Non traumatic liver injuries

Question 1

Risk factors and most common organisms causing bacterial and amebic liver abscess

Answer 1

Bacterial: E. Coli, klebsiella, proteus

Amoebic: entamoeba histolytica (most common worldwide)

RF bacterial: cholangitis, diverticulitis, liver cancer/metastasis, DM and old age and use of PPI chronically

RF amoebic: homosexuality, Central America patients, alcoholics

Question 2

Symptoms and diagnosis for both types of abscess

Answer 2

Both: fever, chills, RUQ pain, jaundice, weight loss. Amoebic also diarrhea and less chills

Dx:
Leokocytosis, high LFTs, US/CT/MRI. For amoebic do indirect hemagglutination titers for organism antibodies (high)

Question 3

Amoebic abscess classic content description and mode of transmission. Treatment for both types

Answer 3

Anchovy paste. Fecal oral route
Bacterial: US or ct guided drainage, IV antibiotics

Amoebic: IV metronidazole (surgical drainage if refractory)

Question 4

What is hydatid cyst and RF

Answer 4

Liver cyst typically in right lobe filled with echinococcus granulosus

RF exposure to dogs, sheep and cattle. Travel

Question 5

Symptoms of hydatid cyst and diagnosis?

Answer 5

Mostly asymptomatic -or RUQ pain, hepatomegaly, jaundice

Eosinophilia, serology, casoni (hypersensitivity) test, abdomen xray may show calcified outline of the cyst, US/CT

Question 6

Treatment? Major risk? Would you surgically drain the cyst?

Answer 6

NEVER aspirate right away due to risk of rupture and leak of contents into the abdomen, causing anaphylaxis.

Give mebendazole then resect surgically

Question 7

Define hemobilia and classic triad

Answer 7

Blood draining by CBD into the duodenum. Triad of RUQ pain, jaundice (clots in bile ducts) and upper GI bleed

Question 8

Causes, diagnosis, and treatment of hemobilia

Answer 8

Liver lacerations PTC (percutaneous trans hepatic cholangiography)

Diagnosis upper endoscopy
Tx embolization of bleeding vessel