Liver Abscesses and Cysts Flashcards
Define Liver Abscess?
Liver infection resulting in a walled off collection of pus
Define Liver Cyst?
Liver infection resulting in a walled off collection of cyst fluid
What is the aetiology of Liver abscesses and cysts?
Pyogenic (producing pus)
Amoebic Abscess
Hyatid Cyst
Other causes: TB
What are the Pyogenic causes of Liver Absecesses and Cysts?
Escherichia coli Klebsiella Enterococcus Bacteriodes Streptococci Staphylococci 60% are caused by biliary tract disease 15% have unknown cause
What are some examples of Biliary Tract Disease?
Gallstones
Strictures
Congenital Cysts
What are Amoebic Abscesses caused by?
Entamoeba Histolytica
What is Hydatid Cyst caused by?
Caused by tapeworm Echinococcus granulosis
What is a Hyatid?
A cyst containing watery fluid
What is the epidemiology of Liver Absecesses and 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 Absecesses and Cysts?
Fever Malaise Nausea Anorexia Night Sweats Weight Loss RUQ/epigastric pain that may be referred to the shoulder (due to irritation of the diaphragm) Jaundice Diarrhoea Pyrexia of unknown origin
What do you ask about in the history for Liver Absecesses and Cysts?
Make sure you ask about foreign travel
What are the signs of Liver Absecesses and Cysts?
Fever - continous or spiking Jaundice Tender hepatomegaly (right lobe affected more than left) Right lung base: - Dullness to percussion - Reduced Breath Sounds - Due to reactive pleural effusion
What bloods do we do to invesigate Liver Absecesses and Cysts?
FBC LFTs High ESR and CRP Blood Cultures Amoebic and hydatid serology
What do we look for on a FBC for Liver Absecesses and Cysts?
Mild anaemia
Leukocytosis
High eosinophils (if hydatid disease)
What do we look for on LFTs for Liver Absecesses and Cysts?
High ALP
High bilirubin
Why do we do a Stool MC&S for Liver Absecesses and Cysts?
For E.histolytica
Why do we do a Liver US or CT/MRI for Liver Absecesses and Cysts?
Helps localise structure of mass
Why do we do a CXR for Liver Absecesses and Cysts?
Check for right pleural effusion or atelectasis, raised hemidiaphragm
Why do we need to do Aspiration and culture of the abscess material?
Most pyogenic liver abscesses are polymicrobial
Amoebic abscesses have fluid of necrotic hepatocytes and trophozoites
