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    Liver Abscess

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    Ali Aborges Jr.
    1) Pyogenic liver abscesses account for about 80% of liver abscesses and are usually polymicrobial, with E. coli being the most common cause. 2) Risk factors for pyogenic liver abscess include diabetes mellitus, GI malignancy, and Crohn's disease. 3) Ultrasound and CT scans are the main diagnostic tools, showing a fluid-filled, hypoechoic lesion in the liver with surrounding edema. Blood cultures are positive in about 50% of cases.

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    Liver Abscess

    Uploaded by

    Ali Aborges Jr.
    251 views15 pages
    1) Pyogenic liver abscesses account for about 80% of liver abscesses and are usually polymicrobial, with E. coli being the most common cause. 2) Risk factors for pyogenic liver abscess include diabetes mellitus, GI malignancy, and Crohn's disease. 3) Ultrasound and CT scans are the main diagnostic tools, showing a fluid-filled, hypoechoic lesion in the liver with surrounding edema. Blood cultures are positive in about 50% of cases.

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    liver abscess

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    1) Pyogenic liver abscesses account for about 80% of liver abscesses and are usually polymicrobial, with E. coli being the most common cause. 2) Risk factors for pyogenic liver abscess include diabetes mellitus, GI malignancy, and Crohn's disease. 3) Ultrasound and CT scans are the main diagnostic tools, showing a fluid-filled, hypoechoic lesion in the liver with surrounding edema. Blood cultures are positive in about 50% of cases.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    251 views15 pages

    Liver Abscess

    Uploaded by

    Ali Aborges Jr.
    1) Pyogenic liver abscesses account for about 80% of liver abscesses and are usually polymicrobial, with E. coli being the most common cause. 2) Risk factors for pyogenic liver abscess include diabetes mellitus, GI malignancy, and Crohn's disease. 3) Ultrasound and CT scans are the main diagnostic tools, showing a fluid-filled, hypoechoic lesion in the liver with surrounding edema. Blood cultures are positive in about 50% of cases.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 15

    liver abscess

    Microbiology
    Liver abscess

    Non Pyogenic liver abscess 20% Pyogenic liver abscess 80%


    • Often polymicrobial ( MC).
    • Fungal infection (< 10% of cases) • E.coli is the most common cause
    • Amebic liver abscess (< 10% of
    • IV drug users → Staph Aureus
    cases): Entamoeba histolytica
    Pyogenic liver abscess
    • A pyogenic liver abscess is characterized by solitary/multiple collections
    of pus within the liver.
    • Risk factors
    • Diabetes mellitus
    • GI malignancy
    • Crohn's disease
    Contiguous area (< 5%)
    1- Subphrenic abscess

    Etiology 2- Perinephric abscess


    3 Pancreatic abscess
    Cryptogenic (∼ 20%)
    Secondary infection of hepatic tumors
    Secondary bacterial infection of amebic
    liver abscess

    Hepatic artery (∼ 15%)


    1 - Sepsis
    2- Bacteremia

    Biliary tract (∼ 60%):


    Most common cause Portal vein (∼ 20%).
    1- Choledocholithiasis 1- appendicitis
    2- Biliary strictures 2- Diverticulitis
    3- Cholangitis 3-Crohn's disease
    4- Gastrointestinal malignancies
    5- Peritonitis (bowel perforation)
    Clinical features
    • Classic triad
    • Fever (with/without chills )
    • Malaise
    • Right upper quadrant pain.
    +
    • Jaundice
    • Painful hepatomegaly.
    • Intercostal tenderness
    • Epigastric tenderness
    • Decreased breath sounds in right lower lobe of the lung

    The symptoms are often non-specific!!!!


    Diagnostic
    • Labs:
    • Leukocytosis is present in 70% to 90% of patients.
    • anemia is commonly encountered.
    • The ALP level is mildly elevated in 80% of patients.
    • total bilirubin concentration is elevated 20% to 50% of the time.
    • Transaminases are mildly elevated inapproximately 60% of patients.

    None of these blood tests specifically help diagnose a hepatic abscess.


    However, together they may suggest a liver abnormality that often leads to
    imaging studies.!!!!
    Imaging studies
    • Chest radiographs are abnormal in 50% of cases
    • may reflect subdiaphragmatic disease
    • such as an elevated right hemidiaphragm
    • right pleural effusion
    • atelectasis
    Imaging studies
    • Ultrasound and CT are the mainstays of diagnostic modalities for hepatic
    abscess.
    • Ultrasound can reliably distinguish solid from cystic lesions.
    • The sensitivity of ultrasound in diagnosing hepatic abscess is 80% to 95%.
    • poorly demarcated, fluid-filled, round hypoechoic lesion within the
    hepatic parenchyma with surrounding edema
    Imaging studies
    • Abdominal CT scan: Findings are similar to those on abdominal ultrasound.
    • The sensitivity of CT in diagnosing hepatic abscess is 95% to 100%.
    Diagnostic
    • Percutaneous aspiration and culture of the aspirate
    • Performed under US or CT guidance
    • Aspirated material is cultured to determine the organism and its antibiotic-
    susceptibility .
    • Its also Curative procedure (drain and culture ).
    • Blood culture - positive in ∼ 50% of cases.
    DDx
    Treatment
    • Antibiotics
    • Indicated in all cases
    • Broad-spectrum IV antibiotics:→ then change according to culture.
    • ampicillin + sulbactam;
    • piperacillin + tazobactam;
    • 3rd generation cephalosporin + metronidazole
    Treatment
    Drainage of the abscess

    liver abscess

    Number ?
    Multiple ? Solitary ?

    Size ?

    Large (> 5 cm) Small (< 5 cm)

    surgical drainage PNA / Percutaneous drainage fails on second attempt ?


    percutaneous drainage and
    intracavitary catheter
    placemen
    PNA
    Contraindications to Percutaneous drainage
    • coagulopathy (INR) > 1.5
    • thrombocytopenia .

    In such cases, the coagulopathy must be corrected before draining the abscess.
    Complications
    • Rupture
    • Into the abdomen → peritonitis
    • Into the chest → empyema
    • Into the retroperitoneum → retroperitoneal abscess
    • Sepsis
    • Pneumonia
    • Pleural effusion

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