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    Abcesul Hepatic

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    AleeAlexandra
    - Pyogenic liver abscess is characterized by collections of pus within the liver caused by bacterial infection, often polymicrobial including E. coli, Streptococcus, and Klebsiella pneumoniae. - Risk factors include diabetes, liver surgery/disease, gastrointestinal cancers, and immunosuppression. Symptoms can include fever, abdominal pain, and weight loss. Diagnosis is confirmed by abdominal imaging and treatment involves IV antibiotics and drainage of the abscess. - Complications include sepsis, pneumonia, and rupture of the abscess into the abdomen or chest. Advances in diagnosis and treatment have reduced mortality rates from pyogenic liver abscess.

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    Abcesul Hepatic

    Uploaded by

    AleeAlexandra
    41 views8 pages
    - Pyogenic liver abscess is characterized by collections of pus within the liver caused by bacterial infection, often polymicrobial including E. coli, Streptococcus, and Klebsiella pneumoniae. - Risk factors include diabetes, liver surgery/disease, gastrointestinal cancers, and immunosuppression. Symptoms can include fever, abdominal pain, and weight loss. Diagnosis is confirmed by abdominal imaging and treatment involves IV antibiotics and drainage of the abscess. - Complications include sepsis, pneumonia, and rupture of the abscess into the abdomen or chest. Advances in diagnosis and treatment have reduced mortality rates from pyogenic liver abscess.

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    Abcesul hepatic

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    - Pyogenic liver abscess is characterized by collections of pus within the liver caused by bacterial infection, often polymicrobial including E. coli, Streptococcus, and Klebsiella pneumoniae. - Risk factors include diabetes, liver surgery/disease, gastrointestinal cancers, and immunosuppression. Symptoms can include fever, abdominal pain, and weight loss. Diagnosis is confirmed by abdominal imaging and treatment involves IV antibiotics and drainage of the abscess. - Complications include sepsis, pneumonia, and rupture of the abscess into the abdomen or chest. Advances in diagnosis and treatment have reduced mortality rates from pyogenic liver abscess.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    41 views8 pages

    Abcesul Hepatic

    Uploaded by

    AleeAlexandra
    - Pyogenic liver abscess is characterized by collections of pus within the liver caused by bacterial infection, often polymicrobial including E. coli, Streptococcus, and Klebsiella pneumoniae. - Risk factors include diabetes, liver surgery/disease, gastrointestinal cancers, and immunosuppression. Symptoms can include fever, abdominal pain, and weight loss. Diagnosis is confirmed by abdominal imaging and treatment involves IV antibiotics and drainage of the abscess. - Complications include sepsis, pneumonia, and rupture of the abscess into the abdomen or chest. Advances in diagnosis and treatment have reduced mortality rates from pyogenic liver abscess.

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    of 8

    Patologie hepatica

    Abcesul hepatic- piogen


    Rezumat

    Pyogenic liver abscess (PLA) is an uncommon condition characterized by solitary or multiple collections of pus within the liver.
    The infection is caused by bacteria and is often polymicrobial, with Escherichia coli, Streptococcus spp. and Klebsiella
    pneumoniae being common causative organisms.
    The majority of cases are caused by:
     ascending infection from a biliary tract pathology (e.g., cholangitis due to choledocholithiasis or biliary strictures)

     infection in the gastrointestinal tract or bacteremia can expose the liver to high bacterial loads because of the liver's dual
    blood supply from the portal vein and hepatic artery.
    Patients may present with nonspecific symptoms, such as fever, malaise, and weight loss. 
    Right upper quadrant pain and tender hepatomegaly are specific features of a liver abscess but are not seen in all cases.
    Diagnosis is confirmed on abdominal imaging (ultrasound or CT), which would typically show intrahepatic fluid-filled lesions with
    surrounding edema.
     Broad-spectrum IV antibiotics and percutaneous or surgical drainage of the abscess cavity are the mainstays of treatment.
    Complications include sepsis, pneumonia, and abscess rupture into the peritoneum or thorax. Advances in diagnostics and
    treatment have reduced the complications and mortality rates of PLA.

    Epidemiologie

    Factori de risc
     Diabet zaharat
     Chirugie hepatica ( ex: transplant hepatic)
     Hepatopatii ( ex: ciroza)
     Neoplazii ( in special cele gastrointestinale)
     Imunosupresie
     Utilizarea cronica de inhibitori de pompa de protoni
     Varsta inaintata
     Sex masculin

    Etiologie
     Cauza infectiei poate fi neclara -> abces hepatic primitiv dar de cele mai multe ori apare secundar unui proces infectios
    abdominal sau ca urmarea a unui afectiuni septice generale

    Sursa Etiologie Patogeneza

    1) Obstructie  Litiaza coledociana


    biliara : cea mai  Stricturi biliare
    comuna cauza  Obstructie maligna
    identificata ( 24-
    60%)

     Anomalii congenitale ale tractului biliar ( chist coledocian)

