Hepatic cyst

Hepatic cyst is a benign formation that is fully filled with fluid. Most often, hepatic cysts are filled with transparent fluid without smell and color, but in some cases formation contain jelly-like substance or green-yellow fluid that may contain bilirubin, cholesterol, fibrin, mucin and epithelial cells. If there was bleeding inside hepatic cyst, its contents can be hemorrhagic, and infection of it can be accompanied by formation of purulent cream-like masses.

Hepatic cyst can be located in different segments, parts and joints of liver, on its surface or deep inside, sometimes formations have a bridge that’s called “cyst peduncle”. The diameter of cyst varies – most often, doctors diagnose hepatic cysts several centimeters wide, though in rare cases formations reached 25 centimeters and even more.

Classification of hepatic cysts

Hepatic cyst is a term that includes several medical entities of similar formations:

  • Real and false cysts. In the first case, we consider inborn cysts that have epithelial lining on the inner walls. Real cysts are divided into multichamber cystadenomas, simple/dermoid/retention cysts. False hepatic cysts have acquired nature, and most often, they form after inflammatory diseases, traumas and operations. Lining of false cyst cavity is liver tissue that was affected by fibrosis.
  • Single and multiple cysts. Here the difference lies in the number of cavities. If many cysts are revealed in one segment of organ, polycystosis of liver is diagnosed.
  • Non-parasite and parasite formations. In this case, doctors consider absence or presence of hydatid disease of liver – it conditions parasite cysts.

Causes of hepatic cysts

Neither doctors, nor scientists have common opinion towards what triggers development of hepatic cysts. In some cases, doctors take into account the duration of hormonal therapy: there’s an opinion that cysts can form as the result of inflammatory hyperplasia of biliary tracts.

As for false hepatic cysts, reasons are clear – necrosis of tumor, traumas of the liver, amebic process, or hydatid disease of liver.

Common symptoms of hepatic cysts

If the benign formation is pretty small, a person will not suffer from any symptoms. As a rule, first clinical symptoms reveal when the cyst reaches size of 7-8 cm, and if there are multiple cysts. It should be noted that there can be the following non-specific symptoms:

  • nausea, vomiting and reflux;
  • flatulency and thin stool;
  • sense of pushing in the area of right hypochondrium after eating or minor physical load;
  • general weakness;
  • low appetite, or full absence of it;
  • increased perspiration;
  • difficulty breathing during physical load and exercises;
  • high temperature up to subfebrile values.

If a big cyst has already formed in liver, there will be the following symptoms:

  • asymmetric inflation of belly;
  • sudden weight loss without visible reasons;
  • jaundice.

Sometimes there’s such condition as complicated hepatic cyst taking place: it means that there was bleeding inside the wall or cavity, purulence, twisting of cyst bridge, perforation of malignant development of cyst. If a bleeding or tearing of cyst took place, this condition will be accompanied by intense abdominal pains. In this case, there’s a risk of peritonitis or bleeding into abdominal cavity.

Complications and outcomes

  • Tearing of cyst and discharge of its contents into abdominal area or hollow organs (stomach, intestine).
  • Abscess of liver – collection of purulent mass in tissues of the organ.
  • Bleeding in cyst cavity.
  • Purulence of cyst.
  • Twisting of cyst attached with a bridge.
  • Mechanic jaundice (yellow skin, mucous membranes and sclerotic coat because of a high concentration of bilirubin in blood (hepatogenous pigment) that’s collecting because of obstruction of bile ducts (the passages through which bile flows).
  • In case of huge single cysts or polycystosis, liver failure can develop: it’s a complex of different symptoms that presuppose poor functioning of liver (functions include collection of bile (substance that’s used for digestion), collection of nutritive components, neutralization of toxins and poisonous substances, etc.) because of its damage.

