Hepatic Abscesses Flashcards
The most common type of liver abscess.
Pyogenic(Bacterial)
What is the most common source/route for liver abscess formation?
The Biliary tract (suppurative cholangitis)
What are the known etiologies of infection from most common to least common?
Biliary tract, portal vein, hepatic artery, direct extension from adjacent structures, trauma/iatrogenic
What is the most common bacteria isolated from a liver abscess?
E.Coli & Klebsiella.
In monomicrobial abscesses, the most common isolate is?
Staph aureus (Hematogenous spread)
In polymicrobial abscesses, what bacteria are most common?
Enterococcus Feacalis, Streptococcus Viridans, Bacteroides species.
What is the typical presentation of a person with a hepatic abscess?
Variable. The classic triad - fever, jaundice & RUQ abdominal pain occurs in 10% of cases. Fevers and chills with abdominal pain are most frequent on presentation.
How are pyogenic abscesses typically treated?
2-3 weeks of antibiotics + Percutaneous drainage. Operative drainage reserved for failure of perc drainage and/or laparotomy is otherwise indicated.
Entameoba Histolytica is a parasite that causes amebic colitis and amebic abscess formation throughout much of the world. The most common site of abscess formation is the liver. What is the typical demographic affected within the US?
Male, Hispanic Origin, 20-40 years old, w/h/o recent travel to endemic areas OR emigration from Mexico or Southeast Asia.
What clinical findings/ imaging characteristics distinguish amebic abscess from pyogenic abscesses?
- -Epidemiology & serology tests define the illness(caveat: if previous infection, may be positive for 20yrs).
- Typically presents similar to pyogenic abscesses. Fever, Hepatomegaly & RUQ tenderness are more common with amebic abscesses. Jaundice, septic shock, eosinophilia or palpable mass are rare.
- U/S and CT CANNOT differentiate pyogenic from amebic abscess
- Hepatic nuclear scan can differentiate “cold” amebic abscess from “hot” pyogenic abscess(leukocytes).
What is the typical treatment of amebic abscesses?
Metronidazole x3weeks + percutaneous drainage. Operative drainage is rarely necessary.
Fungal abscesses occur most commonly in what population?
Immunosuppressed, HIV, leukemia
Monomicrobial infection is typically found with which pathogens?
Candida, aspergillosis, cryptococcus
In patients with biliary malignancies +/- stents, w/h/o cholangitis - abscesses typically have what pathogen(s)
Usually mixed bacterial & fungal.
How are fungal abscesses treated?
Antifungal +/- antibiotics if mixed + Percutaneous drainage. Operative drainage is rare.
