Liver Cysts - Symptoms, Size Chart, Causes and TreatmentQ

Hepatic cyst or liver cysts sound like a severe medical condition. There are multiple factors that play a role in causing hepatic cysts. Liver cysts usually don't present symptoms but if there is a significant change in size, a person may experience pain or other symptoms that call for medical attention.

Most hepatic cysts are diagnosed accidentally while imaging for other conditions. However, the health care practitioner may also advise CT scans, ultrasounds, and antibody tests to diagnose liver cysts. This article explains what is a liver cyst, its causes, symptoms, complications, diagnosis and liver cyst treatment.

A liver cyst is a fluid-filled sac that forms on the surface or inside the liver. These cysts are usually benign and do not cause any symptoms, but in some cases, they can become large enough to cause discomfort or other problems.

Liver cysts are common, and many people have them without even knowing it. These cysts can range in size from a few millimetres to several centimetres in diameter.

Hepatic cysts affect 5% to 10% of the world's population. Although they are asymptomatic in most cases, their treatment is based on the type of the cyst.

Hepatic cysts are classified based on different factors. The classification is based on the cause, cell type (benign or cancerous), and whether infected or non-infected. Below given the classification of liver cysts based on the cause.

1. Simple Cysts: These are also called benign liver cysts, which are the most common type of liver cysts. The subtypes of simple cysts include:
   1. Solitary Cysts: These are the most common non-parasitic liver cysts that are asymptomatic. Sometimes can complicate infection, spontaneous bleeding, rupture, and jaundice.
      In some rare cases, it can develop into adenocarcinoma (cancer of the gland).
   2. Ciliated Liver Foregut Cyst: This is an extremely rare, benign, and solitary cyst structurally similar to a bronchogenic cyst.
      It may contain mucous-like material of white to brown colour or clear serous material.
2. Complex cysts: Complex cysts are more rare and can be more concerning. These cysts have solid components or multiple chambers and can be a sign of a more serious underlying condition.
   1. Cystadenoma: This is a subset of a mucinous cystic neoplasm of the hepatic cyst. It is also referred to as biliary cystadenomas (BCA).
      Biliary cystadenomas and cystadenocarcinomas (BCAC) constitute less than 5% of all liver cysts. These cysts are prevalent in middle-aged women between 40 to 50 years old.
   2. Cystadenocarcinoma: Another subset of a mucinous cystic neoplasm of hepatic cyst is cystadenocarcinomas (BCAC). In 20 to 30% of the cases, cystadenoma can form into cystadenocarcinoma.
      Although it's similar to BCA in its appearance, histologically, it varies. The nodules are larger by up to 10mm in diameter in BCAC.
   3. Primary Squamous Cell Carcinoma: Primary squamous cell carcinoma in the liver has a poor prognosis and a high malignancy rate with an average lifespan of only one year.
      Although the exact cause of the condition is unknown, congenital liver cysts, chronic inflammation, and abnormal changes of biliary epithelial cells are causes thought to be associated.
3. Infectious Cysts: Infectious liver cysts are caused by infection. For instance,
   1. Hydatid Cyst (Echinococcus Infection): The parasite Echinococcus granulosus, which is consumed by tainted food, causes an illness that results in hydatid or echinococcal cysts (ECs).
      Eggs are consumed and then hatch in the small intestine. The parasite then enters the bloodstream, moving on to its intended target organs like the liver or lungs.
   2. Liver Abscess: A liver abscess is a pus-filled tumour in the liver that can arise from liver damage or an infection that has spread throughout the abdomen through the portal vein (the prime vein in the digestive system).
      Although liver abscesses are rare, and only a small percentage of them are brought on by pyogenic or amoebic bacteria, it is crucial to diagnose and treat parasites and fungus early on.
4. Congenital Cysts (since birth): Congenital cysts are detected in infants and children.
   It's a rare and asymptomatic disease with a 2.5% incidence in postnatal life. The most frequent presentation is an incidental discovery during prenatal ultrasound imaging.
   1. Biliary Cyst: Biliary cysts (BC) are rare lesions found in various regions of the biliary tract. Around 1% of all benign biliary cysts include these.
      Mostly found in Asian and female populations. The type of biliary cyst determines clinical presentation and its management.
      The most serious complication of the biliary cyst is cholangiocarcinoma (bile duct cancer).
   2. Polycystic Liver Disease: Polycystic liver disease is a rare hereditary illness that affects 1 to 10 individuals per 100,000. (PLD).
      PLD patients have groups of simple cysts on their liver. PLD is treated by medical professionals using both surgery and medication.
      Most PLD patients also have polycystic kidney disease (PKD), which is characterised by kidney cysts and can cause high blood pressure and kidney failure. It may occasionally be necessary to receive both a kidney transplant and a liver transplant.
5. Endometrial Cysts: These are very rarely detected in the liver, and can resemble mucinous cysts in appearance.
   They have both solid and cystic components and have multiple cells or vesicles. These kinds of cysts develop when endometrial tissue is implanted in liver tissue.
6. Post-traumatic Liver Cysts: These are known as pseudocysts that can develop after an intrahepatic hematoma (blood pool formed after injury or surgery in the liver).
   One case report of a pseudocyst developing from medical treatment or injury from a medical device during a liver biopsy is available in the literature.

