Liver Abscess

Question 1

Types of liver abscess

Answer 1

Pyogenic
Amoebic
Hydatid

Question 2

Pathways of contamination in liver abscess

Answer 2

Portal system
Systemic circulation through hepatic arteries
Umbilical sepsis in neonates
Direct penetration
Cholangitis ( bile duct inflammation )
Septicemia through hepatic artery
Acute cholecystitis

Question 3

Main organism in bacterial liver abscess

Answer 3

E. coli
Staph pyogenes
Hemolytic strep
Proteus vulgaris
Anaerobes

Question 4

Mass morphology of liver abscess

Answer 4

Multiple and scattered throughout liver
Possibly solitary in right lobe

Question 5

Clinical manifestation of bacterial liver abscess

Answer 5

Présent like pathology that caused infection
Constitutional symptoms ( fever, rigors, sweating, malaise, anorexia, vomiting)
RUQ pain

Question 6

Findings on examination in bacterial liver abscess

Answer 6

RUQ tenderness
Hepatomegaly in 60%
Jaundice 50%

Question 7

Investigation of bacterial liver abscess

Answer 7

Blood culture

FBC => elevated leucocytes
LFT normal with possibly elevated ALP
Radiology ( Ultrasound, CT scan)

Question 8

Treatment of bacterial liver abscess

Answer 8

Broad spectrum ( cephalosporin, gentamycin, metronidazole )

Drainage if antibiotics does not work with image guided percutaneous needle aspiration

Question 9

Main organism in amoebic liver abscess

Answer 9

Entamoeba hystolitica

Question 10

Mass morphology of amoebic liver abscess

Answer 10

Mostly solitary in right lobe
Wall has granulation and moderate fibrous rxn
Pus present ( anchovy paste, chocolate colored, green if bile staining )

Question 11

Possible secondary infections in amoebic liver abscess

Answer 11

E. coli
Staph
Strep

Question 12

Microscopy of amoebic liver abscess

Answer 12

Central zone of necrosis
Middle zone of varying degrees of liver parenchymal destruction
Outer zone of normal cells

Question 13

Main population affected by amoebic liver abscess

Answer 13

Young and middle aged men

Question 14

Liver abscess ratio between men and women

Answer 14

Men women 9:1

Question 15

Early symptoms of amoebic liver abscess

Answer 15

Fever
Chills
Weight loss
Malaise
Fatigue
RUQ pain

Question 16

Examination findings of amoebic liver abscess

Answer 16

Diminished breath sounds at right lung bases
Cough with anchovy paste sputum
RUQ pain

Question 17

Right lobe abscess examination findings

Answer 17

Bulging and pitting edema
Pain and tenderness over right lower intercostals

Question 18

Superior amoebic liver abscess

Answer 18

Referred pain to right shoulder

Question 19

Left lobe amoebic abscess examination findings

Answer 19

Epigastrium pain
Can feel mass due to inflammation

Question 20

Differential of liver absces s

Answer 20

HCC
Viral or alcoholic Hepatitis
Lobar pneumonia
Lung abscess
Empyema

Question 21

Investigations in amoebic liver disease

Answer 21

FBC with mild leucocytoses
ESR raised
Stool exam
LFT not helpful
Proctosigmoiydoscopy with visible amoebic ulcer
Abdominal x ray ( elevated right dome diaphragm, pleural effusion, lower lobe consolidation, functional thoracolumbar scoliosis)
Abdominal USG
Abdominal CT scan

Question 22

Amoebic liver abscess complications

Answer 22

Secondary infectons 25%
Rupture into lungs, pericardium, peritoneum

Question 23

Treatment of amoebic liver abscess

Answer 23

Metronidazole 800mg

Image guided aspiration

Open surgery in secondary infection or peritonitis from rupture of abscess

Question 24

Factors determining prognosis of liver abscess

Answer 24

Virulence of organism
Density of infestation
Host resistance
Multiplicity of abscesses
Stage of presentation
Underlying cirrhosis

Question 25

Hepatic TB presents like this liver disease

Answer 25

Ameobic liver abscess

Question 26

Disease leading to honey comb appearance of liver

Answer 26

Hepatic actinomyces leading to multiple abscesses