Liver Abscess

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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 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

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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.

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Investigations

• 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

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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
• 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

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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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