Liver Abscesses

Question 1

Define Liver Abscesses (pyogenic + amoebic)

Answer 1

Purulent collections in the liver parenchyma that results from bacterial, final or parasitic infection

Pyogenic = typically bacterial causes
Amoebic = netamoebe histolytica

Question 2

Aetiology of Liver Abscesses

Answer 2

Often polymicrobial infection
Most common: E. coli, klebsiella, S. Milleri

Recurrent pyogenic cholangitis - salmonella typhi
Immunocompromised - fungal e.g. candida

May be complication of untreated appendicitis, IBD, pancreatitis, diverticulitis

Question 3

Risk factors for Liver Abscesses

Answer 3

Biliary tract disease
Age >50
Underlying malignancy
DM
Interventional biliary or hepatic procedures
Living in or visiting area endemic for amoebiasis
Cirrhosis, liver transplant, alcoholics, male sex, cardiopulmonary disease

Question 4

Symptoms of Liver Abscesses

Answer 4

RUQ pain 
Right shoulder pain (referred)
Fever and chills
Weight loss
Fatigue 
Abdominal pain
Nausea and vomiting 
Cough, SOB, chest pain 
Jaundice

Question 5

Signs of Liver Abscesses on examination

Answer 5

RUQ tenderness
Hepatomegaly 
Jaundice 
Pleural effusion (dullness on percussion, Reduced breath sounds, reduced vocal fremitus)
Shock 
Ascites

Question 6

Investigations for Liver Abscesses

Answer 6

Aspiration of abscess fluid + gram stain + culture: positive for bacterial organism of candida
Liver USS: echoic lesion + guide aspiration

Stool testing: +ve in amoebiasis

FBC: leucocytosis, neutrophilic, anaemia
LFTs: alk phos, bilirubin + ALT/AST raised, hypoalbuminaemia
Blood cultures: positive for cause
PT + APTT: usually normal
Serum antibody testing: +ve in amoebiasis

Contact enhanced CT: hypotenuse mass, usually right love
CXR: may show pleural effusion (blunting of angles)