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Hepatic cystic changes and other common injuries

  1. Gastroepato
  2. Gastroenterology
  3. Hepatic cystic changes
  4. Cirrhosis
  5. Secondary biliary cirrhosis
  6. Percussion of the liver

Notes by dr. Claudio Italiano

Hepatic lesions

The main hepatic lesions are objectified by the ultrasound examination of the abdomen. The cyst is unitoculated in 95% of cases, and multilocular in 5% of cases. The dimensions are variable, from a few mm up to some tens of cm. In 90% of cases the cyst is smaller than 5 cm.

They are divide into:

-Multiple decontogenetic cysts (often also renal and pancreatic).
-Simple bile cysts
It results from dilatation of the bile ducts. The frequency is close to 5% of the liver ultrasound examinations. In at least half of the cases are multiple and are associated with renal cysts in one in four cases. The volume varies from a few millimeters to over 10-20 centimeters. An important characteristic is that they never communicate with the biliary tract. The frequency is higher in women with a ratio of 2 to 1.
The largest cysts are observed mainly over the age of fifty.

A solitary hepatic cyst, which appears to be a round or oval lesion on the ultrasound, and with no recognizable wall.

hydatidosis, liver ultrasound

Hepatic abscess

Hepatic angioma, ultrasound

Polycystic disease

Polycystic disease is characterized by the development of multiple cysts that have a macroscopic, histological and echographic appearance identical to that of simple cysts. On the nosographic level, however, they are two separate entities. Simple cysts are not hereditary, they are not associated with renal cysts and are more common in women than in men. Polycystic disease, on the other hand, is inherited as an autosomal dominant trait, is associated with polycystic kidney disease and affects men and women equally.

Cystic echinococcosis

Dog tapeworm infection (Echinococcus granulosus). To CT ultrasound: smooth and circumscribed cystic images, with different echogenicity from the parenchyma, with wall calcifications, evtl. baffles; demonstration of anti-tapeworm antibodies. The infestation of the man with the tarvic form of Echinococcus granulosus causes cystic echinococcosis which manifests itself with the formation of cysts more often found in the liver (50-70% of cases), and in lower frequency at the pulmonary level ( 20-30% of cases), splenic, renal, bone and in the central nervous system. . The liver disease of the liver can be asymptomatic, or manifest itself with a fever and a dense epatomegathy. In the case of cysts that compress the flow or bile system, high blood pressure or jaundice may occur. Cysts may break up in the biliary system, causing cholangitis, or in the peritoneal cavity or, by contiguity, in the right kidney. Other sites of rupture called cysts can be, through the diaphragm, a clear pleural, pericardial space, in the lung parenchyma or in the bronchi. The rupture of a hydatid cyst, containing highly antigenic material, carries the risk of anaphitactic reactions, even fatal.

Hepatic abscess

It's characterized by fever, increased ESR; ultrasound: hypoechoic image with echoes inside, evtl. presence of gas, usually round in shape and capsulated. The hepatic abscess results from a localized collection of purifying materiate, produced by a bacterial, fungal infection, or an amoebic infestation. E. Coli is the most commonly responsible pyogenic of hepatic abscesses. The abscess from pyogenic incidence varies from 0.006% to 2.2% of hospital admissions, depending on the case series. The infectious agent can reach the liver via the arterial system, the venous system carried, or the biliary tract. The most frequent origin of hepatic abscesses is represented by the biliary system (43%), with formation of the abscess due to contiguity (in particular in cases of acute cholecystitis), or consequently to an ascending cotangitis caused by an obstruction, lithiasic or neoptastic, of extrahepatic biliary tract. Fever with shivering, abdominal pain (particularly at right abdominal quadrant), weighted cato are the clinical features of common pffi. Sepsis, multi-organ failure, singly or associated, hepatic failure and mesenteric venous thrombosis may be the cause of death due to hepatic abscess. The ultrasound allows to guide the puncture of the abscess, the aspiration and the drainage of its contents, which will then be subjected to bacterioscopic, parasitological and cultured examination, and to possible cytological examination, and the hypothesis of differentiated diagnoses with metastases.