Most liver cysts are asymptomatic. However, if a cyst becomes large enough, it can cause one or many symptoms. Liver cysts can occasionally grow to a size that one can feel through the abdomen. When symptomatic, liver cyst symptoms include:

1. Dull pain in the right upper corner of the abdomen
2. Bloating
3. Abdominal distension
4. Nausea and vomiting
5. Loss of appetite
6. Early satiety
7. Breathing difficulty
8. Palpable lump in the abdomen
9. Jaundice as cysts might block bile ducts
10. High fever
11. Abdominal discomfort

Hepatic cyst affects 5% of people. The exact cause of liver cysts is unknown, but some risk factors have been identified.

1. Congenital Cysts: These cysts are present at birth and develop due to abnormal cell growth during fetal development.
2. Polycystic Liver Disease: This is a genetic condition in which multiple cysts develop in the liver, often in conjunction with cysts in the kidneys.
3. Caroli Disease: This is a rare genetic condition in which the bile ducts in the liver are abnormally dilated, leading to the formation of cysts.
4. Parasitic Infection: Parasites such as echinococcus granulosus can cause liver cysts.
5. Trauma: In some cases, trauma to the liver can cause cysts to form.
6. Infection: Infections such as hydatid disease can cause liver cysts.

Understanding risk factors helps in the early detection, and prevention of complications and helps in early treatment. Risk factors for developing liver cysts include:

1. Age: Liver cysts are more commonly found in individuals over the age of 50.
2. Gender: Women are more likely to develop liver cysts than men.
3. Obesity: Being overweight also puts a person at risk of developing liver cyst.
4. Genetics: Some types of liver cysts are inherited and run in families.
5. Caroli Disease: This is another rare genetic condition that affects the bile ducts and can cause liver cysts.
6. Liver Damage: Any type of liver damage, such as that caused by alcohol abuse or liver hepatitis, can increase the risk of developing a liver cyst.
7. Hormonal Changes: Certain hormonal changes, such as those that occur during pregnancy, can increase the risk of liver cysts.

Liver cysts cannot always be prevented, as a majority of simple or solitary liver cysts are present at birth and some liver cysts are malignant or cancerous, which is difficult to prevent. But there are some lifestyle changes one can make to reduce the risk of developing them:

1. Maintain a Healthy Weight: Obesity is a risk factor for liver cysts. If you are overweight, losing weight can help reduce your risk.
2. Limit Alcohol Consumption: Drinking too much alcohol can damage your liver and increase your risk of developing liver cysts. It's important to drink alcohol in moderation or not at all.
3. Avoid Exposure to Toxins: Exposure to certain chemicals, including pesticides and industrial chemicals, can increase your risk of liver cysts.
   If you work in an environment where you are exposed to these toxins, take appropriate safety measures.
4. Practice Good Hygiene: Good hygiene is important to prevent the spread of infectious diseases that can cause liver cysts.
   Wash your hands frequently, especially after using the bathroom and before preparing or eating food.
5. Manage Underlying Health Conditions: Certain health conditions, such as polycystic liver disease and autosomal dominant polycystic kidney disease, can increase your risk of developing liver cysts.
   Work with your doctor to manage these conditions and reduce your risk.

The diagnosis of liver cysts is different from other conditions. Normally doctors suggest scans or other tests when the person presents with signs or symptoms of any particular condition.

However, liver cysts are slow to grow and do not exhibit signs unless there is a complication or malignancy. Thus the first diagnosis of these is by chance while performing imaging tests for some other condition.

1. Patient History: The physician will collect a detailed case history, family history, and history of any illness as well as current medical history.
2. Clinical Examination: The healthcare provider will conduct a thorough physical examination to look for signs and symptoms that might give clues to the cause of the cysts.
3. Investigations: Healthcare provider may also suggest some of the following investigation for proper diagnosis of the condition.
4. Ultrasound Test: High-frequency sound waves are used in ultrasounds to produce real-time images and films of the internal organs or other tissues.
5. Computed Tomography Scan: Using computers and X-rays, CT scans can produce three-dimensional images of the liver tissues, showing exactly the location and size of the liver cyst.
6. Magnetic resonance imaging (MRI): This painless imaging test creates crystal-clear images of the body's organs and structures using a huge magnet, radio waves, and a computer.

After detecting a liver cyst, healthcare providers may perform the following to rule out liver conditions like a parasitic liver cyst, polycystic liver disease, or precancerous or cancerous hepatic cyst.

1. Serodiagnosis test for detecting specific antibodies in blood samples.
2. Contrast ultrasonography: Ultrasound with contrast (high-frequency sound waves pass through the body tissues, and the echoes are recorded as a video or image.

How to prepare for the doctor’s consultation? 

