Liver Abscesses and cysts Flashcards
what is the typical presentation for liver abscesses and cysts?
general FLAWS symptoms
RUQ pain
hepatomegaly
define a liver abscess and cyst?
Abscess: liver infection resulting in a walled off collection of pus
Cyst: liver infection resulting in a walled off collection of cyst fluid
wha are the risk factors for liver abscesses or cysts?
biliary tract disease
more than 50 years old
underlying malignancy
DM
interventional biliary or hepatic procedures
Most cases of amoebic infections occur in Central and South America, Africa, and Asia
what are the causes of pyrogenic abscess?
Escherichia coli
Klebsiella – associated with extra-hepatic complications e.g. CNS infections
Enterococcus
Bacteriodes
Streptococci
Staphylococci
60% are caused by biliary tract disease (e.g. gallstones, strictures, congenital cysts)
15% have unknown cause
what is the cause of an amoebic abscess?
Caused by Entamoeba histolytica (faecal oral route, LI infection - dysentery)
what is the cause of a hydatid cyst?
Caused by tapeworm Echinococcus granulosis
NOTE: hydatid = a cyst containing watery fluid
state another cause for an abscess?
TB
summarise the epidemiology of liver abscesses or cysts?
Pyogenic is the most common type of liver abscess in the industrialised world
Amoebic liver abscess - most common WORLDWIDE
Hydatid cysts - common in sheep-rearing countries
what are the presenting symptoms of liver abscesses and cysts ?
IMPORTANT: make sure you ask about foreign travel (Central+S.America, Africa and Asia)
Fever
Malaise
Nausea
Anorexia
Night sweats
Weight loss
RUQ/epigastric pain that may be referred to the shoulder (due to irritation of the diaphragm => can cause cough, SOB and chest pain)
Jaundice (uncommon)
N+V in about 1/3rd of patients
Pyrexia of unknown origin
May see reactive pleural effusion in right lower lobe (uncommon)
what are the signs of liver abscesses and cysts on physical examination?
Fever - continuous or spiking + chills
Jaundice (uncommon)
Tender hepatomegaly (right lobe affected more than left)
Right lung base (uncommon):
- Dullness to percussion
- Reduced breath sounds
- Due to reactive pleural effusion
what are the investigations for liver abscesses and cysts and what are the results?
FBC- leukocytosis, elevated neutrophil count, anaemia, high eosinophils if hyatid disease
LFTs- elevated alk phos, mildly elevated aminotransferases and bilirubin, hypoalbuminaemia
blood cultures
prothrombin time and activated thromboplastin time- - Indicated to check that blood clotting is within normal limits before aspiration is performed. Aspiration is contraindicated in the presence of abnormal clotting.
Amoebic and hyatid serology
Stool MC&S - for E. histolytica
Liver US or CT/MRI - localises structure of mass (hypodense) – mainly to guide aspiration
Aspiration and culture of the abscess material
- Most pyogenic liver abscesses are polymicrobial
- Amoebic abscesses have fluid of necrotic hepatocytes and trophozoites – may do antibody test/ antigen testing of fluid/ stool
what investigation should you consider for liver abscess or cyst?
CXR- Indicated only if there are any chest symptoms or signs on examination (e.g., symptoms suggestive of diaphragmatic irritation or signs of pleural effusion).
in the presence of pleural effusion: blunting of the costophrenic angles
