Liver Abscess Flashcards
Types of liver abscess
Pyogenic
Amoebic
Hydatid
Pathways of contamination in liver abscess
Portal system
Systemic circulation through hepatic arteries
Umbilical sepsis in neonates
Direct penetration
Cholangitis ( bile duct inflammation )
Septicemia through hepatic artery
Acute cholecystitis
Main organism in bacterial liver abscess
E. coli
Staph pyogenes
Hemolytic strep
Proteus vulgaris
Anaerobes
Mass morphology of liver abscess
Multiple and scattered throughout liver
Possibly solitary in right lobe
Clinical manifestation of bacterial liver abscess
Présent like pathology that caused infection
Constitutional symptoms ( fever, rigors, sweating, malaise, anorexia, vomiting)
RUQ pain
Findings on examination in bacterial liver abscess
RUQ tenderness
Hepatomegaly in 60%
Jaundice 50%
Investigation of bacterial liver abscess
Blood culture
FBC => elevated leucocytes
LFT normal with possibly elevated ALP
Radiology ( Ultrasound, CT scan)
Treatment of bacterial liver abscess
Broad spectrum ( cephalosporin, gentamycin, metronidazole )
Drainage if antibiotics does not work with image guided percutaneous needle aspiration
Main organism in amoebic liver abscess
Entamoeba hystolitica
Mass morphology of amoebic liver abscess
Mostly solitary in right lobe
Wall has granulation and moderate fibrous rxn
Pus present ( anchovy paste, chocolate colored, green if bile staining )
Possible secondary infections in amoebic liver abscess
E. coli
Staph
Strep
Microscopy of amoebic liver abscess
Central zone of necrosis
Middle zone of varying degrees of liver parenchymal destruction
Outer zone of normal cells
Main population affected by amoebic liver abscess
Young and middle aged men
Liver abscess ratio between men and women
Men women 9:1
Early symptoms of amoebic liver abscess
Fever
Chills
Weight loss
Malaise
Fatigue
RUQ pain
Examination findings of amoebic liver abscess
Diminished breath sounds at right lung bases
Cough with anchovy paste sputum
RUQ pain
Right lobe abscess examination findings
Bulging and pitting edema
Pain and tenderness over right lower intercostals
Superior amoebic liver abscess
Referred pain to right shoulder
Left lobe amoebic abscess examination findings
Epigastrium pain
Can feel mass due to inflammation
Differential of liver absces s
HCC
Viral or alcoholic Hepatitis
Lobar pneumonia
Lung abscess
Empyema
Investigations in amoebic liver disease
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
Amoebic liver abscess complications
Secondary infectons 25%
Rupture into lungs, pericardium, peritoneum
Treatment of amoebic liver abscess
Metronidazole 800mg
Image guided aspiration
Open surgery in secondary infection or peritonitis from rupture of abscess
Factors determining prognosis of liver abscess
Virulence of organism
Density of infestation
Host resistance
Multiplicity of abscesses
Stage of presentation
Underlying cirrhosis
