Hepatic

Abscesses
Hepatic Abscesses

A liver abscess occurs when bacteria or protozoa destroy hepatic tissue, producing a
cavity, which fills with infectious organisms, liquelled liver cells, and leukocytes. Necrotic tissue
then walls off the cavity from the rest of the liver. Liver abscess occurs equally in men and
women, usually in those over age 50. Death occurs in 15% of affected patients despite
treatment.

Mainly define in two part:

1. Pyogenic Liver Abscesses

2. Amoebic Abscesses

Alternative Names:

1. Liver abscess

2. Bacterial liver
abscess

Pyogenic liver
abscess is a pus-filled
area in the liver.

Pyogenic organism
like E. Coli
Etiology

Pyogenic Liver Abscess may result from:

1. Via portal vein as occurs in appendicitis or diverticulitis.

2. Via the biliary tree as in cholangitis.

3. Via hepatic artery as in sepsis or generalized septicemia.

4. Via direct extension from infection in the neighborhood such as advance cholecystitis, sub
hepatic abscess .

5. Hepatic Trauma.

The second most common cause is from generalized septicaemia.

Clinical Features

• Symptoms

– Fever

– Weight loss

– Nausea/vomiting

– Right shoulder pain

– Weakness

– Chills

– Abdominal pain

• Signs

– RUQ pain

– Hepatomegaly

– Jaundice

– Pleural effusion

– Elevated hemidiaphragm
Diagnostic Test:

• Blood Examination

• Radiological Investigation

• Barium enema X-ray

• Ultrasonography

• Liver Scan

• Computed tomography

Treatment

 Amoebicidial Drug.

 Metronidazole

 Dehydroemetive

 Chloroquine

 Dudohydroxyquinolene

 Diloxanide furate

 Needle aspiration:

Needle Aspiration is only employed in selected cases.

 Indication for aspiration are:

o Persistence of clinical features of amoebic abscess following a course of amoebicidal drugs.

Clinical or radiography evidence of presence of hepatic abscess.

Pathology:

Gross appearance:

 The liver is enlarged.

 Liquefied material within the abscess.

 Content is mixture of R.B.C. leucocytes, broken down liver cells.

 Pus of amoebic abscess is variously described as 'Chocolate sauce' or 'Anchovy sauce'

Causative factors:

 Biliary tract disease

 Portal bed infection

 Hematogenous seeding

 Immunocompromise

 Trauma (penetrating and non-penetrating)

 Secondary infection

 Cryptogenic