Liver Abscess

Question 1

What is liver abscess?

Answer 1

Usually a result form a polymicrobial bacterial infection spreading from the biliary or GI tract.

This can either be via a contiguous spread or seeding from portal and hepatic veins

Question 2

Common causes

Answer 2

Cholecystitis

Cholangitis

Diverticulitis

Appendicitis

Septicaemia

Question 3

Most common organisms

Answer 3

E. coli

Klebsiella pneumoniae

S. constellatus

Fungal can also be evident in immunosuppressed

Question 4

Clinical features

Answer 4

Fever

Rigors

Abdo pain

Bloating, nausea, anorexia, weight loss, fatigue and jaundice

Question 5

Examination findings

Answer 5

RUQ tenderness

Might have hepatomegaly

Abscess rupture can present with signs of shock as first presentation

Question 6

Lab tests

Answer 6

FBC will show a leucocytosis

LFTs (abnormal with raised ALP and deranged ALT and bilirubin)

Peripheral blood and fluid cultures should be done as well

Question 7

Imaging

Answer 7

USS

CT imaging wih contrast can be used as well.

Question 8

USS findings

Answer 8

Poor-defined lesions

Hypo- and hyper-echoic areas

Potential gas bubbles and septations

Question 9

CT findings

Answer 9

Similar to USS

Also surrounding oedema

Question 10

Management

Answer 10

Fluid resus and staibilised

Appropriate abx therapy guided by sensitivities and local policies

Most cases can be drained by image-guided aspiration of the abscess.

This can be done by US or CT.

Surgery is rare (only done in ruptured cases or refractory)

Question 11

What is amoebic abscess?

Answer 11

Most common extra-intestinal manifestation of amebiasis infection by Entamoeba histolytica

Question 12

How does amoebic abscess spread

Answer 12

Faeco-oral route

Once it is in the colon the trophozoite begin to invade mucosa and spread to liver via portal system

Question 13

Epidemiology of amoebic abscess

Answer 13

12% of the world is infected

Most commonly in developing regions like south america, indian subcontinent and africa

Question 14

Clinical features of amoebic abscess

Answer 14

Vague symptoms with abdo pain, nausea, fever or rigors

Weight loss and bloating.

Cases should be suspected in patients with a history of recent travel to an endemic region.

Patients might have had a prodrome with abdo pain and diarrhoea prior.

Question 15

Investigations of amoebic abscess

Answer 15

Leucocytosis + deranged LFTs

Peripheral blood and fluid cultures should be done to check for Entamoeba histolytica antibodies.

USS as well and CT may be warranted

Question 16

USS findings in amoebic abscess.

Answer 16

Poor-defined lesions

Question 17

Management

Answer 17

Antiobiotics usually alone with metronidazole or tinidazole

Large cysts that are refractory might require surgical drainage

Paromomycin might be used to eradicate amoebiasis from the colon as well