Liver cyst

A liver cyst is considered a benign disease of the organ, which is rightly called the "defender" of the human body. The impact of the liver on normal human life is invaluable, and lesions such as hepatosis, adenoma, cirrhosis or liver cyst can lead to serious consequences, including the following:

• Since the liver is involved in the production of "bilis" or bile, any pathology, such as a liver cyst, leads to stagnation in the gallbladder, which can then lead to pancreatitis and problems in the digestive system.
• Liver pathologies reduce the activity of synthesis of lecithin, quercetin and other substances necessary for normal functioning of the cardiovascular system. The walls of blood vessels lose elasticity, problems with blood pressure and varicose veins are possible.
• A damaged liver provokes a disruption of the general metabolism, the functioning of the hormonal system changes, and there is a risk of cancer.

The liver is responsible for biological detoxification of the body, provides organs and systems with glucose, that is, maintains energy balance, the liver also partially controls the hormonal balance and produces bile acids, maintains the level of hemostasis in the norm. Despite such multifunctionality and the ability to self-regenerate, the liver is a very vulnerable organ to diseases. Among other pathologies, there is also a liver cyst, fortunately, it is not as common as other diseases. Most often, the cause of cysts are congenital anomalies of the bile ducts, which do not develop fully and over time are transformed into cavities. The cyst forms for many years and can be said to grow together with the liver. A liver cyst is a benign disease, rarely developing into a tumor. In women, cystic formation is diagnosed more often than in men, mainly at the age of up to 50-55 years.

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Liver Cyst: Symptoms

Most often, simple, small formations do not manifest themselves with discomfort or pain. If cystic formations are multiple and located close to the porta hepatis - the portal vein, heaviness in the right abdomen, pulling, aching pains, less often in the navel area or on the left can be felt. If a liver cyst develops to a size of 7-9 centimeters, or cysts are multiple and cover more than 15-20% of the organ, nausea and constant pain in the right hypochondrium may appear. When suppurating, a liver cyst manifests itself with hyperthermia, fever, weakness. If a cystic formation is localized closer to the bile ducts, duct, symptoms similar to mechanical jaundice often appear.

A parasitic liver cyst is characterized by specific symptoms that are extremely similar to the signs of a classic allergy - urticaria, rash, swelling, lacrimation. Large echinococcal cysts provoke an increase in temperature, constant right-sided pain, a purulent liver cyst can sometimes manifest itself in the form of a clinical picture of "acute abdomen". Often, a parasitic liver cyst, especially an alveococcal cyst located near the bile ducts, manifests itself in the clinical picture of mechanical jaundice. Rupture of a parasitic cystic formation can end in peritonitis, the clinical picture of a rupture is very obvious, exactly repeating the picture of "acute abdomen" - acute pain, a drop in pulse, blood pressure, cold sweat, pale skin.

Types of liver cysts

Cysts of non-parasitic etiology (non-parasitic).

• Monocyst is a single neoplasm.
• Multiple formations - multiple cysts.

Polycystic disease.

• Cysts of parasitic etiology (parasitic).
• Echinococcus.
• Alveococcal cysts.

Also, liver cysts are divided into the following subtypes:

1. True or solitary neoplasms.
   • Simple.
   • Multilocular cystadenoma.
   • Dermoids.
   • Retention.
2. False neoplasms:
   • Traumatic.
   • Inflammatory.
3. Perihepatic neoplasms.
4. Neoplasms of the liver ligaments.

A liver cyst, which is classified as a non-parasitic neoplasm, includes a solitary and false type. A true neoplasm develops in utero, when individual, usually lateral bile ducts, do not connect to the general biliary system. The epithelial tissue of the lateral undeveloped bile ducts continues to produce secretory fluid, which accumulates, and this is how a cystic formation is formed. Solitary cystic formations are very similar in structure to intrahepatic ducts and have a capsule. A false subtype of cysts is formed as a result of liver injury, drug intoxication, after surgery, or due to an abscess. The walls of such neoplasms consist of liver tissue, which is transformed into fibrous. A false liver cyst is most often localized in the left lobe.

The parasitic category is divided into echinococcosis and alveolar echinococcosis.

This is a kind of helminthic invasion of the liver, which appears as a result of eating dirty food and water, as well as in close contact with animals sick with these types of diseases. The pathogen penetrates the organs and systems along with the bloodstream and lingers in the liver. The parasite, called Echinococcus granulosus, develops in the liver tissue as a larva and encapsulates in a cyst, the alveococcus - Echinococcus multilocularis is transformed into a pathological node capable of growing into nearby tissues. Echinococcosis leads to displacement and compression of the bile ducts and organs surrounding the liver. A liver cyst, which belongs to the echinococcal type, can be single-chambered, as well as multiple, multi-vesicular. Alveococcosis is similar to a tumor process, since it does not displace the liver tissue, but grows into it. The danger of alveolar echinococcosis infection is that the pathogen can even penetrate into the lungs.

