Liver Abscesses

Question 1

Outline the pathogenesis of liver abscesses

Answer 1

• Infection seeded from
  
  • Biliary tree, portal vein (any inflammations of the bowel put this at risk), hepatic vein, penetrating trauma

Question 2

What are the risk factors for development of liver abscesses?

Answer 2

• Biliary tract disease/interventions
• Age > 50
• Malignancy
• Diabetes mellitus

Question 3

What are the likely findings on history and examination in patients with liver abscesses?

Answer 3

• Fever/chills
• RUQ pain/tenderness
• Hepatomegaly
• Uncommonly, constitutional symptoms
• Uncommonly, SOB/cough/chest pain if diaphragm involved

Question 4

What would be some sensible investigations to order for a patient suspected of a liver abscess?

Answer 4

• FBE
• LFTs
• Blood cultures
• Liver ultrasound
• CT abdo

Question 5

What are the management prinicples of patients with liver abscesses?

Answer 5

• Treat infection
  
  • IVAB - pip/taz
  • Anticandidals if immunocompromised - caspofungin
  • If amoebic abscess suspected - metronidazole, then paromomycin
• Abscess drainage
  
  • Aspiration or surgical
• Supportive care

Question 6

What are the common organisms that cause liver abscesses?

Answer 6

• Bacteria - E. coli, Klebsiella, Streptococcus spp, Enterococcus
• Parasitic - Entamoeba histolytica
• Fungal - in immunocompromised