# Hepatic Infections in Children — GCMD Library living collection

Updated: n/a · 1 episodes · 19 cited statements

## Episodes
### Types and Management
- [Hepatic Infections: Hepatitis, Abscess & Cysts with Dr. Alex Bondoc](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315) — podcast · 15:28 · [machine version](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=0) Introduction and Case Presentation: Seven-Year-Old with Right Upper Quadrant Fullness (Ep 1)
- [3:31](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=211) Differential Diagnosis of Simple Hepatic Cysts and Management Algorithm (Ep 1)
- [8:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=520) Mucinous Cystic Neoplasm and Echinococcal Cysts (Ep 1)
- [10:58](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=658) Echinococcal Cyst Treatment and WHO Classification (Ep 1)
- [13:00](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=780) Ciliated Hepatic Foregut Cyst (Ep 1)
- [13:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=820) Pyogenic Hepatic Abscess: Case, Epidemiology, and Treatment (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- 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 (epidemiological) [Ep 1 · 3:31](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=211)
- 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. — Alex Bondoc (clinical) [Ep 1 · 3:31](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=211)
- Symptomatic simple hepatic cysts are definitely larger and complications can occur, but they are very rare. — Alex Bondoc (clinical) [Ep 1 · 3:31](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=211)
- 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. — Alex Bondoc (clinical) [Ep 1 · 8:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=520)
- 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. — Alex Bondoc (clinical) [Ep 1 · 10:58](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=658)
- The most feared complication of intervention on echinococcal cysts is rupture causing anaphylaxis from spilling cystic material. — Alex Bondoc (clinical) [Ep 1 · 10:58](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=658)
- Treatment for echinococcal cysts includes pre- and post-operative anti-parasitic albendazole. — Alex Bondoc (clinical) [Ep 1 · 10:58](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=658)
- The WHO has a classification system for hydatid disease that grades it based on the presence of active daughter cysts. — Alex Bondoc (guideline) [Ep 1 · 10:58](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=658)
- When daughter cysts are more predominant in echinococcal disease, open surgery with packing and double suction is favored over PAIR technique. — Alex Bondoc (clinical) [Ep 1 · 10:58](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=658)
- PAIR technique stands for puncture, aspiration, injection and re-aspiration, used to treat cystic disease of liver. — Alex Bondoc (clinical) [Ep 1 · 10:58](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=658)
- 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. — Alex Bondoc (clinical) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=780)
- Ciliated hepatic foregut cyst can transform into a frank malignant squamous cell carcinoma. — Alex Bondoc (clinical) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=780)
- 25% of hepatic abscesses occur in the first year of life and 50% in the first 5 years of age. — Alex Bondoc (epidemiological) [Ep 1 · 13:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=820)
- Risk factors for hepatic abscess include instrumentation of the biliary tree, diabetes, proton pump inhibitor use, chronic granulomatous disease, and immunosuppression. — Alex Bondoc (clinical) [Ep 1 · 13:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=820)
- Common organisms in hepatic abscess are E. coli and Klebsiella (enteric gram-negative rods), and gram-positive cocci including Strep pyogenes and Staph aureus. — Alex Bondoc (clinical) [Ep 1 · 13:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=820)
- In the modern period, one author suggested Staph to be the most common organism in hepatic abscess. — Alex Bondoc (clinical) [Ep 1 · 13:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=820)
- If Strep milleri is cultured from a hepatic abscess, one would be obligated to look for disseminated infection, specifically ocular and neuraxial infection. — Alex Bondoc (clinical) [Ep 1 · 13:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=820)
- For hepatic abscesses greater than 5 centimeters, there is more propensity to leave a catheter rather than just aspirate and treat with antibiotics. — Alex Bondoc (clinical) [Ep 1 · 13:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=820)
- Treatment for hepatic abscess includes 4 to 6 weeks of IV antibiotics followed by 4 to 6 weeks of oral antibiotics. — Alex Bondoc (clinical) [Ep 1 · 13:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=820)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Imaging features that might be concerning for malignancy in hepatic cysts include calcification, septations, and a thicker rim. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 4:33](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=273)
- An algorithm for managing simple hepatic cystic disease uses a size cutoff of 4 centimeters for concern. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 4:33](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=273)
- For asymptomatic hepatic cysts less than 4 centimeters, no follow-up imaging is recommended by the algorithm. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 4:33](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=273)
- Aspiration and sclerosis for symptomatic hepatic cysts has a recurrence rate in the low single digit range according to retrospective data. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 4:33](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=273)
- Surgical cyst unroofing with packing or argon ablation has a recurrence rate of 0 to 14% across various series. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 4:33](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=273)
- Complications of surgical cyst unroofing include post-operative bleeding, development of an abscess, or bile leak. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 4:33](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=273)
- Sclerosis for hepatic cysts uses 70% ethanol, with risks including ethanol toxicity. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 4:33](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=273)
- Mucinous cystic neoplasm of the liver is very similar in histologic appearance to the mucinous cystic neoplasm of the ovary. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 8:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=520)
- Mucinous cystic neoplasm often occurs more in adults and females, and it's often symptomatic as a true neoplasm rather than a simple cyst. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 8:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=520)
- 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. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 8:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=520)
- 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. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 8:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=520)
- The treatment for mucinous cystic neoplasm is resection, though the entity is exceedingly rare. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 8:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=520)
- Echinococcal cysts represent the larval stage of a dog tapeworm, with ova traveling via the intestine through an enteral route through the portal vein. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 8:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=520)
- Most echinococcal cysts are single cysts. — Tom Basch summarizes what Dr. Alex Bondoc said [Ep 1 · 8:40](https://library.globalcastmd.com/watch/hepatic-infections-hepatitis-abscess-cysts-with-dr-alex-bondoc-7315?t=520)

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