    2)Artera  Bacteriemie, sepsis ( ex: endocardita infectioasa, i.v line infection)


    hepatica (10%)  Tromboza arterei hepatice

    3)Vena porta o Infectii intraabdominale


    (7%) - Apendicita acuta
    - Diverticulita
    - Peritonita ( ex: in cazul perforatiilor , infectie postoperatorie)
    - Febra tifoida
    - Enterocolita acuta
    o Boli inflamatorii intestinale (Crohn)

    o Abces pelvic
    o Cancer colorectal

    4)Raspandire  Abces subfrenic


    de vecinatate  Abces perinefritic
     Colecistita

    5)Altele Criptogenic (10-66%)

     Traumatisme penetrante (5%)


     Iatrogenic
    o Chirurgie hepatica
    o Proceduri hepatica :Trans-hepatic arterial chemoembolization,
    ablatie cu radiofrecventa
    o Proceduri ale tractului biliar : ERCP + sfincterotomie

    Infectie secundara a unui:


     Abces hepatic amoebic
     Chist hidatic
     Tumori hepatice
     Hematom hepatic / necroza cauzata de o contuzie (rar)

    Cei mai frecventi agenti patogeni implicati:


    - Frecvent polimicrobian
    - E.coli
    - Klebsiella pneumoniae
    - Streptococ
    - Altele: Enterococ, Stafilococ si anaerobi (B.fragilis)

    Clinic

    Boala poate debuta brusc sau insidios. Semnele clinice pot fi intricate sau mascate de boala de bază cauzatoare. De cele mai
    multe ori diagnosticul de abces hepatic piogen se face tardiv. Se consideră că timpul mediu pentru diagnosticul de abces hepatic
    piogen este de aprox. două săptămâni.

    Triada clasica: Febra ( cu/fara frisoane)- cel mai comun simptom, Inapetenta/Apatie, Durere in hipocondrul drept

    Alte simptome:
    o Anorexie & Pierdere in greutate
    o Greata si varsaturi
    o Simptome de iritatie diafragmatica
    Examenul obiectiv:
    o Hepatomegalie ferma, neteda si dureroasa
    o Icter sclero-tegumentar : apare de la început în cazul localizărilor multiple ale abcesului sau tardiv după fisurarea acestuia în
    căile biliare în localizările unice
    o In aprox. 40% poate aparea apararea musculara localizata in etajul abdominal superior hipocondru drept si epigastru ( in
    abcesul cu localizare la nivelul lobului stang)
    o Diminuarea murmurului vezicular la nivelul lobului pulmonar drept inferior ( pleurezie, atelectazie) / raluri bronsice, frecaturi
    pleurale – mai ales in localizarile pe fata diafragmatica a ficatului
    o Durere intercostala ( in abcesele lobului drept)
    Diagnostic

    1.Examen de laborator:
    o Hemoleucograma: leucocitoza, anemie normocromica normocitica
    o Functie hepatica: FAL crescuta, TGO, TGP crescute, hipoalbuminemie, hiperbilirubinemie
    o Posibil INR crescut, LDH crescut
    o Hemoculturi pozitive in pana la 60% din cazuri
    Serologie: ( anticorpi anti amebioza /echinococcoza) pentru a face diagnosticul diferential

    2. Imagistic

    De prima intentie
     Echografie abdominala
    2.CT ( de preferat cu substanta de contrast)

    3.RMN

    4.Ultrasonografie cu contrast enhancement (CEUS-contrast enhanced ultrasonography)

    5.Radiografie abdominala

     Colangiografia retrogradă transduodenală ne poate preciza prezenţa cavităţii abcesului când acesta comunică cu căile
    biliare sau ne poate preciza cauza generatoare a abcesului şi de asemenea ne poate ajuta în favorizarea drenajului biliar
    prin papilosfincterotomie endoscopică.

     Aspiratie percutanta a abcesului insotita de examen Gram si cultura


    Diagnosticul diferential

     Abces nonpiogenic
    o Abces amoebic ( 10% dintre abcese) cauzate de Entamoeba hystolitica

     Fungice ( <10%) cel mai frecvent cauzate de Candida


     Echinococcoza hepatica ( chist hidatic)
     Chisturi hepatice
     Carcinom hepatocelular
     Metastaze hepatice

    Tratament
     Principii generale

    1. Antibioterapie empirica

    Single-agent regimens (any of the following) Piperacilina/Tazobactam


    Carbapenem ( Imipenem/Cilastatin , Meropenem, Ertapenem)
    Combination therapy regimens
    Metronidazol + Cefalosporina gen.3 ( Ceftriaxona, Ceftazidim) /
    Fluroquinolona ( Levofloxacina, Ciprofloxacina)

    2. Drenaj percutanat ghidat imagistic

    Indicatii: procedura standard in abcesele unice, interventional accesibilie


    Contraindicatii : coagulopatie ( INR >1.5 , plachete < 50.000/mm3)
    Se realizeaza echoghidata sau CT ghidata

     Drenaj percutanat prin cateter : de preferat pentru ca permite drenajul continuu

     Aspirat percutanat cu ac

    3. Drenaj chirurgical

    Complicatii
     Ruptura
    o In cavitatea abdominala Peritonita
    o In cavitatea toracica Empiem (Piotorax)
    o In retroperitoneu Abces retroperitoneal
    o In pericardTamponada cardiaca

     Sepsis
     Pneumonia
     Efuzie pleurala

    Prognostic

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