Liver abscesses & cysts

Question 1

Define liver abscess

Answer 1

Liver infection resulting in a walled off collection of pus

Question 2

Define liver cyst

Answer 2

Liver infection resulting in a walled off collection of cyst fluid

Question 3

Aetiology of liver abscess & cysts

3

Answer 3

Pyogenic (producing pus)
Amoebic abscess
Hyatid cyst

Question 4

Aetiology of liver abscess & cysts - pyogenic

8

Answer 4

Escherichia coli
Klebsiella
Enterococcus
Bacteriodes
Streptococci
Staphylococci
60% caused by biliary tract disease (e.g. gallstones, strictures, congenital cysts)
15% idiopathic

Question 5

Aetiology of liver abscess & cysts - amoebic abscess

Answer 5

Entamoeba histolytica

Question 6

Aetiology of liver abscess & cysts - hyatid cyst

Answer 6

Tapeworm Echinococcus granulosis

Question 7

Epidemiology of liver abscess & cysts

3 types

Answer 7

Pyogenic is the most common type of liver abscess in the industrialised world
Amoebic liver abscess is the most common WORLDWIDE
Hyatid cysts common in sheep rearing countries

Question 8

Presenting symptoms of liver abscess & cysts

10

Answer 8

Fever
Malaise
Nausea
Anorexia
Night sweats
Weight loss
RUQ/epigastric pain that may are referred to the shoulder (due to irritation of the diaphragm)
Jaundice
Diarrhoea
Pyrexia of unknown origin

Question 9

Signs of liver abscess & cysts on physical examination

4

Answer 9

Fever - contínuos or spiking

Jaundice

Tender hepatomegaly (right lobe more affected than left)

Right lung base
dullness to percussion
reduced breath sounds
due to reactive pleural effusion

Question 10

Investigations for liver abscess & cysts

5

Answer 10

Bloods
Stool MC&S
Liver US or CT/MRI
CXR
Aspiration & culture of abscess material

Question 11

Investigations for liver abscess & cysts - bloods

5

Answer 11

FBC
mild anaemia
leukocytosis
high eosinophils (if hyatid disease)
LFTs
high ALP
high bilirubin 
High ESR & CRP
Blood cultures
Amoebic & hyatid serology

Question 12

Investigations for liver abscess & cysts - stool MC&S

Answer 12

For E.histolytica

Question 13

Investigations for liver abscess & cysts - liver US or CT/MRI

Answer 13

Localises structure of mass

Question 14

Investigations for liver abscess & cysts - CXR

Answer 14

Check for right pleural effusion or atelectasis, raised hemidiaphragm

Question 15

Investigations for liver abscess & cysts - aspiration & culture of abscess material
(2)

Answer 15

Most pyogenic liver abscesses are polymicrobial

Amoebic abscesses have fluid of necrotic hepatocytes & trophozoites