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2. Abscessesof the liver are relatively rare Mortality rates decreased to 5-30% New radiologic techniques Improvement in microbiologic identification Advancement of drainage techniques Improved antibiotics Improved supportive care 3. No sex predilection Age mostly children and elderly Risk more in:- DM Liver transplants Immunosuppressed Mortality ranges from 5 30% 4. Pyogenic abscess Polymicrobial Most common cause Amoebicabscess (Entamoeba histolytica) Fungal abscess (Candida species) 5. MC symptoms :- Fever (either continuous or spiking) Chills Right upper quadrant pain Anorexia Malaise 6. Coughor hiccoughs (diaphragmaticirritation) Referred pain to the right shoulder Insidious course (weight loss, anemia) ?? malignancy Feverof unknown origin Acute systemic toxicity (Multipleabscesses) Afebrile 7. MC :- Fever, Tender hepatomegaly Mass +/- Decreased breath sounds Rt basilar lung zones Atelectasis, effusion Pleuralor hepatic friction rub Jaundice Biliary tract disease Multiple abscesses 8. BiliaryDisease Cholecystitis Empyema A/c Gastritis Hepatocellular Carcinoma Hydatid Cysts Pneumonia 9. CBC:- Anemia Neutrophilic leukocytosis LFT Albumin Alkaline phosphatase SGOT, SGPT, bilirubin levels (variable) Blood cultures (+ve 50%) Culture of abscess fluid ELISA for E histolytica 10. CTscan USG CXR 11. Drainage - percutaneous /surgical Antimicrobial treatment as adjunct Antibiotic therapy as standalone Unfit for invasive procedures Multiple abscesses Many months therapy Serial imaging and close monitoring 12. Indications :- Signs of peritonitis Known abdominal surgical pathology (eg -diverticular abscess) Failure of previous drainage attempts Complicated, multiloculated, thick-walled abscesswith viscous pus 13. EMPERIC Beta-lactam/beta-lactamase inhibitor Carbapenems Second generation cephalosporins+ Anaerobic coverage (metronidazole /clindamycin) Change C&S report 14. Amoebic :- Metronidazole Chloroquine emetine/dehydroemetine Fungal :- Amphotericin B (plain, lipid) Fluconazole 15. 4-6weeks of therapy - solitary lesions 12 weeks - multiple abscesses Guide to the length of therapy :- clinical process radiographic progress 16. Sepsis Empyema :- contiguous spread intrapleural rupture of abscess rupture of abscess Peritonitis Endophthalmitis (K pneumoniaebacteremia) 17. Untreated= fatal Bad prognosis :- Severity of underlying medical conditions Presence of complications Delay in diagnosis Bilirubin > 3.5 mg/dL Encephalopathy S.Albumin level of < 2 g/dL Multiple abscesses Malignant etiology High APACHE II score