Liver cyst

The liver cyst is considered a benign disease of the body, which is rightfully called the "protector" of the human body. The influence of the liver on normal human activity is invaluable, and lesions, such as hepatosis, adenoma, cirrhosis or cyst of the liver, can lead to serious consequences, including the following: 

• Since the liver takes part in the development of "bilis" or bile, any of its pathologies, for example, the cyst of the liver, leads to stagnation in the gallbladder, further pancreatitis and problems in the digestive system are possible.
• The pathology of the liver reduces the activity of the synthesis of lecithin, quercetin and other essential substances for the normal functioning of the cardiovascular system. The walls of the vessels lose elasticity, there may be problems with arterial pressure and varicose veins. 
• The affected liver provokes a violation of the general metabolism, the work of the hormonal system changes, the risk of oncological processes is possible.

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

[1], [2], [3], [4]

Liver cyst: symptoms

Most common simple, small formations do not manifest discomfort or pain. If the cystic formations are multiple and located close to the porta hepatis - portal vein, gravity in the right abdominal region, pulling, aching pain, less often in the navel or on the left can be felt. If the cyst of the liver develops to a size of 7-9 centimeters, or the cysts are multiple and cover more than 15-20% of the body, nausea may occur, permanent pain in the right upper quadrant. When suppuration of the cyst of the liver manifests hyperthermia, fever, weakness. If the cystic formation is localized closer to the bile ducts, the duct, symptoms similar to mechanical jaundice are often manifested.

The parasitic cyst of the liver is characterized by specific symptoms, extremely similar to those of classical allergies - hives, rash, swelling, tearing. Large echinococcal cysts provoke a fever, permanent right-sided pain, a purulent cyst of the liver can sometimes manifest itself in the form of a clinical picture of an "acute abdomen." Often the parasitic cyst of the liver, especially the alveococcus, located near the bile ducts, is manifested by the clinic of mechanical jaundice. The rupture of parasitic cystic formation can result in peritonitis, the rupture clinic is very explicit, precisely repeating the picture of the "acute abdomen" - acute pain, falling of the pulse, pressure, cold sweat, pallor of the skin.

Types of liver cysts

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

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

Polycystic. 

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

Also, the cyst of the liver is divided into such subspecies:

1. True or solitary neoplasms. 
   • Simple. 
   • Cystadenoma is multicameral. 
   • Dermoids. 
   • Retention.
2. False growths: 
   • Traumatic. 
   • Inflammatory.
3. Hepatic neoplasm.
4. Neoplasms of hepatic ligaments.

The cyst of the liver, which belongs to the category of nonparasitic neoplasms, includes a solitary and false appearance. The true neoplasm develops in utero, when the individual, as a rule, lateral bile ducts are not connected to the common bile excretory system. Epithelial tissue of the lateral undeveloped bile ducts continues to produce a secretory fluid that accumulates and forms a cystic formation. Solitary cystic structures are very similar in structure to intrahepatic passages and have a capsule. A false subspecies of cysts is formed as a result of liver injury, drug intoxication, after surgery or because of an abscess. The walls of such neoplasms consist of liver tissue, which is transformed into fibrous tissue. The false cyst of the liver 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 the consumption of dirty products and water, as well as in close contact with animals that are sick with these kinds of diseases. The causative agent penetrates into the organs and systems along with the blood flow and is retained in the liver. The parasite, called Echinococcus granulosus, develops in the form of a larva in the liver tissues and is encapsulated in the cyst; the alveococcus, Echinococcus multilocularis, is transformed into a pathological unit capable of germinating into nearby tissues. Echinococcosis leads to the displacement and squeezing of the bile ducts and the surrounding organs of the liver. The cyst of the liver, which belongs to the echinococcal species, can be single-celled, as well as multiple, multi-vesicular. Alveococcosis is similar to a tumor process, since it does not shift the tissue of the liver, but grows into it. The danger of alveococcal infection is that the pathogen is able to penetrate even into the lungs.

