Hydatid Cyst.pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Introduction & History.

3. Introduction & History. Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus . 

4. Etiology

5. Etiology Human echinococcosis is a zoonotic infection caused by the tapeworm of the genus Echinococcus .  Echinococcus granulosus ,  causing cystic echinococcosis (CE)   Echinococcus multilocularis ,  causing alveolar echinococcosis (AE)   Echinococcus vogeli .

6. Life Cycle 

7. Life Cycle

8. Life Cycle 2 hosts , definitive and intermediate. Humans act as an accidental intermediate host. 3stages (1) the adult tapeworm in the definitive host (2) eggs in the environment, (3) the metacestode in the intermediate host.

9. Life Cycle Metacestodes are ingested by the definitive host. The metacestodes mature into the tapeworm in the definitive host and, in turn, release eggs into the environment. The intermediate host ingests the eggs, which hatch into metacestodes , which infest the liver, lungs, muscles, and other organs of the intermediate host.

10. Clinical Features

11. Clinical Features Rare in Europe and US. The cysts grow slowly, and a cyst is rarely diagnosed during childhood or adolescence unless the brain is affected. CE is a disease of younger adults, with an average age at diagnosis of 30-40 years.

12. Symptoms

13. Symptoms Many hydatid cysts remain asymptomatic, even into advanced age. Symptoms can be produced by mass effect or cyst complications. Nonspecific pain, cough, low-grade fever, and the sensation of abdominal fullness. 

14. Symptoms Echinococcosis can involve any organ. The liver is the most common organ involved, followed by the lungs. These 2 organs account for 90% of cases of echinococcosis Others -muscles (5%), bones (3%), kidneys (2%), brain (1%), and spleen (1%)..

15. Mass effects

16. Mass effects Liver-Abdominal lump, obstructive jaundice and abdominal pain. With biliary rupture, the classic triad of biliary colic, jaundice, and urticaria . Passage of hydatid membranes in the emesis ( hydatid emesia ) and passage of membranes in the stools ( hydatid enterica ) may occur rarely.

17. Lungs Chronic cough, dyspnea , pleuritic chest pain, hemoptysis . Expectoration of cyst membranes and fluid is observed with intrabronchial rupture.

18. Brain-SOL.

19. Brain-SOL. Headache, dizziness, decreased level of consciousness. Specific neurologic deficits may occur depending on the location of the cyst in the brain.

20. Secondary Complications

21. Secondary Complications Infection mild fever to full-blown sepsis. Leakage

22. Leakage  

23. Leakage  increased pain flushing and urticaria . Anaphylactic reaction, A rupture into the biliary tree can lead to obstruction by the daughter cysts, producing  cholangitis . Rupture into the bronchi can lead to expectoration of cyst fluid.

24. Pathology

25. Pathology A primary cyst in the liver is composed of three layers:  1.       Adventitia ( pseudocyst / pericyst ) – 2.       Laminated membrane ( ectocyst ) – is elastic white covering, easily separable from the adventitia.  3.      Germinal epithelium (endocyst) – is a single layer of cells lining the inner aspects of the cyst and is the only living component, being responsible for the formation of the other layers as well as the hydatid fluid and brood capsules within the cyst. In some primary cysts laminated membranes may eventually disintegrate and the brood capsules are freed and grow into daughter cysts.

26. Diagnostic Studies

27. Diagnostic Studies Laboratory Tests Imaging X-ray USG CT MRI Nuclear Scan Other Tests

28. IMAGING TECHNIQUES   Plain X-RAY Films: F indings from plain films of the chest, abdomen, or any other involved site are nonspecific and mostly non revealing . A thin rim of calcification delineating a cyst is suggestive of an echinococcal cyst.

29. USG .

30. Computed Tomographic scan

31. Other Tests

32. Other Tests Casoni test Historically, an intradermal skin test It is now largely abandoned because of its low sensitivity, low accuracy, and potential for severe local allergic reaction.

33. Other Tests ERCP -Endoscopic retrograde cholangiopancreatography : It is both diagnostic and therapeutic in patients with intrabiliary rupture of a hydatid cyst,.

34. Differential Diagnosis Long list Abscess Cysts.

35. Management Surgery is preferred

36. Operative Therapy

37. Operative Therapy Radical surgery (total pericystectomy or partial affected organ resection, Conservative surgery (open cystectomy ), Simple tube drainage-PAIR- Puncture, Aspiration , Injection , Reaspiration .

38. Chemotherapy Albendazole Mebendazole Praziquantel In inoperable

39. MCQs

40. MCQs Hydatid disease is caused by Echinococcus granulosus Echinococcus multilocularis Echinococcus vogeli .

41. MCQs Hydatid disease is caused by Echinococcus granulosus Echinococcus multilocularis Echinococcus vogeli .

42. MCQs Hydatid disease is a Fungal infection parasitic infestation Viral infection

43. MCQs Hydatid disease is a Fungal infection parasitic infestation Viral infection

44. MCQs Hydatid disease is caused by Ring worm Hook worm Tape worm

45. MCQs Hydatid disease is caused by Ring worm Hook worm Tape worm

46. MCQs Hydatid disease is caused by Ring worm Hook worm Tape worm

47. MCQs Man is definitive host of Hydatid disease . Man is intermediate host of Hydatid disease.

48. MCQs Man is definitive host of Hydatid disease . Man is intermediate host of Hydatid disease .

49. MCQs Most common site for Hydatid disease is Lung Liver Muscle Brain Bone.

50. MCQs Most common site for Hydatid disease is Lung Liver Muscle Brain Bone.

51. MCQs The only living part of Hydatid cyst is Pericyst . Ectocyst Endocyst

52. MCQs The only living part of Hydatid cyst is Pericyst . Ectocyst Endocyst

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