ASCITES and ABSCESSES

Question 1

What is a liver abscess

Answer 1

Pus-filled mass inside liver post-infection, appendicitis or haematogenous spread (via portal vein)

Question 2

Most common causes of pyogenic (bacterial) abscesses

Answer 2

Biliary sepsis
Trauma
Haematogenous (bacteria from portal vein)
Infection of tumour or cyst
Direct extension (empyema of gall bladder)
Pathogens

Question 3

What bacteria cause pyogenic abscesses

Answer 3

1. E.coli gram negative
2. Streptococcus millenni
3. Klebsiella pneuomniae gram-negative
4. Bacteroids app and other anaerobes

Question 4

Clinical presentation of pyogenic abscesses

Answer 4

1. Fever
2. Vomiting
3. Weight loss
4. Right upper quadrant abode pain +/- pleuritic/right shoulder pain
5. Tender hepatomegaly +/- obstructive jaundice

Question 5

How is pyogenic abscesses diagnosed

Answer 5

1. Blood culture
2. Serum alkaline phosphatase,ESR and CRP raised
3. CT abdomen (useful if multiple lesions)
4. Ultrasound - to detect and sample abscess

Question 6

How are pyogenic abscesses treated

Answer 6

1. Aspiration of abscess under ultrasound control
2. Antibiotics
3. Surgery isf resolution is too slow or difficult

Question 7

What antibiotics are sued to treat pyogenic abscesses

Answer 7

1. Co-Amoxiclav
2. PIPERACILLIN + TAZOBACTAM
3. GENTAMICIN
4. METRONIDIAZOLE

Question 8

Where are the most common sites of infection in pyogenic abscesses

Answer 8

1. Biliary tract
2. Dental source
3. Renal
4. Intestinal

Question 9

What is an amoebic abscess caused by

Answer 9

Entamoeba histolytica

Question 10

Describe the mechanism by which entamoeba histolytica causes amoebic abscess

Answer 10

1. Entamoeba histolytic can be carried from bowel to liver in portal vein system,

Question 11

Clinical presentation of amoebic abscess

Answer 11

1. Fever
2. Abdo pain
3. Anorexia
4. Weight loss
5. Malaise
6. Tender hepatomegaly
7. Signs of effusion or consolidation in the base of the right side of the chest

Question 12

How are amoebic abscesses diagnosed

Answer 12

1. Serological test for amoeba (Haemagglutination, ELISA)

ALWAYS POSITIVE but don’t show current disease cause they will remain positive for a while after cure

2. Cyst aspiration shows ‘anchovy sauce pus’

Question 13

How is amoebic abscess treated

Answer 13

1. METRONIDAZOLE for 10 days

2. Aspiration for those failing to response

Question 14

Complication of treatment of amoebic abscess

Answer 14

1. Rupture

2. Secondary infection and septicaemia