Abscess of liver

1. ABSCESS OF LIVER
By,
Ms. Ekta S Patel
Assistant Professor (MSN Dept.)

2. liver abscess is a mass filled with
pus inside the liver
Common causes are abdominal
conditions such as appendicitis or
diverticulitis due to haematogenous
spread through the portal vein. It
can also develop as a complication
of a liver injury.

3. 2 types :

4. Anyone can get a liver abscess. The
condition can be caused by
infections in the blood,
gastrointestinal system, or
abdomen. It can also be caused by
injury from a surgical procedure or
other trauma to the liver.

5. Infectious causes of a liver abscess
 Bacterial infection in the bile-draining tubes
 Bacterial infections in the abdomen
associated with appendicitis, diverticulitis,
or perforated bowel
 Bloodstream infections
 Entamoeba histolytica infection (organism
that also causes amebic dysentery; may be
spread through water or through person-to-
person contact)

6. Traumatic causes of a liver abscess
 Liver abscess may result from surgical
and diagnostic procedures in the liver, as
well as accidental trauma including:
 Endoscopy of the bile-draining tubes
 Trauma to the liver

7. What are the risk factors for a liver
abscess?
 Risk factors for pyogenic liver abscess
include:
 Crohn’s disease
 Current, primary abdominal or
gastrointestinal infection
 Diabetes
 Recent abdominal surgery
 Recent endoscopy of the bile-draining

8.  Risk factors for amebic liver abscess
include:
 Advanced age
 Alcoholism or heavy alcohol ingestion
 Compromised immune system due to such
conditions as HIV/AIDS or other
immunodeficiencies, taking
corticosteroids, organ transplant, or cancer
and cancer treatment

9. Poor nutritional status
Travel to regions where amebic
infections are common

10. Pathophysiology

11. Ingestion contaminated water or food
containing E. histolytica cysts -
infective cyst form of the parasite
survives passage through the stomach
and small intestine.
Excystation occurs in the bowel
lumen, where motile and potentially
invasive trophozoites are formed.

12. In most infections the trophozoites
aggregate in the intestinal mucin layer
and form new cysts, resulting in a self-
limited and asymptomatic infection.

13. In some cases, adherence to and lysis of
the colonic epithelium, mediated by the
galactose and N-acetyl-D-galactosamine
(Gal/GalNAc)–specific lectin, initiates
invasion of the colon → neutrophils
responding to the invasion contribute to
cellular damage.
Once the intestinal epithelium is invaded,
extraintestinal spread to the peritoneum,
liver, and other sites may follow.

14. Common symptoms of a liver abscess
Abdominal pain (especially in the
upper right portion of the abdomen)
Clay-colored stool
Cough
Dark urine
Diarrhea

15.  Fever or chills
 Joint pain
 Loss of appetite
 Malaise or lethargy
 Nausea with or without vomiting
 Pleuritis
 chest pain (hurts to breathe)
 Sweating
 Unexplained weight loss
 jaundice

16. Serious symptoms that might indicate a
life-threatening condition
In some cases, liver abscess can be
life threatening.
Change in mental status or sudden
behavior change, such as confusion,
delirium, lethargy, hallucinations and
delusions
High fever (higher than 101 degrees
Fahrenheit)

17.  Jerky movements
 Malaise or lethargy
 Rapid heart rate (tachycardia)
 Respiratory or breathing problems, such as
shortness of breath, difficulty breathing or inability
to breathe, labored breathing, wheezing, or choking
 Severe pain
 Vomiting
 Causes

18. Laboratory & Diagnostic
•
•
WBC (↑), anemia (normocytic
normochromic), sed rate (↑)
LFT nonspesific : AST/ALT ↑ but to a
lesser degree, low albumin (<2mg%)

19. • CXR : 50-80% abnormal (RLL
atelectasis, R pleural eff, R
hemidiaphragm elevation)
• USG initial test of choice :
noninvasive, high sensitivity 80-
90%; to distinguish cyst from
solid lesion/visualizing biliary
tree
• CT (IV contrast) : smaller
abcess, asses peritoneal cavity

20. •
•
usg guided aspiration of liver
abscess•
•

23. Treatment
 Aminoglycosides, such as amikacin (Amikin) or
gentamicin (Garamycin)
 Clindamycin (Cleocin)
 Combination piperacillin-tazobactam (Zosyn)
 Metronidazole (Flagyl

27. Complications:
 Empyema (pus accumulation in the
chest)
 Endocarditis (inflammation of the heart
lining and heart valves)
 Liver failure
 Pleural effusion (accumulation of fluid
around the lungs)
 Sepsis (life-threatening blood infection)
 Spread of infection