The liver is the largest organ in the body and performs several important functions including removing harmful substances from the blood, producing enzymes and bile to aid digestion, and converting food into substances needed for life and growth. Liver metastasis and liver abscesses are two conditions that can affect the liver. Liver metastasis occurs when cancer spreads from its original site such as the breast, colon, or lungs to the liver. Liver abscesses are pus-filled cavities that can be caused by bacteria (pyogenic) or amoebas (amoebic) and may require treatment such as antibiotics or surgery. Liver transplantation is sometimes used to treat life-threatening liver disease when no other treatment options are available.

1. Liver
DAMRA B. HASSAN

2. LIVER
Largest organ
What does Liver do???
It removes harmful substances from the blood.
It makes enzymes and bile that help digest food.
It also converts food into substances needed for life
and growth.

3. NORMAL LIVER CT SCAN

4. Liver Metastasis

5. What is Liver Metastasis?
>Liver metastases are cancerous tumors that have spread to the
liver from somewhere else in the body such as
Breast cancer
Colorectal cancer
Esophageal cancer
Lung cancer
Melanoma
Pancreatic cancer
Stomach cancer
>The risk of cancer spreading to the liver depends on the site of
the original cancer. A liver metastasis may be present when the
original (primary) cancer is diagnosed, or it may occur months or
years after the primary tumor is removed.

6. Liver metastasis shown on CT scan

9. Pathophysiology
• Metastasis from other primary sites, particularly
the digestive system, breast and lungs are likely to
reach the liver by way of portal system or
lymphatic channels or by direct extension from the
abdominal tumor.
• A continuous dull ache in the right upper quadrant,
epigastrium, or back, weight loss, loss of strength,
anorexia, and anemia may occur.
• Liver may be enlarged and irregular on palpation.
Jaundice is present only if the larger bile ducts are
occluded by the pressure of malignant nodules in
the hilum of the liver.
• Ascites develops if such nodules obstruct the portal
veins or if tumor tissue is seeded in the peritoneal
cavity
• Death may occur if left untreated

11. Liver Abscess

12. What is Liver Abscess?
> A liver abscess is a pus-filled cavity within the
liver, usually caused by a biliary tract source;
occasionally, multiple cavities are seen
Two categories: Amoebic and Pyogenic
Amoebic liver abscess are most commonly caused
by Entamoeba histolytica.

13. Liver Abscess on CT Scan

14. Pathophysiology
• Whenever an infection develops anywhere along the biliary
or GI tract, infecting organisms may reach the liver
through the biliary system, portal venous system, or
hepatic arterial or lymphatic system. Most bacteria are
destroyed promptly, but occasionally some gain a foothold.
The bacterial toxins destroy the neighbouring liver cells,
and the resulting necrotic tissue serves as protective wall
for the organisms.
• Meanwhile, leukocytes migrate into the infected area. The
result is an abscess cavity full of a liquid containing living
and dead leukocytes, liquefied liver cells, ,and bacteria
pyogenic abscesses of this type may be either single or
multiple and small. Examples of causes of pyogenic liver
abscess include cholangitis (usually related to benign or
malignant obstruction of the biliary tree) and abdominal
trauma.

16. Liver Transplantation

17. Liver trasplantation
Is used to treat life-threatening ESLD for which no other form of
treatment is available.
- involves total removal of the diseased liver and replacement with a
healthy liver in the same anatomic location (orthotropic liver
transplantation [OLT])
- success depends on successful immunosuppression.
- general indications for liver transplantation include irreversible
advanced chronic liver disease, fulminant hepatic failure, metabolic
liver diseases, and some hepatic malignancies.
- transplant recipient must go through a rigorous selection and
preparation process that includes counselling and education to aid
them in making critical choices for their improved health.

19. REFERENCES
Abscess, Liver
Ferri: Ferri's Clinical Advisor 2013, 1st ed.
Liver Abscess (includes Tables and Images)
Feldman: Sleisenger & Fordtran's
Gastrointestinal and Liver Disease, 9th ed.
Hepatic cysts and liver abscess (includes
Image)
Reid-Lombardo KM - Surg Clin North Am -
August, 2010; 90(4); 679-697
Etiology of Liver Abscess
Mandell: Principles & Practice of Infectious
Diseases, 7th ed.
Etiology of Liver Abscess
Ferri: Ferri's Clinical Advisor 2013, 1st ed.
Clinical Presentation of Liver Abscess
(includes Table)
Mandell: Principles & Practice of Infectious
Diseases, 7th ed.
Clinical Features of Pyogenic Liver Abscess
(includes Tables and Image)
Townsend: Sabiston Textbook of Surgery,
19th ed.
Clinical Features and Diagnosis of Pyogenic
Liver Abscess (includes Image)
Feldman: Sleisenger & Fordtran's
Gastrointestinal and Liver Disease, 9th ed.
Laboratory Findings of Amebic Liver
Abscess (includes Image)
Kliegman: Nelson Textbook of Pediatrics,
19th ed.
Sepsis and cholestasis
Fuchs M - Clin Liver Dis - 01-FEB-2008;
12(1): 151-72, ix
Hepatic cysts and liver abscess
Reid-Lombardo KM - Surg Clin North Am -
01-AUG-2010; 90(4): 679-97
An unusual presentation of amebic liver
abscesses
Broz P - CMAJ - 9-NOV-2010; 182(16): 1755-
7
Treatment of Pyogenic Liver Abscess
Feldman: Sleisenger & Fordtran's
Gastrointestinal and Liver Disease, 9th ed.
Treatment of Amebic Liver Abscess
Long: Principles & Practice of Pediatric
Infectious Diseases, 3rd ed., Revised
Reprint
Hepatic cysts and liver abscess
Reid-Lombardo KM - Surg Clin North Am -
August, 2010; 90(4); 679-697
Disposition of Liver Abscess
Ferri: Ferri's Clinical Advisor 2013, 1st ed.
Outcome of Pyogenic Liver Abscess
Townsend: Sabiston Textbook of Surgery,
19th ed.
Prevention of Pyogenic Liver Abscess
Feldman: Sleisenger & Fordtran's
Gastrointestinal and Liver Disease, 9th ed.
Prevention of Amebic Liver Abscess
Long: Principles & Practice of Pediatric
Infectious Diseases, 3rd ed., Revised
Reprint

20. REFERENCES
Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, Primrose JN, Parks RW. Guidelines for resection of
colorectal cancer liver metastases. Gut. 2006 Aug;55 Suppl 3:iii1-8.
Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D. Society of Interventional Radiology position statement on
chemoembolization of hepatic malignancies. J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):217-23.
Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of
hepatocellular carcinoma. Hepatology. 2005 Nov;42(5):1208-36.
Medically Reviewed by Paul Oneill, MD, Board Certified Oncology
Last Editorial Review: 4/13/2007
Suzanne C. Smeltzer, Brenda G. Bare, Janice L. Hinkle, Kerry H. Cheever,(2010) Brunner & Suddarth’s textbook of Medical-
Surgical Nursing (12th edition), Lippincott-Raven Publisher
National Cancer Institute. Adult primary liver cancer treatment PDQ. Updated July 8, 2010.
National Comprehensive Cancer Network. Hepatobiliary cancers: Pancreatic adenocarcinoma. 2011. Version 2.2011.
Roberts LR. Liver and biliary tract tumors. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa:
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www.google.com

21. End
Thank you =)