Liver abscess

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Liver abscess

  1. 1. NOW
  2. 2.  Abscesses of the liver are relatively rare Mortality rates decreased to 5-30% • New radiologic techniques • Improvement in microbiologic identification • Advancement of drainage techniques • Improved antibiotics • Improved supportive care
  3. 3.  No sex predilection Age – mostly children and elderly Risk more in:- • DM • Liver transplants • Immunosuppressed Mortality ranges from 5 – 30%
  4. 4.  Pyogenic abscess • Polymicrobial • Most common cause Amoebic abscess (Entamoeba histolytica) Fungal abscess (Candida species)
  5. 5.  MC symptoms :- • Fever (either continuous or spiking) • Chills • Right upper quadrant pain • Anorexia • Malaise
  6. 6.  Cough or hiccoughs (diaphragmatic irritation) Referred pain to the right shoulder Insidious course (weight loss, anemia) • ?? malignancy Fever of unknown origin Acute systemic toxicity (Multiple abscesses) Afebrile
  7. 7.  MC :- Fever, Tender hepatomegaly Mass +/- Decreased breath sounds • Rt basilar lung zones • Atelectasis, effusion Pleuralor hepatic friction rub Jaundice • Biliary tract disease • Multiple abscesses
  8. 8.  Biliary Disease Cholecystitis Empyema A/c Gastritis Hepatocellular Carcinoma Hydatid Cysts Pneumonia
  9. 9.  CBC:- • Anemia • Neutrophilic leukocytosis LFT • Albumin ↓ • Alkaline phosphatase ↑ • SGOT, SGPT, bilirubin levels ↑ (variable) Blood cultures (+ve 50%) Culture of abscess fluid ELISA for E histolytica
  10. 10.  CTscan USG CXR
  11. 11.  Drainage - percutaneous /surgical Antimicrobial treatment as adjunct Antibiotic therapy as standalone • Unfit for invasive procedures • Multiple abscesses • Many months therapy • Serial imaging and close monitoring
  12. 12.  Indications :- • Signs of peritonitis • Known abdominal surgical pathology (eg - diverticular abscess) • Failure of previous drainage attempts • Complicated, multiloculated, thick-walled abscess with viscous pus
  13. 13.  EMPERIC • Beta-lactam/beta-lactamase inhibitor • Carbapenems • Second generation cephalosporins + • Anaerobic coverage (metronidazole /clindamycin) Change ≈ C&S report
  14. 14.  Amoebic :- • Metronidazole • Chloroquine ± emetine/dehydroemetine Fungal :- • Amphotericin B (plain, lipid) • Fluconazole
  15. 15.  4-6weeks of therapy - solitary lesions 12 weeks - multiple abscesses Guide to the length of therapy :- • clinical process • radiographic progress
  16. 16.  Sepsis Empyema :- • contiguous spread • intrapleural rupture of abscess – rupture of abscess Peritonitis Endophthalmitis (K pneumoniae bacteremia)
  17. 17.  Untreated= fatal Bad prognosis :- • Severity of underlying medical conditions • Presence of complications • Delay in diagnosis • Bilirubin > 3.5 mg/dL • Encephalopathy • S.Albumin level of < 2 g/dL • Multiple abscesses • Malignant etiology • High APACHE II score

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