Liver abscess

Question 1

Definition

Answer 1

Liver abscesses result from a polymicrobial bacterial infection, either via contigous spread or seeding from the portal and hepatic veins.

Question 2

Common causes

Answer 2

Biliary disease: Cholecystitis & Cholangitis
Portal pyelophlebitis secondary to acute abdominal infection, Diverticulitis, Appendicitis, peritonitis
Septicaemia
Trauma
Infection of a liver cyst

Question 3

Common isolated organisms

Answer 3

E.coli
Klebsiella pneumoniae
S. Constellatus

Question 4

Clinical features

Answer 4

Fever with rigors
Toxic?
Abdominal pain
Bloating
Nausea
Anorexia
LOW
fatigue
Jaundice

Question 5

Physical findings

Answer 5

RUQ tenderness
With or without hepatomegaly
Shock if abscess rupture

Question 6

Amoebic abscess

Answer 6

Liver abscesses id due to infection with the protozoan parasite Entamoeba histolytica.
Mostly occur in the absence of amoebic dysentery
Abscesses may be single or multiple
More common in the right lobe of the liver

Question 7

Clinical features

Answer 7

Insidious onset
RHC PAIN (vague symptoms)
Malaise
Pyrexia
LOW
occasionally rigors and diarrhoea 
Bloating
Jaundice uncommon
History of recent travel to endemic places

Question 8

Investigations

Answer 8

FBC:
-WCC (leucocytosis)
LFTs: abnormal
-ALP high
Blood C&S positive
USS
CT SCAN

Question 9

Treatment plan

Answer 9

IV fluid resuscitation
Antibiotics like metronidazole
Image guided aspiration of the abscess