Hydatid disease-final

Hydatid DiseaseAT A GLANCE

Prepared by;Ibrahim Shibl 6th year medical student

Under supervision of;Prof. Dr. Mona ShehataProf. Dr. Walaa El-khalawany

• Tanta University• Faculty of Medicine• Tropical Medicine and Infectious

Diseases Department

Agenda 📑 Definition & clinical varieties Epidemiology Life cycle & cyst formation Management

Diagnosis History taking Clinical presentation Complications Investigations

Treatment Prevention

Definition

Hydatid disease or echinococcosis is a parasitic zoonosis, caused by the larval stages of different species of the cestode (tapeworm) of genus Echinococcus.

Clinical varieties

Echinococcus

E. granulosus

Cystic echinococcosis

E. multilocularis

Alveolar echinococcosis

E. vogeli

Polycystic echinococcosis

Distribution of E. granulosus

Life cycle of E. granulosus

Cyst formation

Liver 70%

Pulmonary

Spleen, brain, bone

Cyst formation

a)Germinal layerb)Daughter cyst c)Scolicesd)Cavity of primary cyst

e)Laminated layerf)Host response layer

Agenda 📑 Definition & clinical varieties Epidemiology Life cycle & cyst formation Management



We are here

Management of a case of liver hydatid cystHistory

Clinical presentation

Unless complicated, diagnosis is based mainly on CLINICAL SUSPICION


Asymptomatic


NNcomplicated?!!

complications

Rupture

Peritoneal

cavity

Bile duct

Hepatic vein

Lung

Colon

1. Rupture

complications

Secondary invasion by pyogenic organisms follows rupture into biliary passages, giving the picture of a pyogenic abscess

2. Infection

complications

Recurrent urticaria

Anaphylactic shock

3. Hydatid allergy

complications

4. Pressure necrosisExpansion of the cyst may cause pressure necrosis of the surrounding tissues with deterioration of function

5.Membranous glomerulonephritismay be related to glomerular deposits of hydatid antigen

Investigations

1. US is the main diagnostic tool

A. Imaging

US staging

US staging Active

1. CL: cystic lesion with no cyst wall2. CE1: with cyst wall3. CE2: with cyst wall + internal septation

Transitional 4. CE3: detached laminar layer (water-lily

sign) / partially collapsed Inactive

5. CE4: heterogeneous mass6. CE5: thick calcified wall

Investigations

2. X ray

A. Imaging

Investigations

3. CT scan

A. Imaging

Investigations B. ELISA

Investigations C. Eosinophilia

Eosinophilia of greater than 7% is found in about 30% of patients.

Eosinophilia may follow leakage or rupture of a cyst. NNN

Agenda 📑 Definition & clinical

varieties Epidemiology Life cycle & cyst formation Management



✌ Almost there 📑

Treatment options of liver hydatid cyst

Medical Percutaneous drainage

Surgery Radical Conservative

Approach Open Laparoscopic

According to; Size of the cyst Location of the cyst Clinical Manifestations

Overall health of the patient

US staging

Treatment

Mebendazole Albendazole

1. medical For small CL, CE1 and CE3

Treatment 2. Percutaneous drainage “PAIR technique”

For large CE1 lesions and uncomplicated CE3

US guided;

Percutaneous punctureAspirateInject 95% ethanol or hypertonic saline

Re-aspirate


Usually albendazole prophylaxis is started 1 week before PAIR and continued for 3-4 weeks thereafter

PAIR technique is done with extreme caution and under umbrella of antihistamines and corticosteroids for fear of anaphylaxis


PAIR is contraindicated for;1. Superficially located cysts (risk of

rupture)2. Cysts with multiple thick internal septal

divisions (honeycombing pattern)3. Cysts communicating with the biliary tree4. Calcified or inactive cysts

Treatment 3. Surgery

cystectomy segmentectomy Hemi-hepatictomy

Prevention of hydatid disease

✉ Take-home message

Echinococcosis is still endemic in middle east and Mediterranean countries ---- keep in mind

Suspicion is always in favor of your patient

Prevention is better than cure

If I ask you about this presentation after 1 week, you should be able to remember THREE points

Hydatid disease-final

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