A hepatic cyst is a fluid-filled sac that forms in the liver, the largest organ in the human body. Hepatic cysts are common and usually benign, meaning they are not cancerous. They can range in size from very small to quite large and can occur as single cysts or multiple cysts within the liver.
Symptoms of hepatic cysts are often absent, especially in the case of simple cysts. However, if the cysts grow large, they can cause discomfort or pain in the upper right abdomen due to pressure on surrounding organs. In some cases, they might cause symptoms like nausea, vomiting, or a feeling of fullness.
Epidemiology
Hepatic cysts are relatively common, particularly as people age. Simple hepatic cysts are estimated to be present in about 2.5% to 18% of the population, with higher prevalence rates in older individuals. The prevalence of hepatic cysts tends to increase with age, especially after age 40.
Simple cysts are more common in women than in men. Complex hepatic cysts might have different gender distributions, and they can also be seen in children, although they are less frequent.
Anatomy
Pathophysiology
One theory suggests that hepatic cysts can develop from dilatation of the bile ducts within the liver. This can be due to factors such as obstruction of the bile ducts, inflammation, or changes in the normal flow of bile. Some hepatic cysts may be congenital, present at birth, or develop during fetal development. These cysts might arise from abnormal embryonic development of the liver’s structures.
It is thought that hepatic cysts may form when there is an imbalance between the secretion of fluid by the cells lining the cyst and the drainage of that fluid. This can result in fluid accumulation within the cyst, leading to its expansion. An imbalance between cell proliferation and apoptosis processes in the liver tissue might contribute to cyst formation. Abnormalities in these processes could lead to the growth of cysts.
Etiology
Congenital Factors: Some hepatic cysts are present from birth or develop during fetal development. Congenital factors can include genetic predispositions, abnormal embryonic development of the liver’s structures, or genetic mutations that influence cyst formation.
Genetic Factors: Genetic mutations and inherited conditions can contribute to the development of hepatic cysts. For example, polycystic liver disease is a genetic disorder characterized by multiple cysts in the liver. Mutations in specific genes can lead to the abnormal development of bile ducts and the subsequent formation of cysts.
Hormonal Factors: Hormonal changes and imbalances might also play a role in developing hepatic cysts. Hormones can influence cell growth and fluid secretion within the liver tissue.
Prognosis
Simple hepatic cysts usually have a good prognosis. They are generally non-cancerous and tend to remain stable or grow slowly over time. Complex hepatic cysts might have a more varied prognosis. These cysts can be associated with underlying liver conditions or have features suggesting a higher risk of complications.
Genetics
Prognostic Factors
Clinical History
Clinical History
Many hepatic cysts, especially simple cysts, do not cause symptoms and are discovered incidentally during medical imaging for unrelated issues. If the cysts are large or growing, they can cause pain or discomfort in the upper right abdomen. This pain can be dull, aching, or occasionally sharp.
It might be more pronounced during physical activity or when pressure is applied to the area. Large or symptomatic cysts might exert pressure on the stomach or adjacent organs, leading to feelings of nausea and occasional vomiting. If a cyst becomes infected, ruptures, or causes sudden complications, the onset of symptoms can be more acute, leading to sudden and severe pain, fever, and other signs of distress.
Physical Examination
Physical Examination
If the hepatic cysts are large or causing pressure on nearby organs, a physician might palpate the abdomen to check for any tenderness, fullness, or discomfort, especially in the upper right quadrant of the abdomen. Depending on the size and location of the cysts, they might contribute to hepatomegaly. Large hepatic cysts could cause abdominal distension.
In rare cases where hepatic cysts obstruct the bile ducts, jaundice might occur and can be observed during a physical examination. If hepatic cysts are causing significant disruption within the liver or obstructing blood flow, it might lead to ascites. If there are complications such as cyst infection or rupture, a physical examination might reveal signs of infection (e.g., fever, increased heart rate) or signs of acute abdominal distress.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Cholelithiasis
Gastric Dysmotility
Peptic Ulcer Disease
Hepatic Abscess
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Symptomatic Hepatic Cysts
Percutaneous Aspiration
Percutaneous aspiration, a minimally invasive procedure, can be employed either as a standalone technique or in conjunction with sclerosing agents like alcohol or minocycline hydrochloride to address hepatic cysts. In isolation, percutaneous aspiration involves the drainage of cyst fluid, offering symptomatic relief and potentially reducing the size of the cyst. However, it is noteworthy that percutaneous aspiration doesn’t possess a preventative effect against cyst recurrence.
