← All decks
The first 25 slides, exactly as they appear. The full deck has 190 content slides.
General Surgery
Hepatic Abscess and Cystic Disease of the Liver
Built from Maingot's Abdominal Operations
What’s inside
8 sections · 190 slides
Overview
- Cystic lesions of the liver
- The seven lesions covered here
- Classification of cystic hepatic lesions
Pyogenic liver abscess
A pus-filled cavity in the liver caused by bacteria
- Pyogenic liver abscess defined
- How treatment changed over time
- Where the bacteria come from
- Six routes of infection to the liver
- Changing etiology of pyogenic liver abscess
- Biliary causes
- Bowel causes
- Spread from neighbouring disease and from injury
- Arterial and cryptogenic causes
- How often it happens
- Conditions that make it more likely
- Age pattern
- Predicting trouble in older patients
- Pyogenic liver abscess in children
- Predisposing factors for pyogenic liver abscess
- Number, size and site of the abscess
- Confirming the diagnosis by culture
- Which organisms grow
- Organisms isolated from pyogenic liver abscesses
- The organism follows the source
- Klebsiella pneumoniae liver abscess
- How patients present
- Less obvious presentations
- Symptoms of pyogenic liver abscess
- Signs and laboratory data in pyogenic liver abscess
- Blood tests
- Plain X-rays
- Gas-filled right lobe abscess on plain film
- Ultrasound
- Pyogenic liver abscess on ultrasound
- Blood vessels blocking the drainage path
- Computed tomography
- Pyogenic abscess on CT and drainage of a posterior abscess
- Liver abscesses on MRI
- Communicating abscess on cholangiogram
- Two things must be treated
- Antibiotic choice
- How long, and for whom
- Antibiotics for Klebsiella abscess
- Candidal liver abscess
- Antifungal choice
- Needle aspiration versus catheter drainage
- Recurrence guides the choice
- Right lobe abscess before and during drainage
- Shrinking cavity on sinogram and CT
- Surgical drainage
- Who still needs an operation
- Complications
- Complications of Klebsiella abscess
- Outcome
- Factors linked to a poor outcome
- Outcome of Klebsiella abscess
Amebic liver abscess
A single-celled parasite that eats its way into the liver
- Amebic liver abscess defined
- Two amoeba species
- From swallowed cyst to liver abscess
- What the abscess contains
- How common it is worldwide
- Who is at risk
- Age and sex pattern
- What happens in the bowel
- Amebic colitis
- How the liver is involved
- Making the diagnosis
- Typical symptoms
- Symptoms of amebic liver abscess
- Signs and laboratory data in amebic liver abscess
- Blood and stool tests
- Amebic versus pyogenic abscess
- Imaging in amebic abscess
- How slowly the scan clears
- Serology
- When to aspirate
- Better laboratory tests
- Drugs come first
- Metronidazole in practice
- Finish with a gut-acting drug
- Does aspirating help?
- When to drain anyway
- Percutaneous and surgical drainage
- Complications
- Paths of extension of amebic liver abscess
- Chest complications
- Rupture into pleura or bronchus
- Heart and brain complications
- Outcome
- Factors linked to a poor outcome in amebic abscess
Hydatid liver cyst
A tapeworm larva that builds a walled cyst inside the liver
- Hydatid disease defined
- Where the cysts settle
- Life cycle of the tapeworm
- Life cycle in detail
- Life cycle of Echinococcus granulosus
- How humans catch it and how fast cysts grow
- How common it is, and prevention
- How the cyst behaves
- The three layers of a hydatid cyst
- The pericyst
- The laminated membrane
- The germinal membrane
- Brood capsules and hydatid sand
- Daughter cysts
- Ectogenic vesiculation and E. multilocularis
- Clinical presentation
- Symptoms, signs and laboratory data in hydatid liver cysts
- Blood tests for hydatid disease
- Imaging
- The Gharbi classification
- Ruptured and calcified hydatid cysts on CT and ERCP
- Bile ducts opening into a hydatid cyst
- Differential imaging and character of hepatic cysts
- Reading the cyst comparison
- The rest of the imaging work-up
- Treatment principles
- Drug treatment
- The PAIR technique
- How percutaneous treatment became acceptable
- Results of percutaneous treatment
- Who can be treated percutaneously
- When not to puncture
- Complications of percutaneous treatment
- The risks that remain
- Surgery: the objectives
- Why cysts come back after surgery
- Scolicidal agents
- What the World Health Organization advises
- Open cyst evacuation
- Open cyst evacuation and pericystectomy
- Laparoscopic cyst evacuation
- Finishing the laparoscopic operation
- Laparoscopic results compared with open
- Pericystectomy step by step
- Pericystectomy in practice
- Liver resection and transplantation
- Choosing the operation in uncomplicated patients
- Choosing the operation in complicated patients
- Complications
- Rupture into the bile ducts
- Fistulae, retention cysts and free rupture
- Outcome
- Follow-up and mortality
Congenital liver cysts
Cysts present from birth: solitary simple cysts and polycystic liver disease
- Two kinds of congenital liver cyst
- How common simple cysts are
- Where simple cysts come from
- How simple cysts present
- Imaging simple cysts
- Large simple cyst compressing the hepatic veins
- Watching, and why aspiration fails
- Surgery for simple cysts
- Treatment options for congenital liver cysts
- Laparoscopic unroofing
- Polycystic liver disease
- How polycystic liver disease behaves
- Polycystic liver disease on CT
- Treating polycystic liver disease
- Limits of unroofing, and transplantation
Neoplastic liver cysts
Cystic tumours of the liver: cystadenoma and cystadenocarcinoma
- Cystic tumours of the liver
- Diagnosis and tumour markers
- Biliary cystadenoma
- Symptoms and imaging of cystadenoma
- Septated cystic liver tumor on ultrasound
- Liver cystadenoma at operation
- Liver cystadenoma after removal
- Why imaging alone is not enough
- Cyst fluid analysis
- Treatment of cystadenoma
- Treatment options for neoplastic liver cysts
- Cystadenocarcinoma
- Cystadenocarcinoma on CT
Traumatic liver cysts
A bile leak after liver injury that walls itself off
- Changing management of liver trauma
- How a traumatic cyst forms
- What a traumatic cyst is
- Traumatic hepatic cyst on CT and ultrasound
- Injury during gallbladder surgery
- Assessing a bile duct injury
- Treatment of traumatic cysts
Pulling it together
What to carry away from cystic disease of the liver
- Telling the four abscess-like lesions apart
- What each one needs
- Traps worth remembering
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition