Dr. Surendra Singh Rajpoot

Hepatic Abscesses

A liver abscess occurs when bacteria or protozoa destroy hepatic tissue, producing a cavity, which fills with infectious organisms, liquelled liver cells, and leukocytes. Necrotic tissue then walls off the cavity from the rest of the liver. Liver abscess occurs equally in men and women, usually in those over age 50. Death occurs in 15% of affected patients despite treatment.

Mainly define in two part:1. Pyogenic Liver Abscesses2. Amoebic Abscesses

Alternative Names:1. Liver abscess2. Bacterial liver

abscess

or

Pyogenic organism like E. Coli

Pyogenic liver abscess is a pus-filled area in the liver.

1. Via portal vein as occurs in appendicitis or diverticulitis.

2. Via the biliary tree as in cholangitis.3. Via hepatic artery as in sepsis or generalized

septicemia.4. Via direct extension from infection in the neighborhood

such as advance cholecystitis, sub hepatic abscess .5. Hepatic Trauma.

The second most common cause is from generalized septicaemia.

Pyogenic Liver Abscess may result from:

Management of pyogenic liver abscess is based on two principal lines:

1. Antibiotic Therapy2. Surgical Drainage

Some Homeopathic medicine: 1. HEPAR SULPHUR

2. MERCURIUS SOLUBILIS3. MERCURIUS CORROSIVUS4. SILICEA TERRA

The mortality rate for undrained hepatic abscess may reach 100%. So careful management is absolutely essential. Response to treatment should be closely assessed by clinical, laboratory and radiologic investigation. Prior to stopping antibiotic therapy CT scan should be repeated to confirm resolution of the abscess. It must be remembered that patient should be observed carefully for 48 hours after cessation of antibiotics in order to detect recurrent fever.

Amoebic Abscess caused by Entamoeba Histolytica.

Most common in the right lobe of liver.

The abscess consist three zone:

Necrotic Center. Middle zone of destruction of paranchymal cell. Outer zone of normal Hepatic cells.

Two stages:Amoebic Hepatitis.

Amoebic Abscess.

Gross appearance: The liver is enlarged. Liquefied material within the abscess.Content is mixture of R.B.C. Leucocytes, broken down liver cells.Pus of amoebic abscess is variously described as 'Chocolate sauce' or 'Anchovy sauce'

Microscopically:

3 Zone

A central necrotic zone.

A middle zone

An outer zone.

Complication:

It is much better than Pyogenic abscess.

If untreated it may burst.Burst in to Right pleural cavity.Right lungPeritoneal cavity.

Empyema Lung abscess or Pneumonia.

Amoebic Dysentery

Anaemia

Loss of weight.

Fever Accompanied Chill Sweating

Liver pain

Amoebicidial Drug.Metronidazole DehydroemetiveChloroquineDudohydroxyquinoleneDiloxanide Furate

Needle Aspiration: Needle Aspiration is only employed in selected cases. Indication for aspiration are:

o Persistence of clinical features of amoebic abscess following a course of amoebicidal drugs.

o Clinical or radiography evidence of presence of hepatic abscess.

1. HEPAR SULPHUR

2. MERCURIUS SOLUBILIS

3. MERCURIUS CORROSIVUS

4. SILICEA TERRA

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