This document discusses liver abscesses, dividing them into bacterial and parasitic/fungal causes. For bacterial abscesses, it notes that the primary causes are gram-negative bacteria entering the liver via the biliary system or portal vein. Clinical manifestations include fever, abdominal pain, jaundice and hepatomegaly. Investigations include blood tests, imaging like CT scan and ultrasound, and biopsy. Treatment involves drainage procedures like percutaneous needle aspiration as well as antibiotic therapy. For amebic abscesses, the primary cause is Entamoeba histolytica, with manifestations of liver pain, weight loss and jaundice. Investigations include stool tests and imaging, while treatment consists of anti-amebic drugs and surgical

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4. ABSCES HEPARABSCES HEPAR
Definition
A pus-filled cavity within the liver.
Dibahagikan kepada:
• Bakteria
• Parasit/Kulat

5. ABSCES HEPARABSCES HEPAR

6. ABSCES HEPARABSCES HEPAR
Absces Bakteria
Cara-cara memasuki sistem hepar:
• Dari sistem biliari – 60%
• Dari vena portal - 24%
• Dari arteri hepatik
• Melalui terus dari empiema pundi
hempedu
• Kecederaan mencucuk
Penyebab Utama : Gram negatif Escherichia Coli
Klebsiella
Enterococcus

7. ABSCES HEPARABSCES HEPAR

8. ABSCES HEPARABSCES HEPAR

9. ABSCES HEPARABSCES HEPAR
Manifestasi Klinikal
• Pyrexia dan rigor
• Riwayat sepsis di tempat lain
• Sakit di RHC
• Toxisity teruk
• Jaundis
• Hepatomegaly
• Tanda-tanda pleural effusion dan ‘Basal lobe
collaps’
• Leukositosis

10. ABSCES HEPARABSCES HEPAR
Investigasi
• Darah : TWDC, BUSE, C&S, LFT
• X-Ray : CXR, Abd. X-Ray, CT Scan
• Ultra Sound
• ERCP
• Biopsy

11. Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic
procedure used to identify the presence of stones, tumors, or narrowing in
the biliary and pancreatic ducts. After the endoscope is properly placed, a
catheter is advanced which will inject a contrast agent through the ducts. The
contrast is visible on X-rays, and allows a physician to evaluate the caliber,
length and course of the ducts. An ERCP may be performed if a patient
experiences symptoms such as jaundice, abdominal pain, fever, or
malabsorption.
ERCPERCP

12. CT Scan
CT stands for computerized tomography. In this procedure, a
thin X-ray beam is rotated around the area of the body to be
visualized. Using very complicated mathematical processes
called algorithms, the computer is able to generate a 3-D image
of a section through the body. CT scans are very detailed and
provide excellent information for the physician.

13. Ultra Sound
Abdominal ultrasound is a scanning technique used to image the
interior of the abdomen. Like the X-ray, MRI, and CT scan, it has its
place as a diagnostic tool. Ultrasound scans use high frequency
sound waves to produce an image and do not expose the individual
to radiation. The procedure is painless and safe.

14. Biopsy
A liver biopsy is not a routine procedure, but is performed when it is
necessary to determine the presence of liver disease and to look for
malignancy, cysts, parasites, or other pathology. The actual procedure
is only slightly uncomfortable. Most of the discomfort arises from
being required to lie still for several hours afterwards to prevent
bleeding from the biopsy site.

15. ABSCES HEPARABSCES HEPAR
Pengendalian
• Percutaneous needle aspiration
• Liver drainage
• Percutaneous liver drainage
• Surgical drainage
• Transperitoneal approach
• Posterior transperitoneal
• Antibiotik therapy
• aminoglycoside (amikacin, gentamicin etc)

16. ABSCES HEPARABSCES HEPAR
Absces Ameobik
Penyebab Utama: - Entaboeba Histoltica
(protozoa parasit)
- Aspergillus
(cyst mengeluarkan tropozoit ke dalam usus dan
dibawa masuk ke hepar melalui venous portal)

17. ABSCES HEPARABSCES HEPAR
Manifestasi Klinikal
• Sakit RHC
• Anorexia
• Berat badan susut
• Tander
• Hepatomegali

18. ABSCES HEPARABSCES HEPAR
Investigasi
• Stool Ova & Cyst
• Ultrasound
• CT-Scan
Pengendalian
• Amoebicide – Metronidazole (Flygl)
800 mg tds x1/52
• Surgical aspiration/ Drainage

19. ABSCES HEPARABSCES HEPAR
KOMPLIKASI
• Sepsis
• Empyema
• Peritonitis

20. Renungan:
Maksud Hadis
“Sesiapa yang mempelajari ilmu kerana selain
dari Allah atau bermaksud dengannya yang
selain dari Allah, maka hendaklah ia
menyediakan tempatnya di Neraka”
Riwayat Termizi