Diagnosis of hepatic cysts

  • Analysis of patient’s medical history and his complaints (when painful sensations appeared, whether there’s vomiting and nausea, reflux and bloating, and what these symptoms are connected with).
  • Laboratory data:
    • General blood analysis: in case of cyst purulence, there’s a high level of leukocytes (white blood cells) in blood, and a high erythrocyte sedimentation rate – a value that signifies inflammatory process taking place in body.
    • Biochemical blood analysis: there can be a high level of glutamic-pyruvic transaminase – liver ferment that accelerates chemical processes in body, which proves there’s damage of liver tissues.
  • Instrumental data:
    • Ultrasound examination of abdominal cavity – non-invasive (without getting through skin or mucous membranes) examination of human body with the help of ultrasound waves. It allows revealing the presence of cysts, their sized and quantity.
    • X-ray examination of abdominal area – it’s done to define such signs of disease as change of liver contours, misplacement of diaphragm. In some cases, such examinations allow revealing cysts, if their walls have a sufficient amount of salts.
    • Computer tomography of abdominal area – a method that allows scanning different organs layer by layer with X-ray radiation. Computer tomography is used to define liver contours, presence of cysts, their size and quantity.
    • Magnetic-resonance imaging (MRI) a method that’s used to define pathological processes in soft tissues (muscles and inner organs). It shows presence of cysts, their sizes and quantity.
    • Percutaenous puncture (piecing) of cyst with cytological (cell) and bacterial analysis of material. It is used to define whether the cyst is caused by parasites or not.

Treatment of hepatic cyst

There are two kinds of treatment: non-surgical and surgical, as well as general recommendations.

General recommendations

  • Diet containing a higher amount of highly digestible protein, vitamins and minerals, animal fats should be restricted.
  • No alcohol consumption.

Conservative treatment is organized to eliminate the symptoms of disease

  • Pain-killers and antiemetic drugs are used to relieve pain, nausea and vomiting.
  • Hepatoprotectors (medications that protect liver tissues from damage) are used to normalize hepatic functions (production of bile (substance that is needed for digestion), collection of nutrients, neutralization of toxins, etc.).

Surgical treatment

  • In order to treat minor sole (single) cysts, doctors use puncture (piercing) and drainage (removal of fluids) of cyst, after which they inject sclerosing solution (a special solution that contributes to wall joining and dissolving of cyst).
  • If the cyst is so big that it causes compression of inner organs, doctors perform resection (partial removal) of liver together with the cyst, of cyst enucleation.

Surgical treatment of hepatical cyst

There are several indications for surgical treatment of benign liver diseases:

  • bleeding;
  • tearing/perforation of cyst wall;
  • purulence of cyst contents;
  • compression of bile ducts and disorders of bile discharge;
  • formations of big or giant sizes;
  • compression of portal vein system with portal hypertension;
  • intense symptoms that affect life quality.

All surgical invasions concerning hepatic cysts can be divided into radical, palliative and relatively radical. Radical invasion presupposes liver resection. If polycystosis in severe condition have been diagnosed, liver transplantation will be advised for the patient. Relatively radical surgical treatment of hepatic cyst presupposes enucleation of formation, or cutting of its walls. Modern medicine allows performing this operations by minimally invasive laparoscopic method. It is less painful, and doesn’t leave big scars afterwards. Besides, recovery period after minimal invasion is much shorter than with usual open operations. The vast majority of hospitals practice this approach to liver surgery.

Percutaenous cyst puncture is performed for sclerotherapy of formation. This operation is recommended, if the cyst is about 5-6 cm in diameter. Besides, the following methods of surgical treatment of benign cysts can be used:

  • in case of single post-trauma cysts that are complicated by wall tearing or purulence, surgeons perform prosection and exterior drainage;
  • central localization of cyst in portal fissure, compression of bile ducts and portal hypertension are treated by marsupialization (cyst emptying and stitching of its walls together with the edges of surgical wound);
  • multiple cysts (polycystosis) that’s accompanied by hepatic failure is treated by prosection and cutting of their free walls (fenestration);
  • if cysts are giant, surgeons resolve to cystogastroanastomosis, or cystoenteroanastomosis (they create a connective channel between liver cavity and the cavity of stomach or intestine).

Prognosis for hepatic cysts

After radical removal of sole liver cysts, prognosis is mostly positive. After palliative invasion, hepatic cysts can reoccur, which means medical treatment will be required again. However, the risk of experiencing cyst recurrence is relatively small.

General Surgery Department
Chief Physician

Hepatic cyst

Professor MD MD hc Guido Schumacher

Chief Physician

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