False about hydatid cyst-
Correct Answer: Hepatic resection is never done
Description: Ans. is 'd' i.e., Hepatic resection is never done Hydatid cyst of liver f (or Echinococcosis)o Cystic hydatid disease is caused by the larval/cyst stage of the tapeworm - Echinococcus granulosus (Other Echinococcus species affecting human are E. multiloculasis, E. vogeli & E. oligarthus).Man is the intermediate host of Echinococcus.Dog is the definitive host.Sheeps are the usual intermediate host, but humans are accidental intermediate hosts,o Organs commonly involved are liver and lung.The liver is involved in about two-third of E. granulosus infection and in nearly all E. multiloculasis infection,o Usually the cysts are single and involve the rt. lobe of liver.Clinical manifestationo Slowly enlarging echinococcal cysts are usually asymptomatic until their expanding size or their space occupying effect in the involved organ prduces symptoms o Symptoms when produced are - abdominal pain, dyspepsia, vomiting, hepatomegaly.DiagnosisoUSG and CT can diagnose the cystic lesion. There are certain signs which if present are pathognomic of hydatidDaughter cyst within the large cyst (may produce rosette appearance)Calcification of the wallo Serodiagnostic assay (ELISA) can be helpful in over 85% of patients.Treatmento Books differ on the treatment.According to Harrison-o Surgery has traditionally been the principal definitive method of treatment.o Currently 'PAIR' is the preferred method of t/t for sonologically appropriate lesions.PAIR is contraindjcatgiLfor :o Superficially located cysts (because of the risk of rupture)o For cysts with multiple thick internal septal divisions (honeycombing pattern)o For cysts communicating with the biliary tree,o Dead or inactive cystsPAIR stands for Percutaneous Aspirat ion Jn fusion ofscolicidal agents andReaspiration.In PAIR pt. is given prophhylactic coverage of albendazole; cyst is aspirated under ultrasound or CT guidance and scolicidal agents (ethanol or hypertonic saline) infused. Scolicidal agent is then reaspirated.PAIR has been found to'be equally effective as surgery with less morbidity and shorter hospital stay.o Surgery remains the treatment of choice for cysts where PAIR is not possible or cysts are refractory to PAIR and for complicated cysts (e.g. those communicating with the biliary tract). y Pericystectqmy is the preferred surgical approach, in which the complete cyst with surrounding fibrous tissue are removed.If surgical cystectomy is not technically feasible, then formal liver resection can be done.o For those patients who are poor candidates for cyst directed intervention (i.e. PAIR or surgery) - long durations of Albendazole is the mainstay of therapy.According to Schwartz (and Sabiston) -o Surgery is the preferred method of treatment, unless the cysts are small or the patient is not a suitable candidate for surgical resection.o For most cysts surgical resection involving laparoscopic or open complete cyst removal with instillation of a scolicidal agent is preferred and usually is curative.y If complete cystectomy is not possible, then formal anatomic liver resection can be used.o Treatment of Echinococcus multiloeularis.E. multiloeularis cyst is always multiloculated _T/t is surgical resection
Category:
Surgery
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