PYOGENIC LIVER ABSCESS

1. PYOGENIC LIVER ABSCESS

2. Pyogenic liver abscess is a pus-filled pocket of fluid
within the liver.
• Pyogenic means producing pus.
• A liver abscess can develop from several different
sources, including a blood infection, an abdominal
infection, or an abdominal injury which has been
become infected.

3. CAUSES
1. Infection through the portal vein
2. Infection through the common bile duct (CBD)
3. Infection through the hepatic artery
4. Extension abscess
5. Infection through umbilicus

4. Infection through the portal vein
1. Acute appendicitis
2. Acute diverticulitis (sigmoid)
3. Acute amoebic colitis
4. Acute bacillary dysentery
5. Ulcerative colitis

5. Infection through the common bile
duct (CBD)
• Stricture of the CBD
• Periampullary carcinoma resulting
in stasis of the bile, precipitating
infection (cholangitis)
• Recurrent cholangitis due to stone
in the CBD
• ERCP (Endoscopic retrograde
cholangiopancreatography)

6. Infection through the hepatic artery
• Septicaemia and
pyaemia
• Actinomycosis of
faciocervical region

7. Extension abscess
• Subdiaphragmatic
abscess
• Empyema thoracis
• Penetrating injuries

8. Infection through umbilicus
• Neonatal
umbilical sepsis
giving rise to
pyaemia.

9. Certain facts
• Majority of the infective bacteria are derived
from gastrointestinal tract.
• In majority of cases, it is polymicrobial infection
• E.coli is the most common facultative organism
• Bacteroides fragilis is the most common
anaerobe Candida/ infection is increasing due to
chemotherapy, especially for leukaemic patients.

10. Clinical features
• Alcoholic males and debilitated men suffer
more, probably because of poor immunity.
• Acute abscesses are usually multiple, chronic
are single.
• Tender hepatomegaly, low grade or high grade
pyrexia with abdominal discomfort are the
main features.

11. Investigations
• Total WBC count is raised.
• Stool routine examination: Amoebic cysts,
culture and sensitivity for typhoid bacilli.
• Abdominal ultrasound and ultrasound-guided
aspiration establishes the diagnosis.

12. Investigations
• When in doubt, CT scan can be done (Figs 24.4
and 24.5), followed by FNAC which draws
frank pus. Pus is sent for
• Gram's stain, culture and sensitivity. CT also
helps in the diagnosis of associated conditions
such as diverticulitis of the colon.

15. • Chest X-ray:
• Air under the diaphragm (perforation of
hollow viscus) or diagnosis of empyema
thoracis.

17. Treatment
1. Conservative:
• Multiple small abscesses may respond to
antibiotics. However, they have to be given
for 4 to 6 weeks.
2. Percutaneous drainage Method
• Ultrasound or CT-guided aspiration and
drainage by using a pigtail catheter.
• Irrigation of abscess cavity with saline.

18. Open (surgical) method
• Laparotomy is required mainly to treat the
primary causes, e.g. appendicectomy,
drainage of appendicular abscess.
• If liver shows a significant abscess, it is
drained.
• Alternately, a pigtail catheter is introduced
into the abscess cavity and brought outside
through a separate opening.
• It helps to drain for a longer period of time.
• 4. Laparoscopic drainage can also be done.