From the Guidelines
Hepatic cysts can cause pain through several mechanisms, including stretching the liver capsule, compressing surrounding structures, or developing complications, as noted in the easl clinical practice guidelines on the management of cystic liver diseases 1. Pain typically occurs when cysts become large enough to cause these effects. Large cysts can create a sense of fullness or pressure in the upper right abdomen as they expand against the liver capsule, which contains pain receptors. Cysts may also cause pain by compressing adjacent organs like the stomach, intestines, or gallbladder. Some key points to consider about hepatic cysts and pain include:
- Complications such as cyst infection, bleeding into the cyst, or cyst rupture can trigger acute, severe pain, with cyst haemorrhage being a common complication, especially in larger cysts, as described in the guidelines 2.
- The pain is typically located in the right upper quadrant or epigastric region and may be dull, achy, or sharp depending on the underlying cause.
- Most simple hepatic cysts are asymptomatic, however, and are often discovered incidentally during imaging for other reasons, as stated in the easl clinical practice guidelines 1. In terms of management, symptomatic hepatic cysts can be treated surgically or with percutaneous aspiration sclerotherapy, as recommended in the guidelines 1. It's also important to note that conservative management is preferred for complications like cyst haemorrhage, with interventions such as aspiration or laparoscopic deroofing avoided in active haemorrhage, as discussed in the guidelines 2.
From the Research
Causes of Pain in Hepatic Cysts
- Hepatic cysts can be congenital or acquired, and the cause of pain can vary depending on the type of cyst 3
- Acquired cystic lesions can be infectious or non-infectious, and pain can be a symptom of infection or other complications 3
- Simple cysts, polycystic liver disease, and other types of hepatic cysts can cause pain due to various mechanisms, including compression of surrounding tissues or infection 4
Types of Hepatic Cysts that Can Cause Pain
- Simple cysts: can cause pain due to compression of surrounding tissues or infection 3, 4
- Polycystic liver disease: can cause pain due to compression of surrounding tissues or infection 3, 4
- Infectious cysts: can cause pain due to infection, such as hydatid cysts, amoebic abscesses, or pyogenic abscesses 3, 5
Management of Pain in Hepatic Cysts
- Minimally invasive management options, such as percutaneous drainage or laparoscopic fenestration, can be effective in relieving pain 3, 4
- Surgical resection may be necessary in some cases, especially for symptomatic cysts or those suspicious for malignant or premalignant features 4, 6
- Analgesics can be used to manage pain in patients with liver cirrhosis, but with caution and under close monitoring due to the risk of adverse effects 7