Liver Cysts

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Dr Thng Yongxian

MBBS

MMed

MRCS (IRE)

FRCSED

FAMS

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Liver cysts are fluid-filled sacs located within the liver, the largest internal organ of the body. These formations are typically benign and asymptomatic, meaning they often do not cause any symptoms. They can vary greatly in size, ranging from a few millimetres to several centimetres in diameter.

The presence of liver cysts is usually detected incidentally during imaging tests for other reasons. While most liver cysts do not affect liver function or health significantly, understanding their characteristics and potential health implications is important for proper management and treatment.

Types of Liver Cysts

Liver cysts encompass a spectrum of conditions that manifest within the liver, varying widely in their aetiology, presentation, and clinical significance.

Simple Cysts

Simple liver cysts are the most common type, typically benign and without symptoms. They are usually discovered incidentally during imaging tests for other conditions.

Polycystic Liver Disease (PLD)

PLD is a genetic condition characterised by the presence of numerous cysts throughout the liver, which can lead to liver enlargement and, in some cases, impair liver function.

Hydatid Cysts

Caused by infection with the Echinococcus tapeworm, hydatid cysts are less common and can pose serious health risks if they rupture, leading to potentially life-threatening complications.

Cystadenomas

These are rare, potentially cancerous cysts that can grow large and may require surgical removal to prevent malignancy.

Symptoms

Liver cysts often remain asymptomatic and are discovered incidentally during imaging for unrelated issues. However, when symptoms do occur, they may include the following:

  • Discomfort or pain in the upper right abdomen
  • Bloating and feelings of fullness
  • Jaundice (yellowing of the skin and eyes), in rare cases where cysts obstruct bile ducts

Diagnosis

Diagnosis of liver cysts typically involves imaging techniques such as ultrasound, computed tomography (CT) scans, or magnetic resonance imaging (MRI) to visualize the cysts’ size, location, and characteristics. Blood tests may be conducted to assess liver function and rule out infection or malignancy. In certain cases, a biopsy may be performed to definitively diagnose the nature of the cyst.

Causes of Liver Cysts

Congenital Factors

Many liver cysts are congenital, meaning they are present from birth. These cysts may develop due to genetic factors or abnormalities in bile duct formation.

Infections

Certain infections, particularly those caused by parasites like Echinococcus tapeworms, can lead to the development of hydatid cysts in the liver.

Polycystic Liver Disease (PLD)

PLD is a genetic condition where multiple cysts form in the liver, often related to polycystic kidney disease, indicating a hereditary predisposition.

Biliary Duct Obstruction

Blockages or abnormalities in the bile ducts can lead to cyst formation as a result of fluid accumulation.

Liver Injuries

Trauma or injuries to the liver can sometimes result in cyst development as part of the healing process.

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Treatment Options

The treatment for liver cysts depends on the symptoms and potential complications they may cause. Most asymptomatic cysts require no treatment, but monitoring for changes in size or symptoms is recommended.

Observation

Regular monitoring through imaging tests for asymptomatic or small cysts.

Medication

  • Antibiotics for infected cysts
  • Parasiticidal drugs for hydatid cysts caused by Echinococcus tapeworm
Percutaneous Aspiration

For cysts that cause discomfort or symptoms due to their size, percutaneous aspiration under ultrasound or CT guidance may be performed.

This minimally invasive procedure involves draining the cyst fluid with a needle. To reduce the risk of recurrence, sclerotherapy may be administered, where a sclerosing agent is injected into the cyst cavity to harden it.

Laparoscopic Fenestration

Laparoscopic fenestration is a surgical option for larger or symptomatic cysts not suitable for aspiration or when recurrence occurs.

This minimally invasive surgery involves creating openings in the cyst wall to allow fluid to drain into the abdominal cavity, where it can be absorbed. The advantages include reduced recovery time and minimal scarring.

Liver Resection

In rare cases where cysts are suspected to be neoplastic or have turned into cancerous growths, a partial liver resection may be necessary.

This involves the surgical removal of the cyst along with a portion of the liver tissue. Liver resection requires a thorough evaluation of the liver function and the patient’s overall health to ensure a successful outcome.

Management of Polycystic Liver Disease (PLD)

For patients with PLD, where numerous cysts proliferate throughout the liver, management focuses on symptom relief and preventing complications.

Treatment options may include lifestyle modifications, medications to reduce cyst growth, and, in severe cases, liver transplantation.

