The document summarizes different types of liver conditions including abscesses, cysts, and tumors. It describes: 1) Liver abscesses which can be pyogenic (bacterial) or amebic. Pyogenic abscesses are usually caused by bacteria spreading from other sites while amebic abscesses are caused by Entamoeba histolytica infection; 2) Liver cysts including non-parasitic cysts and parasitic hydatid cysts caused by Echinococcus tapeworms; 3) Liver tumors can be benign such as hemangiomas or adenomas, or malignant primary hepatocellular carcinoma which is one of the most common cancers in Africa. Surgical resection is the main treatment

1. Liver cysts ,abscesses, and tumors
• ABSCESSES
Pyogenic
Amebic
• CYSTS
Non-parasitic
Parasitic ( Hydatid cysts )
• TUMOURS
Benign
Malignant
Mr. Abdul-Hameed El -Jali FRCS (Glasg.)
TRIPOLI - LIBYA

2. Liver Abscesses
• ABSCESSES
Pyogenic
Amoebic
• CYSTS
Non-parasitic
Parasitic ( Hydatid cysts )
• TUMOURS
Benign
Malignant

3. Pyogenic abscesses
 The incidence is 0.36% of autopsies
 Usually 6th and 7th decade
 Results from:
 Ascending infection
 Haematogenous
 Generalized septicemia
 Direct extension
 Trauma
 Positive culture obtained n 50% of cases

4. Pyogenic abscesses
 Organisms :
 E.coli
 Staph.aureus
 H.streptococci
 Proteus and klebsiella
 The abscess may be single or multiple
 May be multilocular
 If single usually in the right lobe

5. Pyogenic abscesses
 MANIFESTATIONS
 Fever, Chills, Sweating and vomiting
 Pain is a late symptom
 Hepatomegally in 5% of cases
 Jaundice is uncommon
 Hepatic tenderness
 DIAGNOSTIC STUDIES
 Anemia , Leucocytosis
 Positive blood culture … ( 30% of cases )
 X-ray elevation of the right dome of the diaphragm
 Possible air – fluid level in the liver
 USS, CTS, Angiography may give more evaluations
CIINICAL MANIFESTATIONS AND DIAGNOSTIC STUDIES

6. CT scan

7. Pyogenic abscesses
Antibiotics + Drainage
 Drainage:
 Percutanous
 Surgical
 Antibiotics: broad spectrum antibiotic
Mortality rate: 25 – 70 %
TREATMENT AND PRONOSIS

8. Amebic abscesses
Antamoeba Histolytica
 10% of population are infected
 Male predominance 9:1
Pathology :
Ulcerations in the intestine …. Portal venous
System …. Liver abscess ( anchovy paste ).
Clinical manifestation :
 Generalized systemic
manifestation Fever & pain
 50% gives history of diarrhoea
with or without mucous and
blood
 Tender hepatomegally
Diagnostic studies
 Stool – 15-50% demonstrates
amoeba
 FBC - Leucocytosis and anemia
 CFT - is very reliable
 CTS & Ultrasonography

9. Amebic abscesses
Treatment
 Anti- amoebicidal drugs
Emetine, chloroquine,
diodoquine
 Aspiration
 Surgical drainage
Metranidazole 400mg tds / 4d
Prognosis:
 In uncomplicated cases the
mortality rate is 7%But with
complication it reach 40%

10.  Secondary infection
 Rupture
Amebic abscesses
Complications

11. Liver cysts
• ABSCESSES
Pyogenic
Amebic
• CYSTS
Non-parasitic
Parasitic ( Hydatid cysts )
• TUMOURS
Benign
Malignant

12. Non-parasitic liver cysts
 Single ,multiple, diffuse, localized, unilocular or
multilocular
They include:
 Degenerative
 Dermoid
 Lymphatic
 Retention
 Proliferative
 Middle age, average 50years
 Polycystic liver disease more frequent in females

13. Non-parasitic liver cysts
 The cyst contains clear watery ,yellowish fluid
 Low pressure in contrast to parasitic
 The poly cystic disease has honeycombs appearance
 Traumatic cysts are usually single and filled with bile
Clinical manifestation
 Relatively a symptomatic
 Mass
 Acute abdominal pain if complicated
Treatment
 Complete extirpation
 Excision

14. Parasitic liver cysts (Hydatid cyst)
 The commonest is the unilocular Hydatid cyst is
caused by Echinococcus granulosis
 The alveolar type is by E.mulilocularis
 70% of Hydatid cysts are located in the liver and
 80% in the right lobe
 30% are multiple
 The cyst composed of two layers:
 Inner germinal
 Outer alveolar
 Adventitia ( fibrous reaction of the liver )
 The fluid is colorless, water-like and alkaline

15. Parasitic liver cysts (Hydatid cyst)
 Surgical
 Cysto-pericystectomy
 Cysto-endocystectomy
 Medical
For those cases were cysts are multiple Albendazole should be
given for control of small cysts
TREATMENT AND PRONOSIS

16. Liver Tumours
• ABSCESSES
Pyogenic
Amebic
• CYSTS
Non-parasitic
Parasitic ( Hydatid cysts )
• TUMOURS
Benign
Malignant

17. Liver Tumours
 Benign Tumours
 Hamartoma
Hamartoma are composed of tissues normally present in
the
organ but arranged in a disorderedly fashion
 Haemangioma
The most common nodule & the liver is the internal organ
most
frequent affected by this lesion.
 Adenoma and focal nodular hyperplasia
 Has relationship with oral contraceptive
 Resection is indicated for bleeding or symptomatic
lesions

18. Liver Tumours
 Primary carcinoma
 In Africa the postmortem rates is 1%
 It represents 17- 53% of all cancers
 Common in males
 The most common carcinoma in the fist few years life
Aetiology : Aflatoxin, low protein intake, Liver cirrhosis,
Pathoogy:
Hepatocellular,
Cholangeocarcinoma
Hepatoblatoma

19. Liver Tumours
 Clinical manifestations
 Mass
 Weight loss
 Pain
 Nausea, vomiting
 Jaundice
 Diagnostic tests:
 Erythrocytosis
 Abnormal BSP and Alk.phosphatase
 Angiography
Primary carcinoma
• PNB
• ERCP
• CTS

20. ERCP

21. USS

22. Treatment of primary liver tumors
 The only definitive treatment is surgery
Criteria:
1. The carcinoma must be localized or solitary
2. No nodal , blood vessel or duct involvement
3. No distal metastasis
Surgery by segmental anatomical resection

23. Thank you