What is abscess? An abscess is an enclosed collection of liquefied tissue , known as pus, somewhere in the body.

It is the result of the body's defensive reaction to foreign material.

LIVER ABSCESS

Definition A liver abscess occurs when bacteria or protozoa destroy hepatic tissue, producing a cavity, which fills with infectious organisms, liquefied 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 older than age 50. Death occurs in 15% of affected patients despite treatment. Causes Underlying causes of liver abscess include benign or malignant biliary obstruction along with cholangitis, extrahepatic abdominal sepsis, and trauma or surgery to the right upper quadrant. Liver abscesses also occur from intra-arterial chemoembolizations or cryosurgery in the liver, which causes necrosis of tumor cells and potential infection. The method by which bacteria reach the liver reflects the underlying causes. Biliary tract disease is the most common cause of liver abscess. Liver abscess after intra-abdominal sepsis (such as with diverticulitis) is most likely to be caused by hematogenous spread through the portal bloodstream. Hematogenous spread by hepatic arterial flow may occur in infectious endocarditis. Abscesses arising from 1

hematogenous transmission are usually caused by a single organism; those arising from biliary obstruction, by mixed flora. Patients with metastatic cancer to the liver, diabetes mellitus, or alcoholism are more likely to develop a liver abscess. The organisms that predominate in liver abscess are gram-negative aerobic bacilli, enterococci, streptococci, and anaerobes. Amebic liver abscesses are caused by Entamoeba histolytica. Signs and Symptoms Signs and symptoms of liver abscess depend on the degree of involvement. Some patients are acutely ill; in others, the abscess is recognized only at autopsy, after death from another illness. With a pyogenic abscess, the onset of symptoms is usually sudden; with an amebic abscess, its more insidious. Common signs and symptoms include abdominal pain, weight loss, fever, chills, diaphoresis, nausea, vomiting, and anemia. Symptoms of right pleural effusion, such as dyspnea and pleural pain, develop if the abscess extends through the diaphragm. Liver damage may cause jaundice. Diagnosis Ultrasonography and computed tomography (CT) scan with contrast medium can accurately define intrahepatic lesions and allow assessment of intraabdominal pathology. Percutaneous needle aspiration of the abscess can also be performed with diagnostic tests to identify the causative organism. Contrastaided magnetic resonance imaging may also become an accurate method for diagnosing hepatic abscesses. Abnormal laboratory values include elevated levels of serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin; an increased white blood cell count; and decreased serum albumin levels. With pyogenic abscess, a blood culture can identify the bacterial agent; with amebic abscess, a stool culture and serologic and hemagglutination tests can isolate E. histolytica. Treatment Antibiotic therapy along with drainage is the preferred treatment for most hepatic abscesses. Percutaneous drainage either with ultrasound or CT 2

guidance is usually sufficient to evacuate pus. Surgery may be performed to drain pus in patients with an unstable condition and continued sepsis (despite attempted nonsurgical treatment) and in patients with a persistent fever (lasting longer than 2 weeks) after percutaneous drainage and appropriate antibiotic therapy. Before the causative organism is identified, an antibiotic should be started to treat aerobic gram-negative bacilli, streptococci, and anaerobic bacilli, including Bacteroides species. A combination may be used. When the causative organisms are identified, the antibiotic regimen should be modified to match the patients sensitivities. An I.V. antibiotic should be administered for 14 days and then replaced with an oral preparation to complete a 6-week course. SCHISTOSOMIASIS Schistosomiasis is infection caused by flatworms (flukes), called schistosome. It affects mostly farmers and their families in the rural area. Endemic in 10 regions, 24 provinces, 183 municipalities and 1,212 barangays. High prevalence in Region 5 (Bicol), Region 8 (Samar and Leyte) and Region 11 (Davao). AKA: bilhariasis; snail fever Causative agent: Schistosoma mansoni; S. haematobium. S. japonicum (blood fluke), endemic in the Philippines, is transmitted by a tiny snail Oncomelania quadrasi. Mode of Transmission S. japonicum lay eggs in the intestines of an infected person -> Pass out in the feces ->upon contact with fresh water, hatch into larvae (miracidium) -> penetrate the soft part of the snail -> grow and multiply -> within 2 months bedome infective -> cercariae leave the snail into the water -> enter the skin of man and other warmblooded animals who come in contact with the infected water -> via the lymphatic system -> veins -> heart, systemic and portal circulation. Signs and Symptoms

diarrhea with bloody stools enlargement of the abdomen; splenomegaly; inflamed liver weakness; anemia

Management 1. Prevention 3

Educate the public regarding mode of transmission, method of protection (use rubber boots), sanitary disposal of urine and feces.

2. Control

Treat snail-breeding sites with molluscicides Treat water with iodine or chlorine to inactivate cercariae

3. Treatment

Praziquantel (Biltricide) drug of choice Oxamniquine Metrifonate