Liver abscesses and cysts

Question 1

Define

Answer 1

Abscess - liver infection resulting in walled off area of pus

cyst- liver infection resulting in walled off area of cyst fluid.

Question 2

Aetiology:

Answer 2

Pyogenic - enterococcus, staphylococcus, streptococcus, E.coli + Klebsiella

60% due to biliary tract disease e.g. gall stones
15% due to an unknown cause

Ameobic abscesses - due to E.hystolitica

Hydatid cyst - due to tapeworm echiococcus (this is a cyst filled with watery fluid)

TB

Question 3

Symptoms

Answer 3

Fever
malaise
RUQ pain
Weight loss
Diarrhoea 
nausea
night sweats
pyrexia
reactive pleural effusion - difficulty breathing worse on the right lobe than the left.
jaundice

Question 4

Signs:

Answer 4

Fever- continuous or spiking
Jaundice
tender hepatmegaly
Decreased breath sounds, dullness on percussion of right lower lobe due to the reactive pleural effusion.

Question 5

Investigations:

Answer 5

FBC - leucocytosis, mild anaemia, high esosonophils (if hydatid)

LFT’s - high ALP and bilirubin

ESR and CRP up

Blood cultures

ameobic and hydatid serology

US or CT of the liver

Stool analysis - e.hystolitica

CXR for pleural effusions

Apiration and culture

Question 6

Risk factors:

Answer 6

> 50, DM, IBD, inflammatory conditions and cirrhosis are all risk factors.

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