liver abscesses.pptx

8/10/2019 Liver abscesses.pptx

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Liver abscessesdr. Heny Anggraeny Lenap


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3 major forms of liver abscess : Pyogenic abscess, which is most often

polymicrobial, accounts for 80% of hepaticabscess cases in the United States.

Amebic abscess due to Entamoeba histolytica accounts for 10% of cases.

Fungal abscess, most often due to Candida species, accounts for less than 10% of cases.


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Clinical presentation Fever (either continuous or spiking) Chills Right upper quadrant pain Anorexia Malaise Cough Referred pain weight loss and anemia of chronic disease Fever of unknown origin (FUO Afebrile presentations


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Physic examination Fever and tender hepatomegaly Mid epigastric tenderness Decreased breath sounds in the right basilar

lung zones, with signs of atelectasis and effusion A pleural or hepatic friction rub Jaundice (25%), associated with biliary tract

disease or the presence of multiple abscesses


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Etiology Escherichia coli and Klebsiella pneumoniae being the 2 most

frequently isolated pathogens

Enterobacteriaceae are especially prominent when the infection is of biliary origin. anaerobes are Bacteroides species, Fusobacterium species, and

microaerophilic and anaerobic streptococci Staphylococcus aureus abscesses usually result from hematogenous

spread of organisms involved with distant infections Amebic liver abscess is most often due to E histolytica . Fungal abscesses primarily are due to Candida albicans Other organisms include Actinomyces species, Eikenella corrodens,

Yersinia enterocolitica, Salmonella typhi, and Brucella melitensis .

underlying hepatocellular carcinoma


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Laboratory Studies CBC count (Anemia of chronic disease) Neutrophilic leukocytosis Liver function studies Hypoalbuminemia and

elevation of alkaline phosphatase Elevations of transaminase and bilirubin levels Blood cultures Culture of abscess fluid Enzyme immunoassay ( E histolytica)


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Imaging studies CT scan (sensitivity 95-100%) Ultrasonography (sensitivity 80-90%) Gallium and technetium radionuclide scanning

(sensitivity 50-90%) Chest radiographic


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Invasif procedures Percutaneous needle aspiration

Under CT scan or ultrasound guidance

Percutaneous catheter drainage First intervention considered for small cysts A catheter is placed under ultrasound or CT

guidance The catheter is flushed daily until output is less than

10 cc/d or cavity collapse is documented by serial CTscanning Complication : failure to respond, bleeding at the

catheter site, perforation of hollow viscus, andperitonitis


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Medications Emphiric th/ : beta-lactam/beta-lactamase inhibitor combinations,

carbapenems, or second-generation cephalosporins

anaerobic : Metronidazole or clindamycin should be added for thecoverage of Bacteroides fragilis Systemic antifungal agents : amphotericin B, fluconazole organisms isolated and antibiotic sensitivities Short courses (2 wk) of therapy after percutaneous drainage have

been successful in a small series of patients; Currently 4-6 weeks oftherapy is recommended for solitary lesions that have beenadequately drained. Multiple abscesses are more problematic andcan require up to 12 weeks of therapy.


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Surgical care indications treatment of underlying intra-abdominal

processes, including signs of peritonitis; existence of aknown abdominal surgical pathology (eg, diverticularabscess); failure of previous drainage attempts; and thepresence of a complicated, multiloculated, thick-walledabscess with viscous pus.

Open surgery can be performed by 2 approaches. Atransperitoneal approach and posterior transpleuralapproach

Laparoscopic approach Postoperative complications : recurrent pyogenic liver

abscess, intra-abdominal abscess, hepatic or renalfailure, and wound infection


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Prognosis untreated, the prognosis is uniformly fatal. Indicators of a poor prognosis : multiplicity of

abscesses, underlying malignancy, severity ofunderlying medical conditions, presence ofcomplications, and delay in diagnosis

Indicators of a poor prognosis in amebic abscessinclude a bilirubin level of greater than 3.5 mg/dL,

encephalopathy, hypoalbuminemia (ie, serumalbumin level of < 2 g/dL), and multiple abscesses elderly patients with pyogenic liver abscess, younger

males with alcoholism, a cryptogenic abscess, and K pneumoniae infection


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Thankyou

liver abscesses.pptx

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