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PYOGENIC LIVER ABSCESS-converted.pdf.24/08/24
- 1. PYOGENIC LIVER ABSCESS Dr.M. RIZWAN M.S.(U) Assistant Professor DEPT of SURGERY R.A. & U.T.M.C.H Welcome to another lecture on قیحی کبد دبیال
- 2. G. INTRODUCTION ❑A pyogenicliver abscess is a rare disease characterized by: ❑Solitary /multiple collections of pus within the liver ❑The infection is caused by bacteria and is usually polymicrobial.
- 3. CAUSATIVE ORGANISM E. coli– 1/3rd cases and Staphylococcus aureus Haemolytic streptococcus Proteus klebsiella K. pneumoniae being the common causative organisms.
- 4. CLINICAL FEATURES High fever,with rigors—90%. Pain in the right hypochondrium—60%. Nausea ,vomiting, anorexia Weight loss. Jaundice—occasionally—20%. Intercostal tenderness. Tender, soft liver —60%. Features of toxicity. Constitutional symptoms like Malaise, Lethargy, Vomiting
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- 6. 1. BILIARY SEPSIS35%; COMMONEST ROUTE. a. Empyema gallbladder. b. Cholangitis. c. After biliary tract surgery. d. Instrumentation e. Stone disease, Caroli’s disease, biliary ascariasis, biliary enteric anastomosis.
- 7. 2. PORTAL VEINSEPSIS 20%: A. APPENDICITIS 2%. B. DIVERTICULITIS. C. INFLAMMATORY BOWEL DISEASE, PANCREATITIS, PERFORATION, PID, COLORECTAL CARCINOMA. D. OMPHALITIS IN NEWBORN.
- 8. 3. DISTANT INFECTIONS(THROUGH HEPATIC ARTERY 15%)
- 9. 4. SUPER ADDEDINFECTIONS 5%:
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- 13. PATHOLOGY ❑Due to laminarblood flow right lobe (75%) is commonly involved ❑Left lobe (20%), ❑Caudate lobe (5%) are also often involved. ❑Usually solitary abscess — 60%; ❑Occasionally it can be bilobar and multiple. ❑Cavity contains pus with virulent organisms. ❑Usually abscess is acute. ❑In cryptogenic type chronic presentation is known to occur.
- 14. ❑Ascites and splenomegalyis not common. ❑It is more common in diabetics. ❑Male to female ratio is 1:1. ❑It is more common in old people after 55 years of age. ❑Blood culture commonly shows positive for bacteria PATHOLOGY cont….
- 16. INVESTIGATION ❑CBC-↑ TLC= B/W= 12000-18000 ❑LFT- ↓ Albumin, ↑ alkaline phosphatase, N- bilirubin= In 90 % cases ❑Blood culture- is very relevant, +VE in 1/3 of patient ❑Ultrasound abdomen, Sensitivity is 90% for USG ❑CT scan. Sensitivity is 97% for contrast CT scan.
- 17. ❑Chest X-ray shows: ▪Elevated diaphragm often with ▪ Right sided pleural effusion. • FNAB= Ultrasound guided aspiration of pus after controlling PT. • Liver scan
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- 21. TREATMENT ❑Systemic antibiotics —combinationof third generation cephalosporins and metronidazole. ❑Ultrasound guided aspiration/pigtail catheter— Percutaneous drainage is the treatment of choice at present. ❑Drainage tube/ catheter are placed under US/CT guidance into the liver abscess. ❑Pus culture and sensitivity: Pus should be sent for culture and sensitivity. ❑Follow-up USG,
- 22. ❑LFT, Assessment ❑Assessment ofquantity of daily drainage—should be done to assess the response. ❑75% of pyogenic abscess is drained percutaneously. ❑Percutaneous aspiration without drainage tube placement is also used; ▪ But repeated guided aspirations are required; ▪ Otherwise success rate is similar to drainage.
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- 24. OPEN DRAINAGE ISINDICATED IN Recurrent abscess, Failure of percutaneous drainage, Large abscess of size more than 5 cm. Open drainage is becoming less common at present; But in selected patients it may be a life- saving essential therapeutic modality. Treating the primary causes is very essential.
- 25. APPROACHES OPEN SURGICALDRAINAGE
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- 27. PROGNOSIS ❑Undrained hepatic abscessmortality reaches up to 100 % ❑Prior to stopage of the antibiotics CT scan should be repeated. ❑Patient should assessed carefully for 48 hours after cessation of the antibiotics
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