Liver abscess

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  • 1.Liver Abscess

2.

  • 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,

3.

  • 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 world
  • Pathophysiology
  • 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 .
  • Fever
  • Pain right hypochondrium
  • Chills
  • Rigors
  • Toxicity
  • Right upper quadrant discomfort
  • Diarrhea
  • weight loss
  • Intercostal tendreness
  • Swelling in the right hypo chondrium or epigastrium
  • tender, enlarged liver .

5. 6.

  • USGMof the liver
  • X-Rayof 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)
  • CTscan liver

Investigations 7.

  • 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.

  • Complications:
  • Pneumonitis
  • Pleural effusion
  • Rupture of the liver abscess into the pleural cavity - causing empyema
  • Rupture into the peritoneal cavity
  • Treatment
  • percutaneous or surgical drainage (Ultrasound guided repeated aspiration)
  • antibiotics.
  • Metronidazole
  • 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.

19.

    • 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