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Liver Abscess
<ul><li>Aetiology </li></ul><ul><li>Bacterial, parasitic, or fungal in origin.  </li></ul><ul><li>85% to 90% bacterial or ...
<ul><li>Incidence   </li></ul><ul><li>Liver gets infected by Entamoeba histolytica commonly </li></ul><ul><li>The most com...
Clinical Features <ul><li>Often the diagnosis of a bacterial abscess is suggested clinically . </li></ul><ul><li>Fever </l...
<ul><li>USGM  of the liver </li></ul><ul><li>X-Ray  of the chest to see whether there is any pneumonitis or effusion cause...
<ul><li>CT :  </li></ul><ul><li>a heterogeneous lesion  </li></ul><ul><li>irregular margins </li></ul><ul><li>peripheral c...
CT scan showing liver abscess <ul><li>The abscess is shown as a darker area in the liver shadow </li></ul>
<ul><li>Complications: </li></ul><ul><li>Pneumonitis </li></ul><ul><li>Pleural effusion </li></ul><ul><li>Rupture of the l...
Pleural Effusion secondary to amoebic liver abscess
An amoebic liver abscess causing a bulge in the dome of the diaphragm
Amoebic liver abscess burst into the right pleural cavity
I.  Entamoeba histolytica : Amebic dysentery; amebic liver abscess <ul><li>Epidemiology :  </li></ul><ul><li>Found worldwi...
<ul><ul><li>Amebic dysentery : Colonization of cecum & colon by  Entamoeba histolytica  is common. Localized necrosis resu...
Mature Cysts
Liver abscess
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Liver abscess

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Liver abscess

  1. 1. Liver Abscess
  2. 2. <ul><li>Aetiology </li></ul><ul><li>Bacterial, parasitic, or fungal in origin. </li></ul><ul><li>85% to 90% bacterial or pyogenic. </li></ul><ul><li>Bacteria access the liver via the biliary tree or portal vein. </li></ul><ul><li>Other causes include </li></ul><ul><li>biliary obstruction, </li></ul><ul><li>diverticulitis, </li></ul><ul><li>trauma, </li></ul><ul><li>inflammatory bowel disease, </li></ul>
  3. 3. <ul><li>Incidence </li></ul><ul><li>Liver gets infected by Entamoeba histolytica commonly </li></ul><ul><li>The most common location of a pyogenic abscess is the right lobe. </li></ul><ul><li>Chronic alcoholics - prone to get this infection </li></ul><ul><li>Entamoeba histolytica is endemic in many parts of the world </li></ul><ul><li>Pathophysiology </li></ul><ul><li>The amoebic cyst is ingested </li></ul><ul><li>Cyst develops into the trophozoite form in the colon </li></ul><ul><li>Reaches the liver through portal circulation </li></ul><ul><li>Pyogenic abscess may also occur due to the infection by streptococcus milleri and Escherichia coli. </li></ul><ul><li>Many a time the pyogenic infection follows amoebic infection </li></ul>
  4. 4. Clinical Features <ul><li>Often the diagnosis of a bacterial abscess is suggested clinically . </li></ul><ul><li>Fever </li></ul><ul><li>Pain right hypochondrium </li></ul><ul><li>Chills </li></ul><ul><li>Rigors </li></ul><ul><li>Toxicity </li></ul><ul><li>Right upper quadrant discomfort </li></ul><ul><li>Diarrhea </li></ul><ul><li>weight loss </li></ul><ul><li>Intercostal tendreness </li></ul><ul><li>Swelling in the right hypo chondrium or epigastrium </li></ul><ul><li>tender, enlarged liver . </li></ul>
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  6. 6. <ul><li>USGM of the liver </li></ul><ul><li>X-Ray of the chest to see whether there is any pneumonitis or effusion caused by the irritation of the nearby abscess </li></ul><ul><li>TC -Leukocytosis </li></ul><ul><li>LFT - Abnormal liver function tests (LFTs) </li></ul><ul><li>CT scan liver </li></ul>Investigations
  7. 7. <ul><li>CT : </li></ul><ul><li>a heterogeneous lesion </li></ul><ul><li>irregular margins </li></ul><ul><li>peripheral contrast enhancement. </li></ul><ul><li>Internal septations </li></ul><ul><li>The radiologic differential diagnosis includes </li></ul><ul><li>cystic or necrotic metastases (ovarian or leiomyosarcoma) </li></ul><ul><li>hydatid and echinococcal cysts. </li></ul>
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  9. 9. CT scan showing liver abscess <ul><li>The abscess is shown as a darker area in the liver shadow </li></ul>
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  12. 12. <ul><li>Complications: </li></ul><ul><li>Pneumonitis </li></ul><ul><li>Pleural effusion </li></ul><ul><li>Rupture of the liver abscess into the pleural cavity - causing empyema </li></ul><ul><li>Rupture into the peritoneal cavity </li></ul><ul><li>Treatment </li></ul><ul><li>percutaneous or surgical drainage (Ultrasound guided repeated aspiration) </li></ul><ul><li>antibiotics. </li></ul><ul><li>Metronidazole </li></ul><ul><li>Antibiotics like cephalosporins, aminoglycosides, tetracyclines </li></ul><ul><li>In rare cases it may need insertion of a drain. </li></ul><ul><li>mortality rate is almost 100% if the abscess remains untreated </li></ul>
  13. 13. Pleural Effusion secondary to amoebic liver abscess
  14. 14. An amoebic liver abscess causing a bulge in the dome of the diaphragm
  15. 15. Amoebic liver abscess burst into the right pleural cavity
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  18. 18. I. Entamoeba histolytica : Amebic dysentery; amebic liver abscess <ul><li>Epidemiology : </li></ul><ul><li>Found worldwide, especially in tropical areas, </li></ul><ul><li>There is no animal reservoir. </li></ul><ul><li>Mode of transmission : </li></ul><ul><li>Ingestion of cysts. </li></ul><ul><li>Anal-oral transmission due to sexual practice is also a consideration. </li></ul><ul><li>C. Pathology : Two-stage life cycle. </li></ul><ul><li>The trophozoite (ameba stage) is motile. </li></ul><ul><li>The cyst stage is nonmotile. </li></ul><ul><li>Trophozoites are found in the intestinal and extraintestinal lesions. </li></ul><ul><li>Cysts predominate in the stools, with somes trophozoites present. </li></ul>
  19. 19. <ul><ul><li>Amebic dysentery : Colonization of cecum & colon by Entamoeba histolytica is common. Localized necrosis results in &quot;teardrop&quot; or “flask shaped” ulcerations. Invasion into the portal submucosa is progressive after penetration of the submucosa. </li></ul></ul><ul><ul><li>Liver abscess : </li></ul></ul><ul><ul><li>Penetration of the diaphragm can lead to lung disease. </li></ul></ul><ul><ul><li>Most liver disease not preceded by dysentery. </li></ul></ul>
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  22. 22. Mature Cysts

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