Liver abscesses Flashcards
What are abscesses?
A swollen area within body tissue, made up of an accumulation of pus
What causes liver abscesses?
Infection:
- bacteria
- amoebic
- hydatid (a type of tapeworm)
What bacteria often cause liver abscesses?
E. coli most commonly
Streptococcus species
Staphylococcus species
Bacteroides species
How do bacteria get to the liver and cause an abscess?
By haematogenous spread from an infection elsewhere, usually the gut
Infection in the gut, diverticulitis or appendicitis for example spread to the liver via the portal vein
Are liver abscesses mostly mono or polymicrobial?
Polymicrobial
Name the amoeba that causes amoebic liver abscess?
Entamoeba histolytica
Where does Entamoeba histolytica come from and how does it get to the liver?
Found in water and food
Ingested, ends up in the gut
Gets to liver via the portal venous system
Where in the liver do you mostly find amoebic liver abscesses?
Right lobe
Clinical features of liver abscesses?
Fever
Weight loss
Abdominal pain
Tenderness in RUQ
Right side pleural effusion
Investigation of liver abscesses?
Bloods:
- raised white cell
- cultures of pathogen
- raised ESR
- raised alkaline phosphatase, impaired liver function
USS:
- single or multiple round lesions
CT:
- define the lesions as abscesses, rim of inflammation around lesion characteristic of abscess
Serology:
- to distinguish amoebic from bacterial
History:
- travel to endemic areas?
- any GI symptoms?
Management of an amoebic liver abscess?
Metronidazole orally for 10 days
No need to aspirate
Management of a bacterial liver abscess?
Aspiration: percutaneous and using fluoroscopy
Put catheter in for drainage
Antibiotics chosen from cultures taken during aspiration
What does the portal vein do?
Coveys blood from gut, pancreas, stomach to the liver
