1. liver infections (Abscess) General Surgery25415=.pptx

A liver abscess is a mass filled with pus inside the liver. Common causes are abdominal conditions such as appendicitis or diverticulitis due to hematogenous spread through the portal vein. It can also develop as a complication of a liver injury.

Risk factors for developing liver abscess can be due to infection, post-procedural infection and metastasis such as primary liver tumors, liver metastasis, biliary procedures, biliary injuries, biliary tract disease, appendicitis, and diverticulitis.

1. INFECTIONS OF THE LIVER

2. Pyogenic Liver Abscesses may be single or multiple more frequently found in the right lobe of the liver. When multiple , coalesce to give a honeycomb appearance.

3. Pyogenic Liver Abscesses PPF: Old age Immunocompromised DM Preexisting liver disease (2ry infection: hydatid, amoebic…)

4. Organism The most common: gram-negative bacteria ; Escherichia coli is found in two thirds of cases . In patients with endocarditis and infected indwelling catheters, Staphylococcus and Streptococcus species are more commonly found .

5. Route Bile ducts ( Most common ) Asc cholangitis PV ( portal pyemia ) Acute supp appendicitis,diverticulitis Hepatic artery Infective endocarditis Direct Subphrenic abscess

6. Clinical Presentation Fever, malaise ( Tender Hepatomegaly ) Right upper quadrant pain Jaundice occurs in up to one third of affected patients

7. Diagnosis Leukocytosis Elevated ESR Anemia Elevated AP level and liver enzymes

8. Ultrasound round or oval hypoechoic lesions with well-defined borders CT scan hypodense with peripheral rim enhancement may contain air-fluid levels indicating a gas-producing infectious organism Number, site,size

9. correction of the underlying cause IV antibiotic therapy should be continued for at least 8 weeks a percutaneous drainage : aspiration with or without placement of catheter ( Pigtail ) US guided Treatment

10. Surgical drainage either via the laparoscopic or open approach may become necessary if initial therapies fail Anatomic surgical resection can be performed in selected patients

11. Amebic Abscesses Organism: Entamoeba histolytica Mode of infection Ingestion of food or drink contaminated by entamoeba cysts

12. Amebic Abscesses most commonly located in the superior- Posterior aspect of the right lobe of the liver near the diaphragm. has a necrotic central portion that contains a thick, reddish brown, pus-like material. This material has been likened to anchovy paste or chocolate sauce .

13. Clinical presentation History of attack of dysentery Fever, rigors, nausea, vomiting right upper quadrant pain

14. Diagnosis Leukocytosis anemia elevated transaminase levels and jaundice are unusual. a mildly elevated AP level. Most patients have a positive fluorescent antibody test for E. histolytica , and test results can remain positive for some time after a clinical cure. This serologic test has a high sensitivity.

15. Diagnosis Ultrasound and CT scanning of the abdomen well defined low-density round lesions have enhancement of the wall, ragged in appearance with a peripheral zone of edema. The central cavity may have septations as well as fluid levels.

16. Treatment Metronidazole 750 mg three times a day for 7 to 10 days is the treatment of choice and is successful in 95% of cases. Both ultrasound and CT of the liver can be used as follow-up after the initiation of medical therapy.

17. Treatment Aspiration of the abscess rarely is needed and should be reserved for patients with large abscesses, those who do not respond to medical therapy, or those who appear to be superinfected . Surgical drainage

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