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Transcript of Liver abscess
- 1.Liver Abscess
- 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,
- inflammatory bowel disease,
- 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 world
- 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
4. Clinical Features
- Often the diagnosis of a bacterial abscess is suggested clinically .
- Pain right hypochondrium
- Right upper quadrant discomfort
- weight loss
- Intercostal tendreness
- Swelling in the right hypo chondrium or epigastrium
- tender, enlarged liver .
- USGMof the liver
- X-Rayof the chest to see whether there is any pneumonitis or effusion caused by the irritation of the nearby abscess
- LFT- Abnormal liver function tests (LFTs)
- CTscan liver
- 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.
8. 9. CT scan showing liver abscess
- The abscess is shown as a darker area in the liver shadow
10. 11. 12.
- Pleural effusion
- Rupture of the liver abscess into the pleural cavity - causing empyema
- Rupture into the peritoneal cavity
- percutaneous or surgical drainage (Ultrasound guided repeated aspiration)
- Antibiotics like cephalosporins, aminoglycosides, tetracyclines
- In rare cases it may need insertion of a drain.
- mortality rate is almost 100% if the abscess remains untreated
13. Pleural Effusion secondary to amoebic liver abscess 14. An amoebic liver abscess causing a bulge in the dome of the diaphragm 15. Amoebic liver abscess burst into the right pleural cavity 16. 17. 18. 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.
- Amebic dysentery : Colonization of cecum & colon byEntamoeba histolyticais 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.
20. 21. 22. Mature Cysts