[2] Liver Abscess Flashcards
What do liver abscesses typically result from?
Polymicrobial bacterial infection spreading from the biliary or gastrointestinal tract to the portal or hepatic veins
How can bacterial infection spread from the biliary or GI tract to the portal and hepatic vein?
Either via contiguous spread or seeding
What are the common causes of liver abscesses?
Cholecystitis Cholangitis Diverticulitis Appendicitis Septicaemia
What are the most commonly isolated organisms involved in liver abscesses?
E. Coli
K. Pneumoniae
S. Constallatus
When might fungal cases of liver abscesses be present?
In immunocompromised patients
How do patients with liver abscesses typically present?
Fever
Rigors
Abdominal pain
When should pyogenic abscesses be considered?
In all patients presenting with pyrexia of unknown origin associated with associated abdominal pain or bloating
What are the other symptoms of liver abscesses?
Bloating Nausea Anorexia Weight loss Fatigue Jaundice
What will be found on examination with liver abscesses?
RUQ tenderness, with or without hepatomegaly
How may a patient present with a ruptured liver abscess?
Signs of shock
What investigations should be done in suspected liver abscess?
Bloods
Imagingq
What may bloods show in liver abscesses?
FBC will show leucocytosis
LFTs are often abnormal, with raised ALP in most cases and deranged ALT and bilirubin in a proportion
What should all patients with liver abscesses have sent for microscopy?
Peripheral blood and fluid cultures
What imaging can be done in liver abscesses?
Ultrasound imaging
CT imaging with contrast
What will be shown on ultrasound imaging with liver abscesses?
Poorly-defined lesions with hypo- and hyper-echoic areas, with potential gas bubble and septations
What is the purpose of CT scan with contrast in liver abscesses?
It can provide further delineation
What may a CT scan with contrast show in liver abscesses?
Similar pattern from the collection as seen on ultrasound, with associated surrounding oedema
How should patients with liver abscesses be managed initially?
They should be fluid resuscitated and stabilised accordingly, and started on appropriate antibiotic therapy
What antibiotic therapy should be given in liver abscesses?
Choice guided by sensitivities and local policy
How can liver abscesses be managed definitively?
Most cases can be drained via image-guided aspiration of the abscess, with or without catheter drainage
What image guidance is used in aspiration of liver abscesses?
Either ultrasound or CT
When should the underlying cause of a liver abscess be managed?
Once the patient has been appropriately managed
When is surgery indicated in liver abscesses?
Rarely indicated, predominantly if the abscess has ruptured, or refractory to antibiotic treatment
What is an amoebic abscess?
The most common extra-intestinal manifestation of amebiasis infection
What causes an amoebic abscess?
The organism Entamoeba histolytica
How does amebiasis infection spread?
Via faeco-oral route
What happens once the amebiasis infection is in the colon?
The trophozoite begins to invade the mucosa and spread to the liver via the portal system
What % of the worlds population is estimated to be infected with the Entamoeba histolytica?
12%
Where is infection with Entamoeba histolytica most common?
In developing regions such as South America, the Indian subcontinent, and Africa
What are the clinical features of an amoebic abscess?
Patients present with vague symptoms; Abdominal pain Nausea Fever or rigors Weight loss Bloating
When should cases of amoebic abscesses be suspected?
In patients presenting with the symptoms and a history of recent travel (<6 months) to an endemic region
What early clinical features may patients with amebiasis infection present with due to intestinal involvement?
Abdominal pain and diarrhoea
What investigations should be done in suspected amoebic abscess?
Bloods
Ultrasound imaging
What will bloods show in amoebic abscesses?
Leucocytosis with deranged LFTs
What should all patients with amoebic abscesses have sent for microscopy?
Peripheral blood and fluid cultures
What is the purpose of testing blood and stool samples in suspected amoebic abscesses?
To check for the presence of E. histolytica antibodies
What will ultrasound imaging show in amoebic abscesses?
Poorly-defined lesions
How can amoebic lesions seen on ultrasound be further characterised?
CT imaging
How are most patients with amoebic cysts managed?
Antibiotics alone
What antibiotic are used in the management of amoebic cysts?
Typically metronidazole or tinidazole
When may surgical treatment of amoebic cysts be required?
Large cysts, or those which do not respond well to antibiotic therapy
What is the surgical treatment for amoebic cysts?
Surgical drainage
What can be prescribed to eradicate amoebiasis in the colon?
A luminal agent, such as paramomycin
