THE LIVER: LIVER ABSCESS
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Pyogenic liver abscesses are mostly caused by bacteria like E. coli and are characterized by fever, pain in the right upper quadrant, and tender hepatomegaly. They enter the liver through ascending cholangitis, portal pyemia, septicemia, or direct infection. Amoebic liver abscesses are less common and caused by Entamoeba histolytica spreading from intestinal lesions. Hydatid disease is an infection by the larval stage of Echinococcus granulosus tapeworm acquired from dogs that causes cysts in the liver.
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- Pyogenic liver abscess is usually polymicrobial in origin and often associated with biliary obstruction. Imaging shows hypoattenuating lesions that may be drained percutaneously along with antibiotics.
- Key differences between the two types include demographic factors, number/location of lesions, and diagnostic test results. Prognosis depends on factors like abscess size
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The document provides information on the history, anatomy, physiology, assessment, and management of splenic injuries. Some key points:
- The spleen was historically described as "the organ full of mystery" due to lack of understanding of its function. Splenectomy became more successful in the late 19th century.
- The spleen is wedge-shaped and located in the left upper abdominal quadrant. It has important roles in immune function and filtering blood. Injuries are often due to blunt trauma from motor vehicle accidents or direct blows.
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2. Common indications for splenectomy include trauma, hereditary spherocytosis, idiopathic thrombocytopenic purpura, and various blood disorders. Splenic injuries are graded based on their severity and treatment may involve observation, splenic repair or resection, or splenectomy depending on the grade and stability of the patient.
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Pyogenic and amebic liver abscesses can develop from a variety of causes. Ultrasound or CT imaging are used to identify abscesses, which appear as hypoechoic or low attenuation areas on scans. Treatment involves intravenous antibiotics along with drainage of larger abscesses via needle aspiration or catheter placement. For pyogenic abscesses, antibiotics are chosen based on culture results and typically include combinations targeting common bacteria. Amebic abscesses are generally treated with metronidazole or other nitroimidazole antibiotics, sometimes along with drainage or other antiparasitic drugs. Complications can arise if abscesses rupture or spread beyond the liver.
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Liver Abscess.pptx
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This document summarizes infectious diseases of the liver, focusing on pyogenic liver abscess and amebic liver abscess. Pyogenic liver abscess is usually polymicrobial, with risk factors including biliary tract disease, cirrhosis, and diabetes. Clinical features include fever, right upper quadrant pain, and jaundice. Treatment involves antibiotics and drainage of large abscesses. Amebic liver abscess is caused by Entamoeba histolytica and presents with nonspecific symptoms. Serology and imaging can help with diagnosis, and metronidazole is the treatment. Complications of liver abscesses include rupture, fistula formation, and spread to other organs.
Liver Abscess and Hydatid Cyst, Surgery
- Liver abscesses are typically caused by bacterial infections spreading from other sites like the biliary tract or portal vein. Common bacteria include E. coli and K. pneumoniae. Abscesses are usually diagnosed using imaging like ultrasound or CT scan and treated with antibiotics and drainage if large.
- Amebic abscesses are caused by Entamoeba histolytica infection spreading from the colon. They present similarly to pyogenic abscesses but are diagnosed serologically or with immunoassays. Metronidazole is the treatment.
- Hydatid cysts are caused by the parasite Echinococcus granulosus. Humans are an accidental intermediate host. Cysts usually form in the liver and
AMOEBIC LIVER ABSCESS
1) Amoebic liver abscess is caused by the parasite Entamoeba histolytica infecting the liver via the bloodstream from the intestines.
2) Ultrasound is the primary tool for diagnosis and guided aspiration is usually the first treatment, along with antibiotics like metronidazole.
3) Surgery may be needed if aspiration fails or the abscess ruptures, and homeopathic remedies like Belladonna, Hepar sulphur, Silicea, and Mercurius can help promote pus formation and healing.
AMOEBIASIS
This presentation is made by Dr Ashok Jaisingani for study purpose if any one like this than please give your comments.
Liver abscesses and hydatid disease
A 50-year-old farmer from Gujranwala presented with abdominal pain, jaundice, and urticaria. Differential diagnoses include liver abscess and hydatid disease. Investigations would include blood tests, imaging like ultrasound and CT, and fluid aspiration/culture. Initial management depends on diagnosis but may include antibiotics, drainage, or anti-parasitic drugs. Liver abscesses are generally pyogenic, amoebic, or fungal in origin and present variably. Hydatid disease involves cyst formation from Echinococcus tapeworms and usually affects the liver. Treatment involves surgery, percutaneous drainage, or anti-parasitic drugs depending on individual factors.
Intestinal obstruction2
A 50-year-old man presented with abdominal pain, distension, vomiting, and constipation. Imaging showed findings suggestive of bowel obstruction. The document discusses the evaluation, causes, and management of bowel obstructions, focusing on distinguishing between small vs. large bowel obstruction and determining the etiology and complications like strangulation. Initial management involves resuscitation, decompression, correction of electrolyte abnormalities, and antibiotics while determining need for surgery.
Tuberculosis in surgery
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Intestinal Entamoeba histolytica amebiasis - Copy.ppt
A 20-year-old female developed abdominal cramps and bloody diarrhea after eating at a restaurant. Testing revealed she was infected with Entamoeba histolytica, the causative agent of amebiasis. E. histolytica has a life cycle involving an infectious cyst form and an invasive trophozoite form. Treatment involves antibiotics to eliminate the trophozoites, followed by additional medication to clear the cysts from the intestines.
