With the progress of modern civilized society, people pay more and more attention to personal health, so an annual health checkup has become the main means for people to understand their health status, and many units even take the health checkup as a welfare nature of organized health checkups for working or retired employees. Cysts are one of the most common diseases that can be found during health checkups, especially liver and kidney cysts are the most common and common. So, how do liver and kidney cysts form? What is the danger of it? What should be done when liver and kidney cysts are found?
1. Classification and etiology of liver and kidney cysts.
(1) Liver cysts can generally be divided into parasitic cysts and non-parasitic cysts. The former is caused by parasites, such as cysticercosis in pastoral areas (mainly hepatic cysticercosis); however, common liver cysts refer to non-parasitic cysts.
Non-parasitic cysts can be subdivided into congenital liver cysts and acquired liver cysts.
Most of the liver cysts found clinically are congenital, either only one or multiple, also called congenital polycystic liver, mostly without bile, often accompanied by polycystic kidney or other organs.
Acquired cysts include the following: (1) hematoma and degenerative cysts; (2) lymphatic cysts; (3) retention cysts due to bile duct obstruction; and (4) cystic adenomas. Among them, retention cysts are the most common and may occur due to inflammation, edema, scarring, as well as trauma and puncture.
(2) Renal cyst (alias: simple renal cyst, isolated renal cyst)
It is unknown whether simple renal cyst is congenital or acquired. Its origin may be similar to that of polycystic kidney, only to a different extent. On the other hand, by causing renal tubular obstruction and local ischemia, animals can develop simple renal cysts. This in turn suggests that this lesion can also be acquired. As the cyst increases in size, its compression can damage the renal parenchyma, but not to the extent that renal function is impaired. An isolated cyst can occur at the site of compression of the ureter, causing progressive hydronephrosis, which can then be complicated by infection.
2. What are the clinical manifestations of hepatic and renal cysts?
(1) Most of the liver cysts are slow growing, asymptomatic and not palpable, and only found during ultrasound, CT examination or isotope liver scan, and in most cases can “live peacefully” with the patient for the rest of his life, so there is no need to worry.
In individual cases, acute abdominal pain may occur when the cyst bleeds internally, ruptures, becomes infected or if the cyst with a tip is twisted. The pain is mostly in the upper abdomen or right rib cage, sometimes radiating to the shoulder, back or chest.
(2) The clinical manifestations of renal cysts mainly include.
(1) lumbar and abdominal discomfort or pain: the pain is characterized by vague and dull pain, fixed on one or both sides, radiating to the lower part and lumbar back; (2) hematuria: it can be manifested as microscopic hematuria or carnal hematuria; (3) abdominal mass: it is sometimes the main reason for patients to visit the clinic, and 60-80% of the enlarged kidneys can be palpated. The larger the kidney is, the worse the kidney function is; ④ proteinuria: generally the amount is not much, and will not exceed 2 grams in 24 hours urine, so nephrotic syndrome will not occur; ⑤ hypertension: the cyst compresses the kidney, causing renal ischemia, which increases renin secretion and causes hypertension.
3. What should be done after discovering liver and kidney cysts?
A When liver cysts are found in physical examination, blood should be taken to check A-fetoprotein to exclude liver cancer. Most patients can be observed regularly for a period of time, and if there is no dynamic change, the diagnosis of liver cyst will be clearer and more reassuring. For liver cysts, except for those that are particularly huge or have serious comorbidities that require surgical operation or drainage treatment, most of them do not need to be treated. No Chinese medicine or western medicine can make the cysts disappear or shrink.
B. What should be done after kidney cysts are found? After kidney cyst is found, ① urine examination can be performed: urine routine is normal, if the cyst presses the kidney parenchyma or combined with intracapsular infection, small amount of red blood cells and white blood cells may appear in the urine. ②B ultrasound: it can understand the number, size and cyst wall of the cyst. It can also be distinguished from the renal parenchymal mass, and is the preferred examination method. When the cyst wall shows irregular echogenicity or limited echogenicity enhancement, it should be alerted to malignant changes; when secondary infection occurs, the cyst wall is thickened and there are small dotted echogenicity in the lesion area and echogenicity enhancement when there is bleeding in the cyst. When the imaging suggests multiple cysts, it should be distinguished from multifocal cysts and polycystic kidneys. ③Intravenous pyelogram (ivp) can show the degree of cyst compression of renal parenchyma and can be distinguished from hydronephrosis. ④CT examination is valuable for those who cannot be identified by ultrasound examination. When the cyst is accompanied with bleeding, infection and malignant change, it shows inhomogeneity and the CT value increases, and when CT shows the characteristics of cyst, cyst puncture can be unnecessary.
