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Hepatic Infections in Children
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Simple hepatic cysts are predominantly found in women, especially symptomatic cysts, with one study showing a 1 to 9 male to female predominance in symptomatic simple hepatic cysts. — Alex Bondoc, Hepatic Infections: Hepatitis, Abscess & Cysts with Dr. Alex Bondoc · 3:31
Hepatic Infections: Hepatitis, Abscess & Cysts with Dr. Alex Bondoc
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In this episode, we will be exploring the types, presentation, diagnosis and management of various hepatic infections with Dr. Alex Bondoc, a pediatric surgeon from Cincinnati Children’s Hospital. Throughout this podcast we will use a few i
podcast15:28 · Oct 2023
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Hepatic Infections: Hepatitis, Abscess & Cysts with Dr. Alex Bondoc
Simple hepatic cysts are predominantly found in women, especially symptomatic cysts, with one study showing a 1 to 9 male to female predominance in symptomatic simple hepatic cysts.
epidemiologicalAlex Bondoc3:31 ↗
Simple hepatic cysts are more often noted in the right lobe, probably due to mass issue because the right lobe is larger than the left.
clinicalAlex Bondoc3:31 ↗
Symptomatic simple hepatic cysts are definitely larger and complications can occur, but they are very rare.
clinicalAlex Bondoc3:31 ↗
Imaging features that might be concerning for malignancy in hepatic cysts include calcification, septations, and a thicker rim.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:33 ↗
An algorithm for managing simple hepatic cystic disease uses a size cutoff of 4 centimeters for concern.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:33 ↗
For asymptomatic hepatic cysts less than 4 centimeters, no follow-up imaging is recommended by the algorithm.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:33 ↗
Aspiration and sclerosis for symptomatic hepatic cysts has a recurrence rate in the low single digit range according to retrospective data.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:33 ↗
Surgical cyst unroofing with packing or argon ablation has a recurrence rate of 0 to 14% across various series.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:33 ↗
Complications of surgical cyst unroofing include post-operative bleeding, development of an abscess, or bile leak.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:33 ↗
Sclerosis for hepatic cysts uses 70% ethanol, with risks including ethanol toxicity.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:33 ↗
Mucinous cystic neoplasm of the liver is very similar in histologic appearance to the mucinous cystic neoplasm of the ovary.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position8:40 ↗
Mucinous cystic neoplasm often occurs more in adults and females, and it's often symptomatic as a true neoplasm rather than a simple cyst.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position8:40 ↗
It is important to differentiate whether a mucinous cystic neoplasm is a non-invasive version or associated with an invasive carcinoma, which is often difficult on axial imaging or ultrasound.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position8:40 ↗
It is not a great idea to biopsy mucinous cystic neoplasm because you can seed the peritoneum or the tract, especially if it's an invasive carcinoma.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position8:40 ↗
The treatment for mucinous cystic neoplasm is resection, though the entity is exceedingly rare.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position8:40 ↗
Echinococcal cysts represent the larval stage of a dog tapeworm, with ova traveling via the intestine through an enteral route through the portal vein.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position8:40 ↗
Most echinococcal cysts are single cysts.
Host summaryTom Basch summarizes what Dr. Alex Bondoc said — not the host's own clinical position8:40 ↗
Physical exam findings in echinococcal cysts might include pleuritic pain due to transit between abdominal and thoracic cavity, and a rub heard when listening to the liver.
clinicalAlex Bondoc8:40 ↗
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.
clinicalAlex Bondoc10:58 ↗
The most feared complication of intervention on echinococcal cysts is rupture causing anaphylaxis from spilling cystic material.
clinicalAlex Bondoc10:58 ↗
Treatment for echinococcal cysts includes pre- and post-operative anti-parasitic albendazole.
clinicalAlex Bondoc10:58 ↗
The WHO has a classification system for hydatid disease that grades it based on the presence of active daughter cysts.
guidelineAlex Bondoc10:58 ↗
When daughter cysts are more predominant in echinococcal disease, open surgery with packing and double suction is favored over PAIR technique.
clinicalAlex Bondoc10:58 ↗
PAIR technique stands for puncture, aspiration, injection and re-aspiration, used to treat cystic disease of liver.
clinicalAlex Bondoc10:58 ↗
Ciliated hepatic foregut cyst is histologically analogous to a bronchogenic cyst, with ciliated pseudostratified columnar epithelium, followed by smooth muscle, connective tissue, and a fibrous capsule.
clinicalAlex Bondoc13:00 ↗
Ciliated hepatic foregut cyst can transform into a frank malignant squamous cell carcinoma.
clinicalAlex Bondoc13:00 ↗
25% of hepatic abscesses occur in the first year of life and 50% in the first 5 years of age.
epidemiologicalAlex Bondoc13:40 ↗
Risk factors for hepatic abscess include instrumentation of the biliary tree, diabetes, proton pump inhibitor use, chronic granulomatous disease, and immunosuppression.
clinicalAlex Bondoc13:40 ↗
Common organisms in hepatic abscess are E. coli and Klebsiella (enteric gram-negative rods), and gram-positive cocci including Strep pyogenes and Staph aureus.
clinicalAlex Bondoc13:40 ↗
In the modern period, one author suggested Staph to be the most common organism in hepatic abscess.
clinicalAlex Bondoc13:40 ↗
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