liver abscees

8/12/2019 Liver Abscees

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A liver abscess is a pus-filled cavity within the liver

Types

Amoebic liver abscess Pyogenic liver abscess


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Amoebic liver abscess Caused by ent histolytica

Carried from bowel to liver in portal venous system

More common in adult maleAbscess are usually large single and present in right

upper lobe


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Cont ..

After adherence, trophozoites :-

invadethe colonic epithelium to produce the ulcerativelesions typical of intestinal amebiasis .

lysethe target cells by using lectin to bind to the targetcells' membranes and using the parasite's ionophorelike

protein to induce a leak of ions(i.e, Na+, K+, Ca+) fromthe target cell cytoplasm.

An extracellular cysteine kinasecauses proteolyticdestruction of the tissue, producing flask-shaped ulcers


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Cont ..

Spread of amebiasis to the liver occurs via the

portal blood.Trophozoites ascend the portal veins to

produce liver abscesses filled with acellular

proteinaceous debris. This material has theappearance of anchovy paste.

The trophozoites of E histolyticalyse the

hepatocytes and the neutrophils.


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Cont..

Amebic liver abscessis the most common

form of extraintestinal amebiasis. It results from spread of the organisms from

the intestinal submucosa to the liver via the

portal system.Approximately 40% of patients who have

amebic liver abscess do nothave a history ofprior bowel symptoms.

5% of patients with symptomatic intestinalamebiasis and is 10 times as frequent in men asin women.


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Cont .. presents with fever and a constant, dull, upper right

abdominal or epigastrium pain.

Involvement of the diaphragmatic surface of the liver

may lead to right-sided pleuritic pain or referredshoulder pain.

Associated GI symptoms : - occur in 10-35% of patients and include nausea,

vomiting, abdominal distention, diarrhea, andconstipation.

May present with vague abdominal discomfort, weightloss, and anemia.


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Pain and fever Initially dull in right hypochindrium later becomes

sharp and stabing.

Referred to tip of right or left shoulder and mayincrease by dep inspiration or coughing

Fever initialy high later remittent or intermittent rigorsmay occur


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Examination Ill looking ,toxic and febrile

Enlarged tender liver liver is palpable and severely

tenderJaundice is usually absent

Local edema of chest or abdominal wall may present

Compression test pain on firm pressure with

findertips on intercostel space over a limited area iscommon and valuable in localizing the puss


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Pyogenic liver abscess Thy are uncommon but important because they are

potentialy curable inevitably fatal if untreated

Mortality is 20 to 40% and failure to diagnose is themost common cause

Older patient and those with multiple abscess alsohave high mortality rates


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Causes Billiary obstruction cholingitis

Hematogenous

portal vein mesenteric infection hepatic artery bacteraemia

Truama penetrating or non penetrating

Infection of liver tumor or cyst


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Organisms E coli most common

Strep fecalis

Proteus vulgarisAnaerobes such as bacteriods

S aures occasionally


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Clinical featureAre similar to amebic liver abscess


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Treatment of amebic liver abscessMetronidazole 800 mg 8 hourly orally for 10 days

90% of patient respond within 72 hours with reducepain and fever

Diloxanide furate tab entamizole DS 500 mg 3 timesdaily for 10 days to eliminate intestinal infections

Aspiration of liver abscess


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Indication of aspiration Failure to response clinically in 3 to 5 days

Threat of imminent rupture

Need to rule out pyogenic abscess Left lobe abscess

Large abcess more than 10 cm


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Procedure

A wide bore needle is inserted into area of maximumtendreness or into 8thor 9thintercostal space inmidaxillary line

All available fluid should be removed

Ultrasound guided procedure may be performed


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Treatment of pyogenic liver

abscess Prolonged antibiotic and drainage of abscess

Associated billiary obstruction and cholingitisrequired biliary drainage preferably endoscopicaly

3rdgeneration cephalosporinsuch as cefataxime inj.claforan 1 gm 8 hourly plus metronidazole inj. flagyl500 gm 8 hourly

If cost is problem then use

Ampicillin inj. penbtrin 500 gm 6 hourly Gentamicin inj. gentacin 80 gm 8 hourly

Metronidazole


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AspirationAspiration is required if

abscess is large in size or

does not respond to antibiotics

liver abscees

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