Other liver cysts include hydatid cysts; autosomal recessive Caroli disease (rare), characterized by segmental cystic dilation of the intrahepatic bile ducts (often presenting clinically in adults with calculi, cholangitis, and occasionally cholangiocarcinoma), and true cystic tumors (rare).

How is a liver cyst recognized?

Unfortunately, a liver cyst, no matter what type it is, is most often detected by chance during routine medical examinations. Often, a patient is examined for gastrointestinal pathology, and a cyst is diagnosed at the same time. Most often, a liver cyst is detected during ultrasound scanning or computed tomography of the abdominal organs. The main diagnostic task is to differentiate the cystic formation by type - parasitic or solitary, non-parasitic. It is also important to exclude the risk of malignancy of the cyst (its transformation into a malignant tumor).

To determine the parasitic nature of the cyst, studies are conducted called the Kazzoni reaction or the Hedin-Weinberg reaction. The Kazzoni method involves intradermally injecting the patient with a fluid containing weakened echinococci. The response is considered positive if an infiltrate appears on the skin after 10 minutes. The complement fixation reaction according to the Hedin-Weinberg method involves combining the patient's blood with the fluid of the echinococcal vesicle and identifying the activity of the response to the introduction of the antigen. The oncoprocess is confirmed or excluded using a blood test for tumor markers (alpha-fetoproteins). A complete detailed diagnosis helps to accurately determine the category and type of cyst, determine its size, structure, and localization. Diagnostic information is needed to develop a treatment strategy and tactics.

Isolated liver cysts are usually diagnosed incidentally during ultrasound or CT of the abdominal cavity. These cystic lesions are usually asymptomatic and have no clinical signs. Congenital polycystic liver disease is rare and is usually associated with polycystic disease of the kidneys and other organs. In adults, it manifests itself as progressive nodular hepatomegaly (sometimes massive). At the same time, hepatocellular function of the liver is preserved, and portal hypertension does not develop.

Liver cyst: treatment

A liver cyst diagnosed as non-parasitic and without complications is not operated. The attending physician determines control days for monitoring the condition of the cystic formation. An abdominal ultrasound examination is performed every six months; if the cystic formation does not exceed 2-3 centimeters, it is simply observed and monitored so that it does not increase in size.

Large or giant cysts, especially complicated cystic formations, are subject to surgical removal. Types of surgical intervention:

• Excision of the cyst contents and its membranes.
• Resection of a specific sector of the liver together with the neoplasm.
• Excision of cystic walls or the entire neoplasm.

Partial or palliative surgery is indicated in rare cases when radical surgery is impossible due to concomitant severe pathologies. In such cases, a stoma (a specially created opening) is created, which connects the cyst to the intestine or stomach (cystogastrostomy). Very rarely, an operation is performed to dissect, remove the contents of the cyst and suture its walls to the liver tissue. This method is called marsupialization, from marsupium - a bag. The artificially created "bag" gradually fills with granules and overgrows over time in the form of a scar. Such a "pocket" is created when the liver cyst is located in the center of the liver gate and strongly compresses the bile ducts, that is, provokes portal hypertension. Marsupialization helps to reduce the pressure in the portal vein and the pressure is normalized. When the cystic formation scars, repeated reconstructive surgery is possible.

Using a radical method or laparoscopy, a gentle, minimally invasive method, operations are performed if the following indications occur:

1. Radical operations, marsupial operations.
2. Rupture, internal bleeding.
3. Suppuration of the cyst.
4. A liver cyst whose size exceeds 7-9 centimeters (giant neoplasms).
5. A cystic formation localized in the region of the portal vein of the liver, compressing the biliary tract.
6. A cystic formation that manifests itself with critical symptoms - dyspepsia, severe pain, cachexia.

Laparoscopic surgeries:

• Isolated neoplasms of non-parasitic etiology.
• Cysts, up to 8-10 centimeters in size.
• Liver cyst that recurred after puncture.

A liver cyst removed laparoscopically most often does not recur. The operation itself is minimally invasive, the patient recovers fairly quickly after it, and the hospital stay, as a rule, does not exceed a week.

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Liver cyst, recommendations for behavior during the rehabilitation and postoperative period

All patients who have undergone surgery, regardless of whether it was a full-fledged, abdominal or minor - laparoscopic, must follow a strict diet for 6 months and a gentle diet for life. Fried, spicy, smoked and fatty foods are excluded from the diet, it is necessary to control the cholesterol content in foods. Also, for a year after the operation, it is necessary to monitor the condition of the liver and undergo a scheduled ultrasound examination.

Liver cysts rarely become malignant, the number of patients diagnosed with oncological process does not exceed 10% of all patients with complicated cysts. In any case, it is easier to treat or operate on a cyst at the initial stage, when it does not reach large sizes, therefore, regular medical examinations are so important, as well as a responsible attitude to one's own health on the part of the patients themselves.

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