Hematoma

The hematoma is a localized blood collection within the hepatic parenchyma, below the Glisson capsule, with or without free rupture in perituted cavities. The most common causes are trauma, coagulopathies, intratumoured haemorrhage (adenoma), interventional procedures (liver biopsy), anticoagulant therapy. Clinically, the patient with hepatic hematoma may be asymptomatic, or present pain in the right hypochondrium, anemia, and hypotension, which can lead to shock. The ultrasound aspect called contusion and intraparenchimate hematoma is that of areas with a non-homogeneous echostructure, of various dimensions and distribution in the context of the organ. Typical is also the appearance of an irregular or roundish, hypoechoic area (the hematomas of recent motto onset may be hyperechoic), with blurred margins that become more defined in correspondence to the glissoniana and the vessels. On the other hand, the under-encapsulated hematoma has the typical "double contour" appearance, consisting of a semi-lunar area below the hepatic capsule which tends to follow the organ's profile. The ultrasound examination of the interruption called the hepatic capsule indicates a free rupture of the hematoma and is associated with the high presence of an intraperitoneate fluid collection. The hepatic hematoma undergoes morphotogical changes over time, due to intralesional organization processes.

Cistoadenoma of the liver

It is a very rare lesion: its prevalence is from 100 to 1000 times lower than that of simple cysts. Nine times out of ten it affects the female sex. The suspected diagnosis of cystadenoma often led in the past to work lesions that turned out to be simple cysts of the liver. It must be remembered that cystadenoma is very rare and that in relation to simple cysts it is truly exceptional. These are very voluminous lesions often symptomatic for compression that they exert in the abdomen with a tendency to increase in volume albeit slowly.

Angioma

Hepatic angioma is a vascular neoformation made up of vascular vests coated with endotetio with interposed connective tissue. It is possible to associate haemorrhage or catcification phenomena, and vascular spaces can present thrombosis inside. It is called benign hepatic lesion of the most common finding, with a total incidence ranging from 0.4% to 7%, and a higher frequency in the female sex. Most of the angiomas are small and asymptomatic. The dimensions are generally contained within 2-3 cm, and tend to remain stable over time. Instead, they can increase in number in subsequent checks. Larger angiomas, particularly when they are more than 4 cm in diameter, can cause hepatomegathy, a sensation of "weight" in the right hypochondrium, or pain, fever and anemia, in particular for hemorrhagic events. Nodular focolar hyperplasia is a benign primitive neoplasm most frequently found in women between 20 and 50 years of age. The association with the female sex is not as evident as for hepatic adenoma. According to some authors it is not certain that this is a neoplasm. In addition, although it has been hypothesized that nodular focalopapathy is associated with the use of oral contraceptives, most scholars agree that the natural history of this neoplasm is independent of estrogen-progestin therapy. In 75% of cases, focal nodular hyperplasia is asymptomatic; the symptoms, when they occur, are related to pain due to intrathoraciated hemorrhage or necrosis, infrequent complications. In 80-85% of cases, the hyperplasia nodutare focate is presented as a solitary noduto, smaller than 5 cm, located near the hepatic surface.

Liver metastases

Liver metastases are frequently found in clinical practice and, after cirrhosis, are the second cause of fatal liver disease. In the United States the incidence of clinically relevant liver metastases is at least 20 times greater than that of primary liver tumors. 30% of patients died of neoplastic disease are reported during the autopsy of liver metastases. The liver is home to metastases of several solid tumors, such as colorectal cancer, breast carcinoma, melanoma, neuroendocrine tumors, stomach cancer, pancreatic cancer, gynecological tumors (endometrium and ovary), the sarcomas of the soft parts, the kidney and adrenal tumors. In all these cases, a multidisciplinary approach (surgeon, oncologist, radiotherapist, radiologist, nuclear doctor) guarantees the correct therapeutic procedure customized for each individual case (surgery, chemotherapy, loco-regional therapies).

Clinic

Cysts are often a silent finding, occasionally found in the ultrasound survey, but their finding can be done also in the CT abdomen, magnetic resonance and angiography

Treatment

In almost all cases regardless of the cyst volume there is no indication of any treatment. A therapy can be discussed in cysts complicated by infection or hemorrhage or in very large cysts responsible for compression disorders. carefully the symptoms reported by the patient because often the cyst, accidentally discovered with the ultrasound, are charged functional disorders that have nothing to do with the cyst. Alongside traditional surgery, non-operative techniques have been used, but today the recommended solution is to intervene laparoscopically. The laparoscopic fenestration treatment of cysts appears today the best because the least invasive.

Topics on Gastroenterology