The liver 2 Dr. noori Hanoon Flashcards
how the pt with amoebic liver abscess presented with ?
- common presentation is desentrny (gastroenteritis that results in diarrhea with blood) dysentric abscess
- pt may be presented with amebic abscess common site is paracecal in the liver
how the dysentric abscess ?
70% of pt have solitary large abscess
30% multiple and small
how pt get amoebic liver abscess?
by the ingestion of the cyst of Entamoeba histolytic that then develop into trophozoite in the colon then to the bowel then to the liver
whats the course of the amoebic liver abscess ?
1- first there will be inflammation (amoebic hepatitis )
2- Amoebic abscess and its look like chocolate pus (anchovy paste )
3- encapsulated abscess — dormant
4- may burst and cause many complications
what’re the complications that could happen if the amoebic abscess burst ?
1- infect the peritoneum cavity
2- hallow organs
3-skin
4-lung and the plural cavity
what’re the signs and symptoms of the amoebic live abscess ?
1- pain in the liver area enlarge and tender liver
2- fever and night sweating
3- Anemia
4-weight loss
how to diagnosis the amoebic liver abscess ?
-U/S ,CT, Chest Xray , abdominal X ray
-stool examination for the isolation of the organism
but taking a sample from the liver lesion (abscess)its difficult because its in the periphery
what’re the treatment of the amoebic liver abscess?
1- mainly we give pt metronidazole 750mg X2 Daily for
(7-10)days ( is an antibioticIt is effective for dracunculiasis, giardiasis, trichomoniasis, and amebiasis )
2- possibly aspiration under U/S guidance
3- laparoscopy might needed or open
what’re the types of the cysts ?
1- simple cyst unilocular
2- hydatid cyst most common in the Middle East multilocular
what’re the features of the simple cyst ?
1- regular, define margin
2-thin wall and unilocular
3- homogenous
3- no variation in the density and no surrounding tissue response
how the simple cyst seen in the CT ?
sharp defined margin no separation calcification enhancement mural nodules
what’re the treatment of the simple cyst ?
1- nothing if it asymptomatic
2- aspiration under U/S guidance
3-for large and symptomatic the laparoscopy or open
whats the cause of the polycycstic liver disease ?
congenital
what’re the features of the polycycstic liver disease ?
- multiple cyst
- its asymptomatic
- may there will be discomfort
- pt may have sever pain due to the hemorrhage
how to diagnosis the polycycstic liver disease ?
U/S ,CT
TRT of the polycycstic liver disease ??
1- anaglgesis
2- if no response then laparoscopy or open
whats the cause of the hydatid cyst disease?
-ingestion of the larva of Echincouccus granulosus that found in the dogs that reach the liver by portal circulation
- attack the liver 70%
lung 20%
and 10% the other organs
enumerate the layers of the hydatid cyst ?
1- adventitia
2- ectocyct (laminated layer)
3- endocyct (germinal layer )
what’re the content of the hydatid cyst fluid ?
1- crystal clear
2- active cyst have many small daughter cyst
3-no albumin
4- the specific gravity 1.005-1.009
whats the symptoms of the hydatid cyst ?
1- asymptomatic 2- pressure menfistation as - discomfort - fulness -jaundice 3- abdominal mass 4- complications -suppuration -rupture of the daughter hydatid cyst (ether *intrabilliary : causing jaundice and acute cholengitis *peritoneal : as acute abdominal after minor injury *pleural cavity )
whats the course of the hydatid cyst disease ?
1- ether active cyst that enlarge in size na d become more superficial and float in the peritoneum
2- or died as calcified cyst
3-complication rupture or suppuration (infection)
how to diagnosis the hydatid cyst disease ?
1- u/s to see the cyst multilucunar while the CT to see the cyst floating 2- serology and immunological tests : -ELISA test bt antibody against antigen -Casoni test 75% -compliment fixation
what’re the treatment of the hydatid cyst?
@SURGERY 1-OPEN SURGERY a- derfooing (cut off )and evacuate the content b- excision of the cyst c-liver resection
2- LAPAROSCOPY AND SCOLICIDAL AGENT :
- ethanol alchohol 95%
- hypertonic fluid
- sliver nitrite 0.5%
- povidine iodine
@MEDICATION
- mebandazole 40-50( anthelmintic reat a number of parasitic worm infestations)
- albendazole 10-15mg /kg
- praziquntal 40
what’re the scolicidial agent ?
1- ethanol 95%
2- hypertonic fluid
3-sliver nitrite
4- povidine iodine 0.5%
what’re the complication of the surgical treatment of the hydatid cyst ?
1- billiard leakage --fistula 2- cholangitis ---- 3-suppuration 4-liver tissue damage and bleeding 5- reccurance 6- missed deep cyst ---- 7-injuries to the near organ 8- contamination of the peritoneum cavity (albenazole and parziquntal ) ---- 9-anaplastic shock 10- wound infection
whats the tubercles liver abscess ?
its rare may found in endemic area
associated with pulmonary TB or lymphadintis TB
how the pt presented with tubercles liver abscess ?
- present with non specific symptoms
- or after the diagnosis of the pulmonary TB or rExtra- pulmonary TB
How to diagnosis the tubercles liver abscess ?
u/s and ct
treatment of the tubercles liver abscess?
drainage and anti - TB PIER -Pyrinzmid -isonisid -ethambtol -rifamicin
