L23 liver abscess st

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L23 liver abscess st

  1. 1. LiverAbscessLecture 23 1
  2. 2. Definition• A liver abscess is a pus-filled massinside the liver.2
  3. 3. TypesThere are three major forms of liver abscess,classified by etiology:1.Pyogenic liver abscess, which is most oftenpolymicrobial, accounts for 80% of hepaticabscess cases in the United States.2.Amoebic liver abscess due to Entamoebahistolytica accounts for 10% of cases.3.Fungal abscess, most often due toCandida species, accounts for less than 10%of cases.3
  4. 4. Causes & riskfactors• Common cause:• 1. Biliary tract infection• 2. Inf from GIT or Pelvic organs• 3. Unknown• 4. Hematog. Spread secondary to bacteremia4
  5. 5. Risk Factors5Developed countriesDeveloping countries
  6. 6. Debilitating disease with immunedeficiency is a common setting-e.g.,• Extreme old age• Immunosuppression• Cancer chemotherapy with marrow failure6
  7. 7. The organism reach the liver throughone of the following pathways:• (1) ascending infection in the biliary tract(ascending cholangitis);• (2) vascular seeding, either portal or arterial,predominantly from the GIT• (3) direct invasion of the liver from a nearbysource; or• (4) a penetrating injury.7
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  9. 9. Pyogenic Liver Abscess• In developed countries• bacterial abscesses are morecommon, representing a complication of aninfection elsewhere.9
  10. 10. Causitive organisms• They are generally produced by• gram-negative bacteria such as• Escherichia coli and• Klebsiella sp.10
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  12. 12. Jaundice, Fever, Abd pain12
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  15. 15. Amebic Liver Abscess• In developing countries liver abscesses arecommon; most result from• parasitic infections, such as• emebic, echinococcal, and (less commonly)other protozoal and helminthic organisms.15
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  22. 22. MorphologyNumber: Solitary or multipleSize: millimeters –centimetersBacteremic spread through the arterial orportal system tends to producemultiple small abscesses,Direct extension and trauma usually causesolitary large abscesses.22
  23. 23. • Biliary abscesses, which are usuallymultiple, may contain purulent material fromadjacent bile ducts.23
  24. 24. • Gross and microscopic:• necrotic tissue with abundant neutrophils.• The causative organism can occasionally beidentified in the case of fungal or parasiticabscesses.24
  25. 25. • On rare occasions, abscesses located in thesubdiaphragmatic region, particularly amebic, mayburrow into the thoracic cavity to produceempyema or a lung abscess.25
  26. 26. • Rupture of subcapsular liver abscesses canlead to peritonitis or localized peritonealabscesses.26
  27. 27. • Echinococcal infection has acharacteristic cystic structure;• the wall is laminated (coated), and• hooklets and intact organisms can beidentified.• Calcification in the cystic wall is common.27
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  29. 29. Key points• A liver abscess is a pus-filled cavity within the liver, usually caused bya biliary tract source; occasionally, multiple cavities are seen• Origin may be pyogenic, amebic, or (rarely, and usually in severelyimmunocompromised patients) fungal• Clinical presentation is with fever and abdominal pain but isfrequently nonspecific, without localized right upper quadrantsymptoms• Computed tomography (CT), both with and without intravenous andoral contrast, and ultrasound are the imaging studies of choice• Treatment involves antimicrobial therapy with or withoutpercutaneous or surgical drainage• Liver abscess is almost uniformly fatal if left untreated. Timelytreatment reduces mortality to 5% to 30%29
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