Hepatic Infections: Hepatitis, Abscess & Cysts with Dr. Alex Bondoc

In symptomatic simple hepatic cysts, there is a 1 to 9 male to female predominance.

Simple hepatic cysts are more often noted in the right lobe, probably just a mass issue because right lobe is larger than the left.

Aspiration and sclerosis for hepatic cysts has a recurrence rate in the low single digit range according to retrospective data.

Surgical cyst unroofing has a recurrence rate anywhere from 0 to 14% across various series.

Complications of surgical cyst unroofing include post-op bleeding, development of an abscess, or bile leak.

Sclerosis for hepatic cysts uses 70% ethanol with risks including ethanol toxicity.

Mucinous cystic neoplasm of the liver is very similar in histologic appearance to the mucinous cystic neoplasm of the ovary.

Mucinous cystic neoplasm often occurs more in adults and females and is often symptomatic as it is a true neoplasm rather than a simple cyst.

It is not a great idea to biopsy mucinous cystic neoplasm because you can seed the peritoneum or tract, especially if it's an invasive carcinoma.

Echinococcal cysts represent the larval stage of a dog tapeworm, with ova traveling via the intestine through an enteral route through the portal vein.

The most feared complication of intervention on echinococcal cysts is rupture causing anaphylaxis from spilling cystic material.

Echinococcal cysts are treated both pre and post-operatively with anti-parasitic albendazole.

WHO has a classification system for hydatid disease that grades it, with more active daughter cysts increasing likelihood of spillage or complications.

If daughter cysts are more predominant in echinococcal disease, WHO does not recommend the PAIR technique and favors open surgery.

Ciliated hepatic foregut cyst is histologically analogous to a bronchogenic cyst with ciliated pseudostratified columnar epithelium, followed by smooth muscle, connective tissue, and fibrous capsule.

Ciliated hepatic foregut cyst can transform into a squamous cell carcinoma.

The mass of the right lobe is usually about 60% of the liver and the blood flow to the right lobe accordingly is bigger, so infectious agents preferentially head to the right liver.

25% of hepatic abscesses occur in the first year of life and 50% in the first 5 years of age.

Risk factors for hepatic abscess include instrumentation of the biliary tree, diabetes, proton pump inhibitor use, chronic granulomatous disease, and immunosuppression.

Common organisms in hepatic abscess include E. coli and Klebsiella (enteric gram-negative rods), and Streptococcus pyogenes and Staphylococcus aureus (gram-positive cocci).

In the modern period, one author suggested Staphylococcus to be the most common organism in hepatic abscess.

If Streptococcus milleri is cultured from a hepatic abscess, one would be obligated to look for disseminated, specifically ocular and neuraxial infection.

For hepatic abscesses greater than 5 centimeters, there is more propensity to leave a catheter rather than just aspirate and treat with antibiotics.

One author suggested treatment for hepatic abscess consists of 4 to 6 weeks of IV antibiotics followed by 4 to 6 weeks of oral antibiotics.