When augmented with a sclerosing agent, the effectiveness of the procedure significantly improves, leading to a marked reduction in the likelihood of cyst recurrence. Introducing a sclerosing agent enhances the outcome by promoting adhesion and collapse of the cyst wall, discouraging fluid reaccumulation. This combined approach demonstrates improved outcomes in terms of both symptom management and the prevention of cyst reappearance.
Laparoscopic Deroofing
In cases where percutaneous aspiration is deemed impractical or fails to yield the desired results, an alternative approach known as laparoscopic deroofing can be considered. This surgical technique involves the removal of the upper portion of the cyst wall. While it boasts a significantly reduced likelihood of cyst recurrence compared to percutaneous aspiration, it is accompanied by the drawback of increased postoperative morbidity.
Complete cyst excision or Hepatectomy
Full cyst excision or hepatectomy represents the ultimate recourse among the available treatment options. These interventions are of a more radical nature and should be undertaken solely when deemed indispensable and as a measure of last resort.
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A hepatic cyst is a fluid-filled sac that forms in the liver, the largest organ in the human body. Hepatic cysts are common and usually benign, meaning they are not cancerous. They can range in size from very small to quite large and can occur as single cysts or multiple cysts within the liver.
Symptoms of hepatic cysts are often absent, especially in the case of simple cysts. However, if the cysts grow large, they can cause discomfort or pain in the upper right abdomen due to pressure on surrounding organs. In some cases, they might cause symptoms like nausea, vomiting, or a feeling of fullness.
Hepatic cysts are relatively common, particularly as people age. Simple hepatic cysts are estimated to be present in about 2.5% to 18% of the population, with higher prevalence rates in older individuals. The prevalence of hepatic cysts tends to increase with age, especially after age 40.
Simple cysts are more common in women than in men. Complex hepatic cysts might have different gender distributions, and they can also be seen in children, although they are less frequent.
One theory suggests that hepatic cysts can develop from dilatation of the bile ducts within the liver. This can be due to factors such as obstruction of the bile ducts, inflammation, or changes in the normal flow of bile. Some hepatic cysts may be congenital, present at birth, or develop during fetal development. These cysts might arise from abnormal embryonic development of the liver’s structures.
It is thought that hepatic cysts may form when there is an imbalance between the secretion of fluid by the cells lining the cyst and the drainage of that fluid. This can result in fluid accumulation within the cyst, leading to its expansion. An imbalance between cell proliferation and apoptosis processes in the liver tissue might contribute to cyst formation. Abnormalities in these processes could lead to the growth of cysts.
Congenital Factors: Some hepatic cysts are present from birth or develop during fetal development. Congenital factors can include genetic predispositions, abnormal embryonic development of the liver’s structures, or genetic mutations that influence cyst formation.
Genetic Factors: Genetic mutations and inherited conditions can contribute to the development of hepatic cysts. For example, polycystic liver disease is a genetic disorder characterized by multiple cysts in the liver. Mutations in specific genes can lead to the abnormal development of bile ducts and the subsequent formation of cysts.
Hormonal Factors: Hormonal changes and imbalances might also play a role in developing hepatic cysts. Hormones can influence cell growth and fluid secretion within the liver tissue.
Prognosis
Simple hepatic cysts usually have a good prognosis. They are generally non-cancerous and tend to remain stable or grow slowly over time. Complex hepatic cysts might have a more varied prognosis. These cysts can be associated with underlying liver conditions or have features suggesting a higher risk of complications.
Clinical History
Many hepatic cysts, especially simple cysts, do not cause symptoms and are discovered incidentally during medical imaging for unrelated issues. If the cysts are large or growing, they can cause pain or discomfort in the upper right abdomen. This pain can be dull, aching, or occasionally sharp.
It might be more pronounced during physical activity or when pressure is applied to the area. Large or symptomatic cysts might exert pressure on the stomach or adjacent organs, leading to feelings of nausea and occasional vomiting. If a cyst becomes infected, ruptures, or causes sudden complications, the onset of symptoms can be more acute, leading to sudden and severe pain, fever, and other signs of distress.
Physical Examination
If the hepatic cysts are large or causing pressure on nearby organs, a physician might palpate the abdomen to check for any tenderness, fullness, or discomfort, especially in the upper right quadrant of the abdomen. Depending on the size and location of the cysts, they might contribute to hepatomegaly. Large hepatic cysts could cause abdominal distension.
In rare cases where hepatic cysts obstruct the bile ducts, jaundice might occur and can be observed during a physical examination. If hepatic cysts are causing significant disruption within the liver or obstructing blood flow, it might lead to ascites. If there are complications such as cyst infection or rupture, a physical examination might reveal signs of infection (e.g., fever, increased heart rate) or signs of acute abdominal distress.
Differential Diagnoses
Cholelithiasis
Gastric Dysmotility
Peptic Ulcer Disease
Hepatic Abscess
Symptomatic Hepatic Cysts
Percutaneous Aspiration
Percutaneous aspiration, a minimally invasive procedure, can be employed either as a standalone technique or in conjunction with sclerosing agents like alcohol or minocycline hydrochloride to address hepatic cysts. In isolation, percutaneous aspiration involves the drainage of cyst fluid, offering symptomatic relief and potentially reducing the size of the cyst. However, it is noteworthy that percutaneous aspiration doesn’t possess a preventative effect against cyst recurrence.
When augmented with a sclerosing agent, the effectiveness of the procedure significantly improves, leading to a marked reduction in the likelihood of cyst recurrence. Introducing a sclerosing agent enhances the outcome by promoting adhesion and collapse of the cyst wall, discouraging fluid reaccumulation. This combined approach demonstrates improved outcomes in terms of both symptom management and the prevention of cyst reappearance.
Laparoscopic Deroofing
In cases where percutaneous aspiration is deemed impractical or fails to yield the desired results, an alternative approach known as laparoscopic deroofing can be considered. This surgical technique involves the removal of the upper portion of the cyst wall. While it boasts a significantly reduced likelihood of cyst recurrence compared to percutaneous aspiration, it is accompanied by the drawback of increased postoperative morbidity.
Complete cyst excision or Hepatectomy
Full cyst excision or hepatectomy represents the ultimate recourse among the available treatment options. These interventions are of a more radical nature and should be undertaken solely when deemed indispensable and as a measure of last resort.
medtigo
Hepatic Cysts
Updated :
August 21, 2023
A hepatic cyst is a fluid-filled sac that forms in the liver, the largest organ in the human body. Hepatic cysts are common and usually benign, meaning they are not cancerous. They can range in size from very small to quite large and can occur as single cysts or multiple cysts within the liver.
Symptoms of hepatic cysts are often absent, especially in the case of simple cysts. However, if the cysts grow large, they can cause discomfort or pain in the upper right abdomen due to pressure on surrounding organs. In some cases, they might cause symptoms like nausea, vomiting, or a feeling of fullness.
Hepatic cysts are relatively common, particularly as people age. Simple hepatic cysts are estimated to be present in about 2.5% to 18% of the population, with higher prevalence rates in older individuals. The prevalence of hepatic cysts tends to increase with age, especially after age 40.
Simple cysts are more common in women than in men. Complex hepatic cysts might have different gender distributions, and they can also be seen in children, although they are less frequent.
One theory suggests that hepatic cysts can develop from dilatation of the bile ducts within the liver. This can be due to factors such as obstruction of the bile ducts, inflammation, or changes in the normal flow of bile. Some hepatic cysts may be congenital, present at birth, or develop during fetal development. These cysts might arise from abnormal embryonic development of the liver’s structures.
