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4) Trauma
a) Penetrating wound
b) Blunt trauma
5) Direct
a) Perforated peptic ulcer
b) Subphrenic abscess
c) Adjacent abscess- Perinephric
abscess
6) Miscellaneous
Obscure in 5 % cases
Other unusual causes:
a) Cysts- Including Polycystic
liver disease)
b) Intrahepatic malignancy
c) Hydatid cyst
Bacteriology
Majority derived from GI tract in
>75% cases
Aerobic:
a) E.coli most common cause
b)Klebsiella pneumoniae
c)Others: Pseudomonas
aerogenosa, Morganella morganii,
Serratia marsecens, etc.
Anaerobic:
a) Bacteroides fragilis (most
common)
b) Others: Fusobacterium spp.,
anaerobic Streptococci, Clostridium
spp., Actinomyces spp.
Based on size & distribution of focal
sites;
a) Macroscopic abscess
b) Microscopic abscess
Macroscopic Microscopic
a) Single a) Multiple
b) Restricted to one b) Widely distributed
lobe throughout the
hepatic
parenchyma
c) Present subacutely
with symptoms of c) Manifest acutely
several days to over a few days
weeks duration
d) Require primary d) Require primary
drainage medical treatment
with surgery
Clinical features
Symptoms:
Fever
Abdominal pain
Chills
Anorexia
Weight loss
Nausea, Vomiting
Right shoulder pain / irritable cough
Signs:
Hepatomegaly
Tenderness
Rebound tenderness
Jaundice (late)
Histology
7) Aspiration of material:
Diagnostic & Therapeutic
Treatment
Start with empiric antibiotics:
Ampicillin
Metronidazole
Gentamicin
Specific antibiotics (Depending on cultures)
6-16 weeks
If persisting
Percutaneous drainage (under USG/CT
guidance)
Surgical Drainage
Indications for surgical drainage:
a) Abscess with intra-abdominal
pathology requiring surgery
b) Ascitis
c) Multiple large abscesses
d) Abscess which cannot be
drained percutaneously
Amoebic Abscess
Commonest extra-intestinal
presentation of amoebiasis
Common in alcoholics
Caused by Entamoeba histolytica
Entry by faeco-oral route
Pathology
Amoeba multiply-block in intrahepatic
portal radicles-focal infarction of liver
cells-
proteolytic enzymes released- destiny
liver parenchyma
Site: Right lobe of liver,
supraanteriorly, just below the
diaphragm
Large necrotic area which is
liquefied into thick reddish-brown pus
(Anchovy sauce pus) due to liquefied
necrosis, thrombosis of blood vessels,
lysis of liver cells
Histology
Necrotic area containing degenerated
liver cells, leucocytes, RBCs,
connective tissue strands, debris &
amoeba
Clinical features
Symptoms:
High grade fever with rigor
Weight loss
Upper quadrant pain ( Initially
dull aching, later on stabbing)
Jaundice (not common)
Signs:
Hepatomegaly (tender)
Consolidation in right lower
zone of lungs
Pleurisy
Complications
1) Rupture into lung/pleura
a) Empyema
b) Hepatobronchial fistula
c) Pulmonary abscess
d) Pneumonitis
e) Pleural effusion
2) Rupture into pericardium
3) Intraperitoneal rupture
4) Rupture into portal vein (rare)
5) Secondary infection
Investigations
1) Routine:
Leucocytosis
Anemia
2) Liver function test:
Increased Alkaline Phosphatase
Increased Transaminase
3) Stool examination: cysts/
trophozoites
4) Aspiration: Anchovy sauce pus
5) Chest X-Ray
Raised fixed diaphragm
Right lateral abscess
6) USG (most useful) : Round lesion
7) CT : Irregular edge
8) Serology: ELISA
Treatment
Metronidazole 750mg orally/i.v. 3 daily x
4 days
If response, continue for 10 days;
followed by luminal agents:
Iodoquinol 650mg 3 X 20 days
Paramomycin 500mg 3 X 10
days
If no response,
Dihydroemetine 1.5mg/Kg
i.m. 4 X 5 days
+
Chloroquine phosphate
600mg base/day orally 4 X 2 days,
then 300mg base/day orally 4 times
If no response to medical treatment:
Percutaneous drainage
Thank
You