Liver Abscess Flashcards
Liver abscesses infectious etiologies…..?
pyogenic, meaning involving bacteria, or
parasitic, such as with amebiasis, ascariasis, or toxocariasis.
Bacteria can invade the liver through 1 of 4 sources……?
hematogenously through the hepatic artery (e.g., in the presence of bacteremia),
through the biliary tract, through the portal vein (portal sepsis), and
directly by contiguous infection
Risk factors for pyogenic liver abscess…..?
chronic granulomatous disease (CGD),
hyper–immunoglobulin E (hyper-IgE) syndrome, or
malignancies
The most common abnormal laboratory findings in liver abscess…..?
elevated inflammatory markers and
hypoalbuminemia
Chest x-rays findings in liver abscess ….?
Elevation of the right hemidiaphragm with a right pleural effusion
Most common cause of bacteria in pyogenic liver abscess in CGD……?
Escherichia coli, Klebsiella pneumoniae, and Serratia
Most common extraintestinal manifestation of Entamoeba histolytica infection …..?
Amebic liver abscess (ALA)
Route of spread of amebic liver abscess……?
Amoebic trophozoites invade colonic mucosa and reach the liver through the portal circulation.
Patients may not have an associated colitis. Fever, right upper quadrant pain, anorexia, and weight loss are often present.
Diagnosis of ALA ……?
Serum ELISA - false negatives early in the infection and cannot distinguish active infection from previous exposure
Most sensitive and specific among stool assays is PCR, followed by stool antigen detection, and least reliable is microscopy
Treatment for ALA …..?
Treatment involves 7-10 days of a nitroimidazole (most commonly metronidazole) to kill trophozoites, followed by 7 days of a luminal agent (such as paromomycin) to kill colonic cysts.
Indication for percuteneous aspiration in ALA …..?
Patients with large abscesses (≥5-7 cm in diameter)