Amebiasis
Entamoeba histolytica is a protozoan parasite that causes amebiasis. It is transmitted through ingestion of cysts from fecally contaminated food, water, or objects. Most infections are asymptomatic, but some can cause intestinal disease with diarrhea or dysentery. Rarely, the parasite can spread to other organs like the liver to cause amoebic liver abscesses. Diagnosis involves microscopic identification of cysts or trophozoites in stool samples. Treatment depends on symptoms but involves drugs like metronidazole to eliminate the parasite from the intestines and other infected tissues.
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2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
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4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
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Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
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Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
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Influence on behavior
Selection of food based on metabolic needs
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Taste buds on the tongue
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Primary and Secondary Taste Sensations:
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Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
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Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
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Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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THE LIVER: LIVER ABSCESS
- 1. THE LIVER: LIVER ABSCESS DR ROOPAM JAIN PROFESSOR & HEAD, PATHOLOGY
- 2. PYOGENIC LIVER ABSCESS • Most liver abscesses are of bacterial (pyogenic) origin • less often they are amoebic, hydatid and rarely actinomycotic. • uncommon due to improved diagnostic facilities & early use of antibiotics. • Incidence is higher in old age & in immunosuppressed patients such as in AIDS, transplant recipients and those on intensive chemotherapy
- 3. PYOGENIC LIVER ABSCESS • modes of entry: • 1. Ascending cholangitis through ascending infection in the biliary tract due to obstruction • 2. Portal pyaemia by means of spread of pelvic or GI infection resulting in portal pylephlebitis or septic emboli • 3. Septicaemia through spread by hepatic artery. • 4. Direct infection resulting in solitary liver abscess • 5. Iatrogenic causes • 6. Cryptogenic from unknown causes, especially in the elderly.
- 4. PYOGENIC LIVER ABSCESS • The commonest infecting organisms are • gram-negative bacteria chiefly E. coli • Pseudomonas, • Klebsiella, • Enterobacter • number of anaerobic organisms, bacteroides and actinomyces
- 6. PYOGENIC LIVER ABSCESS • clinically characterised by • pain in the right upper quadrant, • fever, • tender hepatomegaly and • sometimes jaundice. • Laboratory examination reveals • leucocytosis, • elevated serum alkaline phosphatase, • Hypoalbuminaemia • positive blood culture
- 7. PYOGENIC LIVER ABSCESS • occur as single or multiple yellow abscesses, 1 cm or more in diameter • abscesses are particularly common in right lobe of the liver • adjacent viable area shows pus and blood clots in the portal vein, inflammation, congestion and proliferating fibroblasts.
- 8. AMOEBIC LIVER ABSCESS • less common than pyogenic liver abscesses and have many similar features. • caused by the spread of Entamoeba histolytica from intestinal lesions. • The trophozoite form of amoebae in the colon invade the colonic mucosa forming flask-shaped ulcers. • Amoebae multiply and block small intrahepatic portal radicles resulting in infarction necrosis of the adjacent liver parenchyma. • Cysts of E. histolytica in stools are present in only 15% of patients of hepatic amoebiasis.
- 9. AMOEBIC LIVER ABSCESS • Intermittent low-grade fever, pain and tenderness in the liver area are common presenting features. • A positive haemagglutination test (sensitive & diagnosis of amoebic liver abscess)
- 10. AMOEBIC LIVER ABSCESS Commonly solitary & its wall is irregular & necrotic
- 11. AMOEBIC LIVER ABSCESS MORPHOLOGIC FEATURES Grossly • Amoebic liver abscess may vary greatly in size but is generally of the size of an orange. • centre of the abscess contains large necrotic area having reddish- brown, thick pus resembling anchovy or chocolate sauce. Histologically, • The necrotic area consists of degenerated liver cells, leucocytes, red blood cells, strands of connective tissue and debris. • Amoebae are most easily found in the liver tissue at the margin of abscess. • PAS-staining is employed to confirm the trophozoites of E. histolytica.
- 12. HYDATID DISEASE (ECHINOCOCCOSIS) • infection by the larval cyst stage of the tapeworm, Echinococcus granulosus. • dog is the common definite host, • man, sheep and cattle are the intermediate hosts. • dog is infected by eating the viscera of sheep containing hydatid cysts • The infected faeces of the dog contaminate grass and farmland from where the ova are ingested by sheep, pigs and man. • man can acquire infection by handling dogs as well as by eating contaminated vegetables.
- 13. HYDATID DISEASE (ECHINOCOCCOSIS) • uncomplicated hydatid cyst of the liver may be silent or may produce dull ache in the liver area and some abdominal distension. • Complications of hydatid cyst include its rupture (e.g. into the peritoneal cavity, bile ducts and lungs), secondary infection and hydatid allergy due to sensitisation of the host with cyst fluid. The diagnosis • peripheral blood eosinophilia, • radiologic examination and • serologic tests such as indirect haemagglutination test & Casoni skin test
- 14. HYDATID DISEASE (ECHINOCOCCOSIS) MORPHOLOGIC FEATURES • Hydatid cyst grows slowly and may eventually attain a size over 10 cm in diameter in about 5 years. • E. granulosus generally causes unilocular hydatid cyst while E. multilocularis results in multilocular or alveolar hydatid disease in the liver. • The cyst wall is composed of 3 distinguishable zones— • outer pericyst, • intermediate characteristic ectocyst • inner endocyst
- 15. HYDATID DISEASE (ECHINOCOCCOSIS) MORPHOLOGIC FEATURES • Hydatid sand is the grain-like material composed of numerous scolices present in the hydatid fluid. • Hydatid fluid, also contains antigenic proteins so that its liberation into circulation gives rise to pronounced eosinophilia or may cause anaphylaxis.
- 16. HYDATID DISEASE (ECHINOCOCCOSIS) MORPHOLOGIC FEATURES
- 17. Microscopy shows 3 layers in the wall of hydatid cyst Inbox in the right photomicrograph shows a scolex with a row of hooklets