespread availability of abdominal imaging techniques, including ultrasonography and CT scans, liver cysts were diagnosed only when
they grew to an enormous size and became apparent as an abdominal mass or as an incidental finding during laparotomy. Today, imaging studies
often reveal asymptomatic lesions incidentally.
• The clinician has a number of options for imaging the liver in patients with hepatic cysts. Ultrasonography is readily available, noninvasive, and highly
sensitive. Computed tomography scan (see image below) is also highly sensitive and is easier for most clinicians to interpret, particularly for
treatment planning. MRI, nuclear medicine scanning, and hepatic angiography have a limited role in the evaluation of hepatic cysts.Computed
tomography (CT) scan appearance of a large hepatic cyst.
• Simple cysts have a typical radiographic appearance. They are thin walled with a homogenous low-density interior.
• PCLD is confirmed by ultrasound or CT scan with multiple liver cysts identified at the time initial of evaluation, as depicted in the image
below.Computed tomography (CT) scan of polycystic liver disease curiously limited to the right lobe.
• Hydatid cysts can be identified by the presence of daughter cysts within a thick-walled main cavity, which are clear in the MRI below.Hepatic cysts.
Sagittal magnetic resonance imaging (MRI) reconstruction in a patient with a large echinococcal cyst; note daughter cysts in interior.
• In patients who are jaundiced with hydatid disease, endoscopic retrograde cholangiopancreatography (ERCP) should be performed to determine if
the cyst has ruptured into the bile duct.
• Central necrosis of large solid neoplasms can mimic cystic hepatic tumors, as this area of necrosis appears cystic.
• Cystadenoma and cystadenocarcinoma usually appear multiloculated with internal septations, heterogeneous density, and irregularities in the cyst
wall. The image below is a CT scan of biliary cystadenoma.Computed tomography (CT) scan appearance of biliary cystadenoma.
• Unlike many tumors, calcifications are rare in cystadenoma and cystadenocarcinoma.
• A practical problem in the evaluation of a patient with a cystic hepatic lesion is differentiating cystic neoplasms from simple cysts.Cystic neoplasms
tend to have thicker, irregular, hypervascular walls, whereas simple cysts tend to be thin walled and uniform.
• Simple cysts tend to have homogenous low-density interiors, whereas neoplastic cysts usually have heterogeneous interiors with septa and papillary
extrusions.
• Abscesses of the liver appear cystic on imaging studies, as shown in the image below, but can usually be diagnosed from the overall clinical
presentation.Ultrasonographic appearance of a patient with a large simple hepatic cyst.
• Previous
•