4, liver and kidney cyst disease patients in the life of the precautions.
(1) liver and kidney cysts can be congenital or acquired, some are alone or multiple, some are simple liver cysts, some have cysts in liver and kidney at the same time, generally speaking, liver and kidney cysts do not affect human health as much as polycystic liver or polycystic kidney, and the patient does not need to be nervous.
(2) If there are multiple small cysts, sometimes more and sometimes less are found during ultrasound or CT examination, that is because the limitations of the examination equipment or the carefulness of the examiner are not the same, not surprisingly, one less does not mean good, one more does not mean bad either.
(3) Excessive liver and kidney cysts that have compression symptoms on the liver or kidney itself or surrounding organs, or inflammation, do surgery to open the cysts to reduce the pressure, and ultrasound-guided percutaneous fine needle aspiration of acetic acid, polyglactin, anhydrous alcohol sclerotherapy is currently the best or preferred treatment, of course, the treatment also has a certain recurrence rate, but its recurrence rate is not higher than that of surgery or laparoscopic treatment The recurrence rate is not higher than that of surgery or laparoscopic treatment.
(4) Ultrasound or CT diagnosis of liver and kidney cysts is very reliable, with a correct rate of over 95%, and more tests are generally not necessary.
(5) Those who have liver cyst and/or kidney cyst can work and exercise, and there is nothing to pay special attention in life.
5.Treatment methods of liver and kidney cysts.
(1) Treatment of liver cysts
Liver cysts are benign lesions of the liver, and traditional treatment methods are surgical resection or minimally invasive laparoscopic surgery, which are highly traumatic and slow to recover, and all of them have a certain possibility of recurrence. In recent years, percutaneous treatment with high concentration of acetic acid or polyvinyl alcohol or anhydrous alcohol injection has become the easiest and most effective method, which is performed by direct percutaneous puncture of the liver cyst under ultrasound guidance and local anesthesia, and the fluid inside the cyst is extracted and injected with acetic acid or polyvinyl alcohol or anhydrous alcohol, etc. The amount of acetic acid concentration and anhydrous alcohol or polyvinyl alcohol is adjusted according to the amount of cyst fluid. Using this method to treat single or multiple cysts in the liver, the recurrence rate is low, the number of injections is low, the impact on liver function is small, there are no obvious side effects, the patient is painless, and it is economically safe.
(2) Treatment of renal cysts
Ultrasound-guided puncture and drainage treatment for renal cysts is basically the same as the treatment for hepatic cysts. The difference is that before injecting acetic acid or polyglactin, anhydrous alcohol, the examination of the cyst night should be performed first to determine whether it is a cyst connected to the renal pelvis and calyces, and if it is connected, it is prohibited to inject any drug into the cystic cavity to prevent damage to the renal pelvis and ureter and cause chemical pyelonephritis and urinary tract infection.
(3) Treatment of complications: Whether it is a liver cyst or a renal cyst, when the cyst is complicated by infection, antimicrobial therapy should be intensified, although Muther and Bennett found in 1980 that the concentration of antimicrobial agents that could be reached in the cyst fluid was very low. As a result, percutaneous puncture drainage is often required. If percutaneous puncture and drainage fails, open or laparoscopic surgery to remove part of the cyst wall or all of the cyst wall has been shown to be effective. In the case of hydronephrosis, removal of the cyst wall causing obstruction can relieve ureteral obstruction. Pyelonephritis involving the kidney suggests the presence of urinary tract obstruction followed by ureteral drainage failure. Removal of the cyst naturally relieves urinary tract pressure thus making antimicrobial therapy more effective.