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Liver Abscess

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Aetiology

• Bacterial, parasitic, or fungal in origin. • 85% to 90% bacterial or pyogenic.

Bacteria access the liver via the biliary tree or portal vein.

Other causes include • biliary obstruction, • diverticulitis,• trauma, • inflammatory bowel disease,

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Incidence • Liver gets infected by Entamoeba histolytica commonly• The most common location of a pyogenic abscess is the

right lobe. • Chronic alcoholics - prone to get this infection• Entamoeba histolytica is endemic in many parts of the

worldPathophysiology• The amoebic cyst is ingested • Cyst develops into the trophozoite form in the colon • Reaches the liver through portal circulation• Pyogenic abscess may also occur due to the infection by

streptococcus milleri and Escherichia coli.• Many a time the pyogenic infection follows amoebic

infection

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Clinical FeaturesOften the diagnosis of a bacterial

abscess is suggested clinically.

FeverPain right hypochondriumChills RigorsToxicityRight upper quadrant discomfort Diarrheaweight lossIntercostal tendrenessSwelling in the right hypo

chondrium or epigastriumtender, enlarged liver.

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• USGM of the liver• X-Ray of the chest

to see whether there is any pneumonitis or effusion caused by the irritation of the nearby abscess

• TC -Leukocytosis• LFT - Abnormal

liver function tests (LFTs)

• CT scan liver

Investigations

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CT : • a heterogeneous lesion • irregular margins• peripheral contrast enhancement. • Internal septations

The radiologic differential diagnosis includes

• cystic or necrotic metastases (ovarian or leiomyosarcoma)

• hydatid and echinococcal cysts.

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CT scan showing liver abscess

• The abscess is shown as a darker area in the liver shadow

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Complications:

PneumonitisPleural effusionRupture of the liver abscess into the pleural cavity - causing

empyemaRupture into the peritoneal cavity

Treatmentpercutaneous or surgical drainage (Ultrasound guided repeated

aspiration)antibiotics. MetronidazoleAntibiotics like cephalosporins, aminoglycosides, tetracyclinesIn rare cases it may need insertion of a drain.mortality rate is almost 100% if the abscess remains untreated

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Pleural Effusion secondary to amoebic liver abscess

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An amoebic liver abscess causing a bulge in the dome of the

diaphragm

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Amoebic liver abscess burst into the right pleural cavity

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I. Entamoeba histolytica: Amebic dysentery; amebic liver abscess

• Epidemiology: • Found worldwide, especially in tropical areas, • There is no animal reservoir. • Mode of transmission:• Ingestion of cysts. • Anal-oral transmission due to sexual practice is also a

consideration. • C. Pathology: Two-stage life cycle. • The trophozoite (ameba stage) is motile. • The cyst stage is nonmotile. • Trophozoites are found in the intestinal and

extraintestinal lesions. • Cysts predominate in the stools, with somes trophozoites

present.

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– Amebic dysentery: Colonization of cecum & colon by Entamoeba histolytica is common. Localized necrosis results in "teardrop" or “flask shaped” ulcerations. Invasion into the portal submucosa is progressive after penetration of the submucosa.

– Liver abscess: – Penetration of the diaphragm can lead to lung

disease. – Most liver disease not preceded by dysentery.

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Mature Cysts

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