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Abscess hepar

• amebiasis
• Pyogenic
Amebiasis hepar
• Entamoeba : E.dispar dan E.histolitica
• Banyak terdapat pada daerah yg memiliki sanitasi
tidak baik
• Manusia merupakan hospes
• Cara infeksi : menelan kista matang

Entamoeba histolitica Ulkus pada usus
Abses hepar
Abses Paru paru
Abses Otak
Hematogen / perkontinuitatum
Peritonistis
Amebiasis intestinal
amebiasis perianal
Vagina
Appendicitis
Extraintestinal amebiasis yg palig sering adalah liver abses
Tanda dan gejala liver abses : sakit pada daerah abdomen , demam ,
pembesaran hati , anoreksia dan bb turun , abses hepar
Intestinal amebiasis  extraintestinal amebiasis
Intestinal amebiasis
Tanda dan gejala : demam(tidak sering) distensi abdomen , hiperistaltis ,
diare  disentri , hematochezia
Pengobatan
• Amebiasis intestinal : metronidazole dan
tinidazole
• Hepatic abscess dan extraintestinal amebiasis
yg lain
– metronidazole
– tinidazole
Diagnosis
• pemeriksaan serologis : antibodi (+)
• pemeriksaan tinja : kista
• pencitraan
• percutaneus aspiration with image-guided
needle : abses aspirat
Pyogenic hepatic abscess
• Etiologi : E.coli , klebsiella pneumonia , proteus
vulgaris , entrobacter aerogenes , K
pneumoniae , dll
Pyogenic (bacterial) hepatic abscesses may occur as solitary or multiple lesions,
ranging from millimeters to massive lesions, many centimeters in diameter. They are
generally produced by gram-negative bacteria such as Escherichia coli and Klebsiella
sp.
Gross and microscopic features are those of any pyogenic abscess,
consisting of necrotic tissue with abundant neutrophils. Occasionally, fungi
or parasites rather than bacteria can be identified.
Tanda dan gejala
Symptoms Percentage Signs Percentage
Abdominal pain 89-100 Normal findings 38
Fever 67-100 Right upper
quadrant tenderness
41-72
Chills 33-88 Hepatomegaly 51-92
Anorexia 38-80 Mass 17-18
Weight loss 25-68 Jaundice 23-43
Cough 11-28 Chest findings 11-48
Pleuritic chest pain 9-24 –
The most common microorganisms isolated from blood and abscess cultures
are as follows
7,9
:
E coli - 33%
K pneumoniae - 18%
Bacteroides species - 24%
Streptococcal species - 37%
Microaerophilic streptococci - 12%
PENATALAKSANAAN
Presently, most liver abscesses are treated with antibiotics and catheter
drainage under ultrasonographic or computed tomography (CT)
scan guidance.

The 5 indications for surgical drainage are as follows:
Abscess not amenable to percutaneous drainage secondary to location
Coexistence of intra-abdominal disease that requires operative
management
Failure of antibiotic therapy
Failure of percutaneous aspiration
Failure of percutaneous drainage
Pyogenic hepatic abscess
Kista

Needle aspiration

Actinomycosis