Bacterial, parasitic, or fungal in origin. 85% to 90% bacterial or pyogenic. Bacteria access the liver via the biliary tree or portal vein. Other causes include biliary obstruction, diverticulitis, trauma, inflammatory bowel disease,
Many a time the pyogenic infection follows amoebic infection
. Chronic alcoholics .Incidence Liver gets infected by Entamoeba histolytica commonly The most common location of a pyogenic abscess is the right lobe.prone to get this infection Entamoeba histolytica is endemic in many parts of the world Pathophysiology The amoebic cyst is ingested Cyst develops into the trophozoite form in the colon Reaches the liver through portal circulation Pyogenic abscess may also occur due to the infection by streptococcus milleri and Escherichia coli.
. Fever Pain right hypochondrium Chills Rigors Toxicity Right upper quadrant discomfort Diarrhea weight loss Intercostal tendreness Swelling in the right hypo chondrium or epigastrium tender.Clinical Features
Often the diagnosis of a bacterial abscess is suggested clinically.
USGM of the liver X-Ray of the chest to see whether there is any pneumonitis or effusion caused by the irritation of the nearby abscess TC -Leukocytosis LFT .Abnormal liver function tests (LFTs) CT scan liver
The radiologic differential diagnosis includes cystic or necrotic metastases (ovarian or leiomyosarcoma) hydatid and echinococcal cysts.
CT : a heterogeneous lesion irregular margins peripheral contrast enhancement.
CT scan showing liver abscess
The abscess is shown as a darker area in the liver shadow
causing empyema Rupture into the peritoneal cavity Treatment percutaneous or surgical drainage (Ultrasound guided repeated aspiration) antibiotics. Metronidazole Antibiotics like cephalosporins. aminoglycosides.Complications: Pneumonitis Pleural effusion Rupture of the liver abscess into the pleural cavity . mortality rate is almost 100% if the abscess remains untreated
. tetracyclines In rare cases it may need insertion of a drain.
Pleural Effusion secondary to amoebic liver abscess
An amoebic liver abscess causing a bulge in the dome of the diaphragm
Amoebic liver abscess burst into the right pleural cavity
There is no animal reservoir. Cysts predominate in the stools. The trophozoite (ameba stage) is motile. Pathology: Two-stage life cycle.
. amebic liver abscess
Epidemiology: Found worldwide. Mode of transmission: Ingestion of cysts. with somes trophozoites 18 present. The cyst stage is nonmotile.I. Anal-oral transmission due to sexual practice is also a consideration. Trophozoites are found in the intestinal and extraintestinal lesions. C. especially in tropical areas. Entamoeba histolytica: Amebic dysentery.
± Amebic dysentery: Colonization of cecum & colon by Entamoeba histolytica is common.
. Invasion into the portal submucosa is progressive after penetration of the submucosa. ± Most liver disease not preceded by dysentery. Localized necrosis results in "teardrop" or ³flask shaped´ ulcerations. ± Liver abscess: ± Penetration of the diaphragm can lead to lung disease.