CONCEPTS AND CAUSES OF LIVER CYSTS
Liver cysts are called the presence in the liver of lesions more or less rounded and of variable size formed by a wall with liquid content inside. The vast majority are diagnosed casually when doing an imaging study, such as an ultrasound, usually for another reason, and usually, do not produce any symptoms. As it has been commented, the size can be variable, from few millimeters to giant cysts of several centimeters and that can occupy a great part of the liver.
The causes of these cysts are very varied, so we will discuss some of them below:
Simple cyst: it is the most frequent type of cyst and it is totally benign. It is composed of clear fluid and does not communicate with the intrahepatic bile ducts. Normally they do not give any symptoms and when they do it is usually due to the development of complications, especially in large cysts, which may present spontaneous bleeding, infections, cyst twisting, rupture, etc. Simple cysts are located more frequently on the right side of the liver and also usually appear more in women.
Polycystic liver disease: is a disease characterized by the development of many cysts in the liver, usually related to the presence of multiple cysts in the kidney, being more frequent as the patient gets older and there is more kidney damage. There is another rarer, genetic form that is not related to renal cysts.
Hydatid cyst: is a cyst produced by the larva of a parasite called Echinococcus granulosus that is usually spread through infected dogs. In the liver, symptoms usually occur when they are large and complicated.
Tumors: there are tumors with the cystic appearance that usually develop intrahepatic bile ducts, being rare. In addition, there may be secondary tumors (metastases) in the liver of another origin: ovary, colon, pancreas, kidney … whose appearance is similar to that of a cyst.
Biliary cysts: are dilatations of intrahepatic biliary branches giving rise to the appearance of a cyst. Usually, they tend to give complications such as stenosis (narrowing of the ducts), infections, stone development, breaks.
SYMPTOMS OF LIVER CYSTS
In most cases the liver cysts are asymptomatic. In a small percentage of patients can cause symptoms derived, especially from large:
By compression of nearby digestive structures, causing abdominal distension, early satiety, among others.
Due to complications of the cyst itself, such as rupture of the same or intracystic bleeding. Infrequent circumstances and that can appear in the large ones, as we have already indicated.
DIAGNOSIS OF LIVER CYSTS
The liver cysts are a heterogeneous group of lesions with a different origin, frequency, and symptoms. Most are diagnosed accidentally in imaging studies that are performed for another reason and have a benign behavior. Only a minority produce symptoms or complications. The larger ones are more likely to produce symptoms or complicate. Some specific types of cysts have unique complications such as malignant transformation in the mucinous cyst by anaphylactic shock (severe allergic reaction) in the hydatid cyst.
The diagnosis of hepatic cysts is made by imaging techniques that also help us differentiate them. The initial diagnostic test is abdominal ultrasound, which is also very useful in the follow-up of the lesions. When there are doubts about the diagnosis, abdominal computed tomography (CT) and / or Magnetic Resonance (MR) can be performed. The use of intravenous contrast helps to differentiate the lesions since the contrast uptake is different in each of them. In addition, the contrast may show characteristics of the cyst that are not visible in the absence of contrast. The puncture of the cysts is not usually necessary for the diagnosis.
WHAT TREATMENTS ARE AVAILABLE FOR LIVER CYSTS?
Liver cysts are abnormal spaces filled with fluid within the parenchyma. Depending on whether they are single or multiple, they have different clinical management.
Simple cysts: they are usually of congenital origin and is the most frequent lesion of the liver, with an incidence of 2.5%, more frequent in women. They are usually asymptomatic and discovered by chance by performing an imaging test for another reason. They tend to be smaller than 5 cm and do not have the potential to malignify, although uncommonly they can present complications, such as bleeding or compression of neighboring structures, when they reach a large size.
Only in these cases would it be indicated to perform a treatment of it, either by puncture-aspiration and sclerosis of it with alcohol or by laparoscopic surgery in Delhi. Through imaging tests (ultrasound, CT, Resonance) can be distinguished well from other cystic lesions such as hydatid cyst or cystadenoma that would have another therapeutic approach.
Solitary and asymptomatic cysts do not require any treatment (even if they are large).
In case of multiple cysts (> 3), but in a limited number, it would be called multicystic hepatic disease and with similar management than isolated simple cysts.
Polycystic liver disease: is a rare disease with the presence of an infinity of cysts distributed diffusely within the liver parenchyma. It is usually associated with polycystic kidney disease, although it can also occur in isolation.
In this entity there are many liver cysts of variable size between millimeters and up to 10 cm or more.
Rarely need treatment, and is usually conditioned by the size of the cysts that causes discomfort or compression of neighboring structures or by the presence of intracystic complications (bleeding or infection). The appropriate treatment is surgical fenestration, which consists of the opening of the cyst to the peritoneal cavity, the laparoscopic approach is recommended, which implies lower morbidity, although sometimes it must be performed in an open manner depending on the size or presence of adhesions. Percutaneous treatment by injection of sclerosing agents is usually reserved for when there is a dominant cyst, since treating all cysts in this way is practically impossible.
In selected cases, a partial hepatic resection can be considered, when the cysts do not respond to previous therapies and there is enough residual functioning liver tissue, although this approach is very aggressive and may hinder subsequent liver transplantation.
Finally, in case of advanced liver failure or severe symptoms that hinder the quality of life, liver transplantation is suggested by a laparoscopic surgeon in Delhi, usually associated with kidney transplantation when both entities are associated, with very good results and long survival. Although this treatment is limited by the limited availability of organs.