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Infective liver lesions Flashcards

1
Q

Name the 3 main types of infective liver lesions

A

Pyogenic liver abscess
Amoebic liver abscess
Hydatid cyst

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2
Q

Which infective liver lesion is the most common?

A

Pyogenic liver abscess

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3
Q

Name risk factors for pyogenic liver abscess

A

Male
>50yo
Immunocompromised
Liver injury

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4
Q

Which lobe is most often affected by pyogenic liver abscess and why?

A

Right lobe

  • larger
  • preferential flow due to main portal vein continuation as right portal vein
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5
Q

Name causes of pyogenic liver abscess

A
  1. Portal spread
  2. Biliary spread
  3. Local extension
  4. Arterial spread
  5. Trauma
  6. Cryptogenic
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6
Q

Name portal spread causes of pyogenic liver abscess

A

Appendicitis
Diverticulitis
IBD
Perforated viscera

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7
Q

Name biliary spread causes of pyogenic liver abscess

A

Ascending cholangitis
Bile duct stent
Biliary-enteric anastomoses
Undrained contrast

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8
Q

Name local extension causes of pyogenic liver abscess

A

Perinephric abscess
Diverticulitis
Cholecystitis
Subphrenic abscess

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9
Q

Name arterial spread causes of pyogenic liver abscess

A 
Endocarditis
Indwelling lines
Dental work
Pneumonia
Septic arthritis
TB
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10
Q

Name trauma/surgery causes of pyogenic liver abscess

A

Haematomia
Arterial embolization
Arterial ligation
Ablation

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11
Q

What is the common microbiology in pyogenic liver abscess?

A

40% monomicrobial
40% polymicrobial
20% culture negative

Predominantly gram -

  • e.coli
  • enterococcus
  • klebsiella
  • strep faecalis
  • proteus vulgaris

Other

  • staph
  • strep
  • bacteroides fragilis (anaerobe)
  • mycobacterium
  • fungi
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12
Q

Name clinical features of pyogenic liver abscess

A 
Vitals of septic shock
RUQ pain 
Cough
Dyspnea
Peritonitis
Pleural effusion
Pericardial effusion
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13
Q

Name investigations for pyogenic liver abscess

A 
Bloods (WCC, CRP, ESR, ALP, bili, culture)
AXR
CXR
U/S
CT
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14
Q

Discuss the management of pyogenic liver abscess

A 
Resus
Pain control
Drainage 
- percutaneous
- laparoscopic
- open 
IV antibiotics 
Treat the cause
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15
Q

Which organism causes amoebic liver abscess?

A

Entamoeba histolytica

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16
Q

What is entamoeba histolytica?

A

Non-flagellated pseudopod forming protozoa

17
Q

What is the most common site for amoebic abscess to form?

A

Right antero-superior lobe of the liver

18
Q

Discuss the life cycle of entamoeba histolytica

A

Vegetative form = cyst
Passes through GIT -> trophozoite in the colon -> invades mucosa -> flask shaped ulcers -> enters portal circulation -> hepatocyte infarction

19
Q

Discuss the clinical features of amoebic abscess

A

Similar to pyogenic abscess
Travel history
Hepatomegaly

20
Q

Name investigations for amoebic abscess

A 
Bloods (WCC, LFTs, PTT, bili, serology)
AXR
CXR
U/S (not specific)
CT (not specific)
Nuclear medicine (does not enhance)
21
Q

Discuss the management of amoebic abscess

A

Metronidazole 750mg tds po x 10d

If medical treatment fails -> surgical drainage `

22
Q

Name indications for surgical drainage of an amoebic abscess

A

Failed medical treatment
Secondary bacterial infection
Left liver lobe
>5cm size

23
Q

Which organism causes hydatid cyst?

A

Echinococcus granulassi

24
Q

Discuss the lifecycle of echinococcal granulassi

A

Sheep with cysts -> intestine eaten by dog -> cyst scolices attach to dog intestinal wall -> taenia lay eggs -> ova shed in dog faeces -> fecal-oral spread -> ovum dissolves in stomach -> burrows into small bowel mucosa -> enters portal system

25
Q

Describe the three layers of a hydatid liver cyst

A

Inner internal germinal endocyst
Middle anuclear hyaline ectocyst
Outer compressed liver tissue with fibrous capsule

26
Q

Name clinical features of hydatid cyst

A

Asymptomatic
Affected organs
Septic shock

27
Q

Name investigations for hydatid cyst

A

U/S
Serology
CT

28
Q

Discuss the WHO classification of hydatid cysts

A
  1. Univesicular anechooic cystic lesion with double line sign
  2. Multiseptated, honeycomb cyst
  3. Cyst with detached membranes (water lily) or daughter vesicles in solid matrix
  4. Cyst with heterogenous content
  5. 4 plus calcified wall
29
Q

Discuss the management of hydatid cysts

A 
Medical
- albendazole 
Surgical
- open drainage
- laparoscopic aspiration 
- PAIR procedure (percutaneous, aspirated, instilled, re-aspirated)
29
Q

Discuss the management of hydatid cysts

A 
Medical
- albendazole 
Surgical
- open drainage
- laparoscopic aspiration 
- PAIR procedure (percutaneous, aspirated, instilled, re-aspirated)

MBChB Surgery (38 decks)

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