HYDATID CYST AND LIVER ABSCESS

HYDATID CYST AND LIVER ABSCESS

1. HYDATID CYST

AETIOLOGY

• Caused by the larval stage of Echinococcus granulosus, a cestode (tapeworm).

• Definitive host: Dog

• Intermediate hosts: Sheep, cattle, and humans (accidental hosts).

• Transmission occurs via ingestion of eggs from contaminated food, water, or direct contact with infected dogs.

• After ingestion, the embryos penetrate the intestinal mucosa, reach the liver through the portal circulation, and form cysts.

CLASSICAL AYURVEDIC CORRELATION
Hydatid cyst may be correlated with Yakrit Granthi or Yakrit Vidradhi depending upon the presentation.

“यकृत्प्लीहोरसौ दोषैः समुत्थौ श्लेष्मणोऽधिका।”
(Su. Ni. 9/30)
– Explains the formation of granthi in liver and spleen due to predominance of Kapha and Pitta.

CLINICAL FEATURES

• Often asymptomatic in early stages.

• Symptoms appear as cyst enlarges:

  • Right upper quadrant pain

  • Abdominal mass

  • Nausea, vomiting

  • Jaundice (if biliary obstruction occurs)

  • Anaphylactic reaction due to cyst rupture

  • Fever (if infected)

MODERN CLINICAL CORRELATION

• Hepatomegaly with cystic consistency

• Hydatid thrill (palpable vibratory sensation due to hydatid sand)

DIAGNOSIS

• Imaging Studies:

  • Ultrasound (USG): First line, shows well-defined cyst with daughter cysts.

  • CT Scan / MRI: Better delineation of internal architecture and complications.

• Serological Tests:

  • ELISA

  • Indirect hemagglutination test

  • Complement fixation test

• Histopathology: Shows laminated ectocyst and germinal layer.

MANAGEMENT

• Medical Treatment:

  • Albendazole (10-15 mg/kg/day) for 1-3 months.

  • Mebendazole (as alternative).

• Surgical Management:

  • PAIR (Puncture, Aspiration, Injection, Reaspiration): minimally invasive

  • Cystectomy / Pericystectomy

  • Laparoscopic cyst removal

AYURVEDIC MANAGEMENT

• Shodhana Chikitsa – Virechana for Pitta–Kapha disorders.

• Shamana Aushadhi:

  • Triphala Guggulu, Kanchanara Guggulu, Punarnavadi Kashaya

• Bhedana Karma in case of pus collection (Sushruta Chikitsa Sthana 1/38)

“शोफेषु पित्तकफजेषु बोधनं पाचनं हितम्।
बस्तिशोधनमादाय स्रंसनं चोपयोजयेत्॥”
(Su. Chi. 1/38)

2. LIVER ABSCESS

AETIOLOGY

• Pyogenic Liver Abscess (PLA):

  • Caused by bacterial infection (e.g., E. coli, Klebsiella, Streptococcus, Anaerobes)

  • Source: Biliary tract infections, portal vein seeding (e.g., appendicitis), direct spread, trauma.

• Amoebic Liver Abscess (ALA):

  • Caused by Entamoeba histolytica

  • Transmitted via contaminated food or water.

  • More common in tropical countries.

CLASSICAL AYURVEDIC CORRELATION
Liver abscess may be correlated with Yakrit Vidradhi (suppurative swelling of the liver).

“प्लीहायकृत् कफपित्ताभ्यां दोषाभ्यां सन्निपाततः।
विद्रधिं जनयेत् क्रुद्धं स प्लीहायकृत् उदाहृतः॥”
(Cha. Chi. 11/18)

CLINICAL FEATURES

• Fever with chills and rigors

• Right upper abdominal pain

• Anorexia, nausea

• Tender hepatomegaly

• Jaundice (occasionally)

• In amoebic abscess: referred shoulder pain, diarrhea, history of dysentery

MODERN CLINICAL CORRELATION

• Common in alcoholics and immunocompromised patients

• “Anchovy sauce” pus in ALA

• Leukocytosis, elevated alkaline phosphatase

• Hepatic tenderness

DIAGNOSIS

• Ultrasound / CT scan: Single or multiple hypoechoic lesions

• Blood tests:

  • Elevated WBC count

  • Raised liver enzymes

  • Serological tests (for amoebiasis)

• Aspiration: Pus examination for culture and sensitivity

• Liver Function Tests

MANAGEMENT

• Medical Management:

  • Amoebic Abscess:

    • Metronidazole + Luminal agent (Diloxanide furoate)

  • Pyogenic Abscess:

    • Broad-spectrum IV antibiotics (e.g., ceftriaxone + metronidazole)

• Percutaneous Drainage: USG-guided aspiration

• Surgical Drainage: In non-resolving/multiple abscesses

AYURVEDIC MANAGEMENT

• Sopha–Vidradhi Chikitsa principles applied

• Shamana Aushadhi:

  • Patolakaturohinyadi Kashaya, Punarnavadi Mandura, Guggulu Tiktaka Ghrita

• Shodhana Chikitsa (if indicated):

  • Virechana, Basti Karma

“स्नेहस्वेदनपूर्वं तु रक्तपित्तहरं शुभम्।
विरेचनं प्रशंसन्ति विद्रधीषु विशारदाः॥”
(Cha. Chi. 11/44)

DIET & REGIMEN

• Easily digestible, low-fat diet

• Avoid heavy, fried, fermented, and spicy food

• Emphasis on Langhana (lightening therapy) initially

PROGNOSIS

• Hydatid cyst: Good with early intervention; risk of rupture and anaphylaxis if untreated.

• Liver abscess: Curable with antibiotics and drainage; risk of rupture into peritoneum or pleura if delayed.

COMPARISON TABLE