Liver Abscess

Question 1

What are the common causes of liver abscesses

Answer 1

GI tract infection 
Diverticulitis 
Appendicitis 
Cholecystitis 
Cholangitis

Question 2

What is the most common pathogen within a liver abscess

Answer 2

E-Coli

Klebsiella pneumoniae

Question 3

How do liver abscesses present

Answer 3

Swing pyrexia 
RUQ pain
Tenderness +/- hepatomegaly
fever 
Rigors
Jaundice

Question 4

How would you investigate liver abscesses

Answer 4

FBC ( would show leukocytosis )
Abnormal LFTs
USS 
CT constrast 
Peripheral blood cultures should be sent for microscopy

Question 5

What is the management of liver abscesses

Answer 5

Appropriate Abx based on blood cultures
US/CT guided aspiration
Fluid resus and vital signs stabilisation

Question 6

What is a amoebic abscess

Answer 6

Collection of fluid caused by entamoeba histiolytica which is spread through the faecal-oral route
( enters to gut venous circulation )

Question 7

What are the clinal features of amoebic abscesses

Answer 7

Same as liver abscess but also may have travel history + pt may have bloody diarrhoea with this too

Question 8

How do you investigate entamoeba liver abscess

Answer 8

FBC - leukocytosis ( eosinophilic )
LFT
USS
CT scan 
Blood culture
Stool samples 
Peripheral blood and fluid cultures for E.histiolytica

Question 9

How do you manage entamoeba liver abscess

Answer 9

Metronidazole/tinidazole
If not responding to Abx then surgical drainage may be needed ( however risk of seeding )
Intra-luminal agent may be needed - paromomycin