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Liver Abscess
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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,
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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
worldPathophysiology• 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
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Clinical FeaturesOften the diagnosis of a bacterial
abscess is suggested clinically.
FeverPain right hypochondriumChills RigorsToxicityRight upper quadrant discomfort Diarrheaweight lossIntercostal tendrenessSwelling in the right hypo
chondrium or epigastriumtender, enlarged liver.
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• USGM of the liver• X-Ray of 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)
• CT scan liver
Investigations
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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.
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CT scan showing liver abscess
• The abscess is shown as a darker area in the liver shadow
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Complications:
PneumonitisPleural effusionRupture of the liver abscess into the pleural cavity - causing
empyemaRupture into the peritoneal cavity
Treatmentpercutaneous or surgical drainage (Ultrasound guided repeated
aspiration)antibiotics. MetronidazoleAntibiotics like cephalosporins, aminoglycosides, tetracyclinesIn rare cases it may need insertion of a drain.mortality rate is almost 100% if the abscess remains untreated
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Pleural Effusion secondary to amoebic liver abscess
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An amoebic liver abscess causing a bulge in the dome of the
diaphragm
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Amoebic liver abscess burst into the right pleural cavity
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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.
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– Amebic dysentery: Colonization of cecum & colon by Entamoeba histolytica is 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.
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Mature Cysts
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