It is thought that hepatic cysts may form when there is an imbalance between the secretion of fluid by the cells lining the cyst and the drainage of that fluid. This can result in fluid accumulation within the cyst, leading to its expansion. An imbalance between cell proliferation and apoptosis processes in the liver tissue might contribute to cyst formation. Abnormalities in these processes could lead to the growth of cysts.
Congenital Factors: Some hepatic cysts are present from birth or develop during fetal development. Congenital factors can include genetic predispositions, abnormal embryonic development of the liver’s structures, or genetic mutations that influence cyst formation.
Genetic Factors: Genetic mutations and inherited conditions can contribute to the development of hepatic cysts. For example, polycystic liver disease is a genetic disorder characterized by multiple cysts in the liver. Mutations in specific genes can lead to the abnormal development of bile ducts and the subsequent formation of cysts.
Hormonal Factors: Hormonal changes and imbalances might also play a role in developing hepatic cysts. Hormones can influence cell growth and fluid secretion within the liver tissue.
Prognosis
Simple hepatic cysts usually have a good prognosis. They are generally non-cancerous and tend to remain stable or grow slowly over time. Complex hepatic cysts might have a more varied prognosis. These cysts can be associated with underlying liver conditions or have features suggesting a higher risk of complications.
Clinical History
Many hepatic cysts, especially simple cysts, do not cause symptoms and are discovered incidentally during medical imaging for unrelated issues. If the cysts are large or growing, they can cause pain or discomfort in the upper right abdomen. This pain can be dull, aching, or occasionally sharp.
It might be more pronounced during physical activity or when pressure is applied to the area. Large or symptomatic cysts might exert pressure on the stomach or adjacent organs, leading to feelings of nausea and occasional vomiting. If a cyst becomes infected, ruptures, or causes sudden complications, the onset of symptoms can be more acute, leading to sudden and severe pain, fever, and other signs of distress.
Physical Examination
If the hepatic cysts are large or causing pressure on nearby organs, a physician might palpate the abdomen to check for any tenderness, fullness, or discomfort, especially in the upper right quadrant of the abdomen. Depending on the size and location of the cysts, they might contribute to hepatomegaly. Large hepatic cysts could cause abdominal distension.
In rare cases where hepatic cysts obstruct the bile ducts, jaundice might occur and can be observed during a physical examination. If hepatic cysts are causing significant disruption within the liver or obstructing blood flow, it might lead to ascites. If there are complications such as cyst infection or rupture, a physical examination might reveal signs of infection (e.g., fever, increased heart rate) or signs of acute abdominal distress.
Differential Diagnoses
Cholelithiasis
Gastric Dysmotility
Peptic Ulcer Disease
Hepatic Abscess
Symptomatic Hepatic Cysts
Percutaneous Aspiration
Percutaneous aspiration, a minimally invasive procedure, can be employed either as a standalone technique or in conjunction with sclerosing agents like alcohol or minocycline hydrochloride to address hepatic cysts. In isolation, percutaneous aspiration involves the drainage of cyst fluid, offering symptomatic relief and potentially reducing the size of the cyst. However, it is noteworthy that percutaneous aspiration doesn’t possess a preventative effect against cyst recurrence.
When augmented with a sclerosing agent, the effectiveness of the procedure significantly improves, leading to a marked reduction in the likelihood of cyst recurrence. Introducing a sclerosing agent enhances the outcome by promoting adhesion and collapse of the cyst wall, discouraging fluid reaccumulation. This combined approach demonstrates improved outcomes in terms of both symptom management and the prevention of cyst reappearance.
Laparoscopic Deroofing
In cases where percutaneous aspiration is deemed impractical or fails to yield the desired results, an alternative approach known as laparoscopic deroofing can be considered. This surgical technique involves the removal of the upper portion of the cyst wall. While it boasts a significantly reduced likelihood of cyst recurrence compared to percutaneous aspiration, it is accompanied by the drawback of increased postoperative morbidity.
Complete cyst excision or Hepatectomy
Full cyst excision or hepatectomy represents the ultimate recourse among the available treatment options. These interventions are of a more radical nature and should be undertaken solely when deemed indispensable and as a measure of last resort.
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