Other liver cysts include hydatid; autosomal recessive Caroli disease (rarely), characterized by segmental cystic enlargement of the intrahepatic bile ducts (often manifested clinically in adults with calculus formation, cholangitis and sometimes cholangiocarcinoma) and true cystic tumors (rarely).

How is the cyst of the liver recognized?

Unfortunately, the cyst of the liver, to which species it would not belong, is most often detected at random, during routine clinical examinations. Often, the patient is examined for gastrointestinal pathology, and the cyst is also diagnosed at the same time. Most often, the cyst of the liver is detected with ultrasound scanning or computer contrast tomography of the abdominal cavity. The main diagnostic task is the differentiation of cystic education in appearance - 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, cysts conduct studies called the Cazzoni reaction or the Gedin-Weinberg reaction. The method of Cazzoni is that the patient is intradermally injected with a fluid containing weakened echinococci. Positive is the answer, if after 10 minutes on the skin appears infiltration. The RCC - complement binding reaction according to the Gedin-Weinberg method is that the patient's blood is connected to the fluid of the echinococcus bubble and the activity of the response to antigen challenge is revealed. Oncoprocesses are confirmed or excluded by the blood test for oncomarkers (alpha-fetoproteins). A full detailed diagnosis helps to establish the category and type of cysts accurately, determine its size, structure, location. Diagnostic information is needed to develop a strategy and treatment tactics.

An isolated cyst of the liver is usually diagnosed accidentally with 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 kidney disease and other organs. In adults, this manifests itself as progressive hummocky hepatomegaly (sometimes massive). At the same time hepatocellular function of the liver is preserved, and portal hypertension does not develop.

Cyst of the liver: treatment

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

Cysts large or gigantic in size, especially complicated cystic formations, are subject to rapid removal. Types of surgical intervention: 

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

Partial or palliative surgery is indicated in rare cases when a radical operation is impossible due to concomitant severe pathologies. In such cases, an ostomy is applied (a specially created hole) that connects the cyst with the intestine or stomach (cystogastroanastomosis). It is extremely rare to perform an operation to dissect, remove the contents of the cyst and suturing its walls to the liver tissues. This method is called marsupialisation, from marsupium - a bag. Artificially created "bag" is gradually filled with granules and eventually overgrown in the form of a scar. A similar "pocket" is created when the liver cyst is located in the center of the gateway of the liver and strongly squeezes the bile ducts, that is, provokes portal hypertension. Marsupialization helps to reduce pressure in the portal vein and pressure is normalized. When cystic formation is scarring, a re-reconstructive surgical intervention is possible.

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

1. Radical operations, marsupialytic operations. 
2. Rupture, internal bleeding. 
3. Suppuration of the cyst. 
4. The cyst of the liver, the size of which exceeds 7-9 centimeters (giant neoplasms). 
5. Cystic formation localized in the portal portal vein of the liver, compressing the biliary tract. 
6. Cystic formation, which manifests itself as a critical symptom - dyspepsia, severe pain, cachexia.

Laparoscopic operations: 

• Isolated neoplasms, non-parasitic etiology. 
• Cysts, up to 8-10 centimeters in size. 
• A cyst of the liver that recurred after puncturing.

The liver cyst, removed by a laparoscopic method, most often does not recur. The operation itself is not very traumatic, the patient after it is restored quickly enough, and stay in the hospital, as a rule, does not exceed a week.

[5], [6], [7], [8]

Cyst of the liver, recommendations for behavior in the rehabilitation, postoperative period

All patients who underwent surgery, regardless of whether it was complete, cavitary or small - laparoscopic, should follow a strict diet for 6 months and a sparing diet throughout life. Excluded from the diet are fried, spicy, smoked and fatty foods, you need to control the content of cholesterol in foods. Also within a year after the operation, it is necessary to monitor the liver and undergo a routine ultrasound examination.

The liver cyst is rarely malignant, the number of patients diagnosed with oncology does not exceed 10% of all patients with a complicated cyst. In any case, the cyst is easier to treat or operate in the initial stage, when it does not reach a large size, so the measures for regular medical examination, as well as responsible attitude to one's own health on the part of the patients themselves, are so important.

[9], [10], [11], [12]