Potential Complications

While liver cysts are generally benign, certain situations can lead to complications:

  • Cyst Rupture
    A ruptured cyst can cause severe pain and lead to internal bleeding or infection.
  • Infection of Cysts
    Cysts can become infected, leading to fever, increased pain, and a risk of spreading the infection.
  • Bile Duct Obstruction
    Large cysts may obstruct bile ducts, causing jaundice, cholangitis (infection of the bile ducts), and liver dysfunction.
  • Pressure on Other Organs
    Large or numerous cysts can exert pressure on adjacent organs, causing pain, discomfort, and potential impairment of organ function.
  • Malignant Transformation
    Although rare, some types of cysts, such as cystadenomas, have the potential to become cancerous.

Prevention and Management

Preventing liver cysts, particularly those of congenital or genetic origin, may not always be possible. However, certain measures can be taken to reduce the risk of developing cysts related to infections or other preventable causes.

Healthy Lifestyle

Maintain a healthy diet and exercise regularly to support overall liver health.

Parasite Prevention

Practice good hygiene, such as washing hands thoroughly and ensuring safe food and water consumption, especially in areas where parasitic infections are common.

Regular Medical Checkups

Routine health screenings can help detect liver abnormalities early, even if symptoms are not present.

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Dr Thng Yongxian

MBBS (SG)

MMed (Surg)

MRCS (Ire)

FRCSEd (Gen)

FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery,
    National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.

Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.

Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

Patient Reviews

I cannot possibly express how grateful I am for the compassionate care received by Dr Thng during my hospitalization. I was 20 hours away from flying back to the USA after a long work trip, and homesick already when diagnosed with acute appendicitis and a UTI. To say that I was nervous to undergo surgery so far away from home, friends and family is an understatement. He was expedient, attentive and thorough. He even took the time to text and call my husband back home multiple times to update him on my status. His infectious laugh, sense of humor and kindness helped to sooth my own frazzled nerves. I am so appreciative to have had Dr Thng as my surgeon.

Ms Tina Hunter

I was diagnosed for ampullory cancer in 2021. I am very thankful to Dr. Thng Yongxian who kept me calm when revealing the report to me. I really felt like God sent his angel to speak to me.He helped me overcome the operation. Dr. Thng said 3 things that I needed to do before the operation....Stay positive, exercise n eat well, have faith in God. He even gave me his handphone number incase I need to consult him when home. Indeed the 8 hrs operation was a success n I am able to write this testimonial, living a normal life. Finally, its still God who works all things good for those who love Him... Romans 8:28.

Mdm Tang K H

I recently underwent gallbladder stone removal surgery performed by Dr. Thng, and I am impressed with the quality of care I received during this process. Dr. Thng demonstrated exceptional professionalism and expertise throughout my entire experience. From the initial consultation to the post-operative care, Dr. Thng explained the procedure in great details, answered all my questions, and alleviated my concerns and ensuring that I fully understood each step of the process. His compassionate and caring demeanor put me at ease, making me feel confident in his abilities. The outcome of the procedure was beyond my expectations. Dr. Thng successfully removed all my 3 gallstones, and I experienced a smooth recovery process. I am grateful for his expertise and the care I received under his supervision. Overall, my experience with Dr. Thng was exceptional. I highly recommend him for his professionalism, compassion, and outstanding surgical skills. Thank you, Dr. Thng for your excellent care.

Mr Low LT

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    Frequently Asked Questions (FAQ)

    Are liver cysts common?

    Yes, liver cysts are relatively common and often discovered incidentally during imaging tests for other conditions. Most cysts are benign and asymptomatic.

    Can lifestyle changes shrink liver cysts?

    There is no direct evidence that lifestyle changes can shrink existing liver cysts. However, maintaining a healthy lifestyle can support overall liver health and potentially prevent the formation of new cysts.

    Is liver cyst removal surgery risky?

    Like any surgical procedure, liver cyst removal carries certain risks, such as infection, bleeding, and complications related to anaesthesia. However, with advances in surgical techniques, especially laparoscopic surgery, the risks are minimized, and recovery times are generally shorter.

    Can liver cysts recur after treatment?

    Yes, liver cysts can recur after treatment, particularly in cases of polycystic liver disease or if the entire cyst is not removed. Regular follow-up with a healthcare provider is important to monitor for recurrence.

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