Before visiting a doctor, one can prepare himself/herself by taking up the following:

1. Prepare a list of all the concerns.
2. Visit the doctor with a family member or a friend.
3. Explain all the medical conditions, ongoing medications and supplements.
4. Explain past and family history to your doctor.
5. One can expect the following things from the doctor.
   1. The healthcare expert will collect detailed medical history, including family history and personal history of liver disease.
   2. They will conduct a thorough physical examination. Also, they may advise for further:
      1. Blood tests
      2. Contrast ultrasonography
6. One can think of some questions that he/she would like to ask to the doctor. Here are some questions to ask your doctor to understand and deal with liver cysts.
   1. How to know if the cyst is cancerous or non-cancerous?
   2. What tests are needed?
   3. Is a liver biopsy needed?
   4. What is the treatment for painful liver cysts?
   5. What other tests to do to see if the liver cyst is spreading to other body parts?

Liver cysts are typically asymptomatic, and most do not require any liver cyst treatment. However, in some cases, the cysts may grow in size and cause symptoms, leading to the need for medical intervention.

Liver cyst treatment depends on various factors, including the type, size, and location of the cyst, as well as the severity of symptoms, if any.

Liver Cyst Treatment Without Surgery

1. Observation: Simple hepatic cysts that don’t have any symptoms don't need to be treated. However, cysts greater than 4 cm in diameter need to be monitored.
   Follow-up ultrasounds can be done to monitor the cysts' size and stability. These are completed every three and twelve months. No ultrasound follow-up is needed if the cyst is stable for two to three years.
2. Cyst Aspiration or Percutaneous Cyst Drainage: Large liver cysts that cause significant symptoms, such as abdominal pain, nausea, and vomiting, may require drainage.
   The cyst fluid can be drained using a needle or catheter inserted through the skin and into the cyst.
   In some cases, a sclerosing agent may be injected into the cyst after drainage to prevent it from refilling with fluid.
3. Medications: Medications like antiparasitic drugs such as benzimidazoles are prescribed for the treatment of hydatid cysts to treat the parasite forming the cyst.

Liver Cyst Treatment With Surgery

1. Surgery: Surgical intervention may be required for large or complex cysts, or if drainage procedures are not effective in relieving symptoms.
   The most common surgical procedure used to treat liver cysts is laparoscopic deroofing, in which the roof of the cyst is removed, and the remaining cyst wall is sutured to prevent fluid accumulation.
2. Liver Transplantation: In rare cases, liver cysts may cause significant liver damage, leading to the need for a liver transplant.

There are different kinds of liver cyst size charts. Most charts help understand the cyst's severity and the treatment mode it needs.

Liver cysts are usually benign and do not cause any problems. However, in some cases, they can grow and cause symptoms or complications. Here are some of the potential risks and complications associated with liver cysts:

1. Cyst infection
2. Bleeding from the cyst
3. Rupture of the cyst
4. Biliary tree compression
5. Cancer

When to See a Doctor?

Liver cysts are often found incidentally during routine imaging tests and may not require any treatment. However, it is essential to see a doctor if you experience any symptoms associated with liver cysts or have an underlying condition that may increase your risk of developing liver cysts.

You should see a doctor if you experience any of the following symptoms:

1. Abdominal pain or discomfort
2. Nausea and vomiting
3. Unexplained weight loss
4. Jaundice (yellowing of the skin and eyes)
5. Fever
6. Fatigue
7. Loss of appetite

Diet and lifestyle modifications are an important part of managing several disorders. Diet has no role to play in congenital liver cysts and cancerous liver cysts.

In addition to medical treatment, certain dietary changes can help manage the symptoms of liver cysts. Here are some dietary recommendations for liver cysts:

1. Low-fat Diet: A low-fat diet may help reduce symptoms associated with liver cysts, such as pain and discomfort.
   Reducing your intake of saturated and trans fats, as well as fried and processed foods, can help manage these symptoms.
2. High-fiber Diet: Consuming a diet rich in fibre can help regulate bowel movements and reduce the risk of constipation.
   Foods such as fruits, vegetables, whole grains, and legumes are excellent sources of fibre.
3. Plenty of Fluids: Staying hydrated is important for overall health and may help manage symptoms of liver cysts.
   Drinking plenty of water, herbal tea, and fresh juices can help keep you hydrated.
4. Limiting Alcohol: Consuming too much alcohol can cause liver damage, which may worsen symptoms associated with liver cysts.
   Limiting alcohol intake or avoiding it altogether is recommended.
5. Supplements: Certain supplements may help improve liver function and reduce symptoms associated with liver cysts.
   Milk thistle, dandelion root, and turmeric are among the supplements that may benefit individuals with liver cysts. However, it is important to talk to a healthcare provider before taking any supplements.

Liver cysts are a common condition that can often be asymptomatic and not require any treatment. However, in some cases, they can cause complications such as pain, infection, or obstruction of nearby organs. It is important to seek medical attention if you experience any symptoms or have risk factors for liver cysts.

If you have any further doubts regarding liver cysts, do not hesitate to contact HexaHealth experts. HexaHealth is your one-stop platform for all your healthcare needs. So, contact us TODAY!

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