absces hepar - (liver abscess)

Disediakan Oleh : Nassruto

ABSCES HEPARABSCES HEPAR

DefinitionA pus-filled cavity within the liver.

Dibahagikan kepada:• Bakteria• Parasit/Kulat


Absces Bakteria

Cara-cara memasuki sistem hepar:• Dari sistem biliari – 60%• Dari vena portal - 24%• Dari arteri hepatik• Melalui terus dari empiema pundi hempedu• Kecederaan mencucuk

Penyebab Utama : Gram negatif Escherichia Coli Klebsiella Enterococcus


Manifestasi Klinikal

• Pyrexia dan rigor• Riwayat sepsis di tempat lain• Sakit di RHC• Toxisity teruk• Jaundis• Hepatomegaly• Tanda-tanda pleural effusion dan ‘Basal lobe collaps’• Leukositosis


Investigasi

• Darah : TWDC, BUSE, C&S, LFT

• X-Ray : CXR, Abd. X-Ray, CT Scan

• Ultra Sound

• ERCP

• Biopsy

Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure used to identify the presence of stones, tumors, or narrowing in the biliary and pancreatic ducts. After the endoscope is properly placed, a

catheter is advanced which will inject a contrast agent through the ducts. The contrast is visible on X-rays, and allows a physician to evaluate the caliber,

length and course of the ducts. An ERCP may be performed if a patient experiences symptoms such as jaundice, abdominal pain, fever, or

malabsorption.

ERCPERCP

CT Scan

CT stands for computerized tomography. In this procedure, a thin X-ray beam is rotated around the area of the body to be visualized. Using very complicated mathematical processes

called algorithms, the computer is able to generate a 3-D image of a section through the body. CT scans are very detailed and

provide excellent information for the physician.

Ultra Sound

Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, and CT scan, it has its

place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce an image and do not expose the individual

to radiation. The procedure is painless and safe.

Biopsy

A liver biopsy is not a routine procedure, but is performed when it is necessary to determine the presence of liver disease and to look for

malignancy, cysts, parasites, or other pathology. The actual procedure is only slightly uncomfortable. Most of the discomfort arises from being required to lie still for several hours afterwards to prevent

bleeding from the biopsy site.


Pengendalian

• Percutaneous needle aspiration

• Liver drainage• Percutaneous liver drainage• Surgical drainage

• Transperitoneal approach• Posterior transperitoneal

• Antibiotik therapy• aminoglycoside (amikacin, gentamicin etc)


Absces Ameobik

Penyebab Utama: - Entaboeba Histoltica (protozoa parasit) - Aspergillus

(cyst mengeluarkan tropozoit ke dalam usus dan dibawa masuk ke hepar melalui venous portal)


Manifestasi Klinikal

• Sakit RHC• Anorexia• Berat badan susut• Tander• Hepatomegali


Investigasi

• Stool Ova & Cyst• Ultrasound• CT-Scan

Pengendalian• Amoebicide – Metronidazole (Flygl)

800 mg tds x1/52• Surgical aspiration/ Drainage


KOMPLIKASI

• Sepsis• Empyema• Peritonitis

Renungan:

Maksud Hadis

“Sesiapa yang mempelajari ilmu kerana selain dari Allah atau bermaksud dengannya yang selain dari Allah, maka hendaklah ia menyediakan tempatnya di Neraka”

Riwayat Termizi

absces hepar - (liver abscess)

Health & Medicine