Liver 2 Flashcards
In the past pyogenic liver abscesses were a result of what?
infections from the intestinal tract such as acute appy and diverticulitis
which spread to liver via portal circulation
What are causes of pyogenic liver abscesses now?
usually from biliary tract dx or cryptogenic
Most common liver abscesses seen in US?
pyogenic liver abscess
What bugs do we see with pyogenic liver abscess?
40/40% mono/polymicrobial
20% culture negative
Most common bacteria seen in pyogenic liver abscesses?
2/3 are gram negative bacteria
e.coli in 2/3 of cases (strept. faecalis, klebsiella other bugs)
Pyogenic liver abscesses can be single or multiple but tend to be found on which side of liver more frequently?
right lobe
Clinical presentation and labs seen in someone w/pyogenic liver abscess?
clinically; RUQ pain, fever, jaundice (1/3)
labs: leukocytosis, increased ESR, ALK
What do we see on US of suspected pyogenic liver abscess?
round or oval hypoechoic lesions w/well defined borders
variable number of internal echoes
Initial therapy for pyogenic liver abscess?
IV abx for at least 8 weeks
(need gram neg and anaerobic coverage)
surgical drainage laparoscopically or open may become necessary if initial therapy fails
Do we do catheter drainage of pyogenic liver abscess?
effective in small number of pts
fluid is usually viscous and does not drain well
Distribution of pyogenic liver abscesses in the liver?
75% right lobe
20% left lobe
Causes of pyogenic liver abscesses?
infections from biliary tree are most common identifiable cause
obstruction causes bile stasis, bacterial overgrowth, and infection and extention into liver
What is pyelophlebitis?
the portal venous system drains the GI system; thus any infectious d/o of GI tract can result in ascending portal vein infection
Most common organisms cultured from pyogenic liver bascesses?
e.coli
klebsiella
Pyogenic liver abscesses tend to occur in what age group?
50-60s
Abx for pyogenic liver abscesses?
ampicillin + metronidazole
Most common type of liver abscess worldwide?
amebic liver abscess
Male vs female predominance of amebiasis?
10;1 male
Amebic liver abscess caused by?
ameoba histolytica
affecting 10% of world’s population
Who gets amebiasis?
males 20-40 with travel to endemic tropical areas
mexico, india, central america
Some risk factors for contracting amebiasis?
immunosuppression
heavy etoh use
Life cycle of entamoeba histolytica?
exists as cysts outside body (vegetative form)
cyst passes thru stomach and small bowel
transforms into a trophozoite in colon
invades colonic mucosa, forming flask-shaked ulcers
carried to liver
How does abscess of amoeba hystolitica appear?
common in R-lobe of liver
has a necrotic central portion that contains thick-reddish brown pus like material–:> anchovy paste
Anchovy or chocolate like paste is assc w/?
amebiasis from entamoeba histolytica