This document discusses surgical disorders of the liver, specifically focusing on pyogenic and amebic liver abscesses. It details the incidence, pathology, diagnostic investigation, treatment options, and potential complications of liver abscesses, highlighting the importance of appropriate management strategies. Key treatment approaches include antibiotics, drainage procedures, and the use of antifungals for fungal infections.

1. Surgical Disorders of the Liver
Liver Abscess
Dr. Taha K.
2024

2. PYOGENIC LIVER ABSCESS

3. Incidence
• The incidence of pyogenic liver abscess is on
the rise( 15/100000)
• single or multiple and are more frequently
found in the right lobe of the liver

4. Predisposing Factor

5. Pathology
• The Source of the liver abscess is predictive of the
number, location, and size
of the abscess affecting a given patient.
• Portal, traumatic, and cryptogenic hepatic abscesses
are solitary and large, whereas biliary and arterial
abscesses are multiple and small.
• Bilateral disease may be seen in 90% of patients with
an arterial or biliary source
• Fungal abscesses are usually multiple, bilateral, and
miliary.

6. Bacteriology
40% of abscesses are monomicrobial, 40% are polymicrobial,
and 20% are culture-negative.
most common infecting agents are gram-negative bacteria.
Escherichia coli is found in two thirds of cases, and other
common organisms include Streptococcus faecalis,
Klebsiella, and Proteus
vulgaris.
Anaerobic organisms such as Bacteroides fragilis also
are seen frequently.
In endocarditis and infected indwelling catheters,
Staphylococcus and Streptococcus species

7. Clinical Presentation
• Classic triad of fever, jaundice, and right upper
quadrant tenderness in less than 10% case

8. Diagnostic Investigation
• CBC, BG and RH
• LFT, Coagulation profile, Albumin
• ESR,
• Blood Culture and Sensitivity..50%
• Abdominal Ultrasound
• Abdominal CT Scan.. Diagnostic and theraptic
• Abdominal MRI

9. Treatment
• The appropriate treatment for pyogenic liver abscesses
requires treatment of the abscess itself and concomitant
treatment of the source
• Steps in management include antibiotic administration,
radiologic confirmation by US or CT, and drainage.
• Exceptions to this strategy include multiple small
abscesses and miliary fungal abscesses. These abscesses
are treated with intravenous antibiotics and antifungals,
respectively, without a drainage procedure.

10. Modality of Treatment
• Antibiotics
• Antifungal Treatment
• Needle aspiration and percutaneous catheter
drainage
• Surgical drainage (lap or Open)
• Liver resection-recalcitrant abscesses

11. Antibiotics
• Classic antibiotic regimens include an
aminoglycoside /Fluoroquinolones, clindamycin
/metronidazole, and either ampicillin or vancomycin
• Treatment used to be given for 4 to 6 weeks;
• Antibiotics alone have an 80% success rate for
solitary abscesses with a diameter <5 cm. In patients
with unilocular hepatic abscesses of <3 cm, treatment
with antibiotics alone had a 100% success rate.

12. Complications
• Up to 40% of patients develop complication
• Most common being generalized sepsis
• Other pleural effusions, empyema, and
pneumonia.
• Abscesses also may rupture intraperitoneally
• Perihepatic abscess.
• Hemobilia and hepatic vein thrombosis

14. AMEBIC LIVER ABSCESS

15. Amebic Liver Abscess
• Should be considered in every case of solitary
abscess
• Is the most common extra intestinal manifestation
of amebiasis
• The parasite exist in 2 forms: an infective cyst
stage and a trophozoite stage whichis the form
causes invasive disease
• Presentation usually happen within 4 months
after rturn from an endemic area

16. • Etiology- Entamoeba Histolytica
• Source:- Portal vein from gut(Amebic dysentry). The
anteedent intestinal phae has subsided by the time patient
presents
• Mainly adult man( 10x) despite equal sex distribution of
intestinal amebiasis
• Pathology: liquefactive necrosis of the liver (Cavity full of
blood andliquefied liver tissue)
• This fluid is described as ‘Anchovy sauce’ chocolate/odorless
unless secondary bacterial infection (20%) occurs.

17. Clinical feature
• Persistant fever/RUQ pain/anorexia/ history of
dysentry/hepatomegally and point tendernessover the
liver.
• General symptom is less than pyogenic abscess but
local is more than
• Diagnosis: Ultrasound and CT
• Stool “Amoeba are found in fresh stool examination in
15% of the cases
• Serology” indirect hemagglutination test is 100%
positive

18. Fate
• Resolution or complications (20% mortality)
as secondary infection “20%”
• Chronicity
• erosion into surrounding structures
• Free rupture into the peritoneum

19. Treatment
• Metronidazole 500mg IV 6hourly or then orally
( 750mg orally TID ) for 7 to 10 days
• After complication of the course of
Metronidazole ,intraluminal agent as diloxanide
furoarate should be used to eradicate cyst even if
stools ared negative for amebae
• Percutaneous drainage if refractory to metronidazole
or bacterial superinfection
• Surgery is indicated only if failed other lines of
treatment or complications as rupture