Hydatid disease is a parasitic infection caused by Echinococcus granulosus. It affects both animals and humans. Symptoms can include abdominal pain, jaundice, and rupture of cysts into other organs causing related symptoms. Diagnosis involves blood tests, imaging like ultrasound and CT. Treatment options include medications like albendazole, surgery to remove cysts, and a procedure called PAIR which involves puncturing, aspirating, and re-injecting cysts with scolicidal agents. Complete surgical removal of cysts is often the best treatment when possible.

1. HYATID DISEASE
•PRESENTED BY: AKSHITA BEHL
•ROLL NO. 19010

2. CONTENTS
• INTRODUCTION
• LIFE CYCLE
• SYMPTOMS AND SIGNS
• INVESTIGATIONS
• TREATMENT

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

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

11. Rim of calcification
deleniating a cyst suggestive
of echinococcus.

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)

15. TREATMENT
• MEDICAL TREATMENT
• PAIR
• SURGERY

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.

17. PAIR
• P: PUNCTURE
• A: ASPIRATION
• I INJECTION
• R : REASPIRATION

18. • INDICATIONS:
• MORE THAN 5 CM
• CYST WITH DETACHMENT OF MEMBRANE , DAUGHTER CYST
• REPLAPSE AFTER SURGERY OR CHEMOTHERAPY

19. CONTRAINDICATIONS
• PREGNANCY
• CALCIFIED CYSTS
• CYST COMMUNICATE WITH BILLIARY TREE.
• LUNG CYST

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.

27. • THANK YOU