Infective syndrome of hepatobiliary system and abdomen.pptx

Hepatobiliary diseases

1. Infective syndromes of Hepatobiliary systems and Abdomen

2. Contents Hepatitis liver abscess Cholangitis Infection of Peritoneum Infection of Spleen Infection of Pancreas

3. Normal Human Microbiota Normal microbial flora (also called “ indigenous microbiota ”) refers to the diverse group of microbial population that every human being harbors on his/her skin and mucous membranes

4. Normal Human Microbiota

5. Hepatitis Hepatitis refers to inflammation of the liver S elf-limiting or can progress to fibrosis (scarring ), cirrhosis or hepatocellular cancer The causes of hepatitis include both infectious (more common) and noninfectious such as toxic substances (e.g. alcohol, certain drugs ), and autoimmune diseases

6. Viral agents causing hepatitis Hepatitis viruses (HAV to HEV): They account for the most common cause of hepatitis worldwide Yellow fever virus : Causes hepatomegaly, and hemorrhagic fever Sporadic hepatitis : cytomegalovirus, Epstein-Barr virus, herpes simplex virus, adenoviruses, rubella virus, hantaviruses , mumps virus and enteroviruses such as Coxsackie viruses

7. Parasitic causes of hepatitis Causative Agent Disease Echinococcus granulosus Hydatid cyst in liver Trypanosoma cruzi and Leishmania species Hepatomegaly Entamoeba histolytica Hepatitis & Liver abscess Fasciola hepatica Hepatomegaly Clonorchis sinensis Hepatitis & Cirrhosis Leishmania donovani, Schistosoma mansoni and S. japonicum Hepatomegaly

8. Bacterial hepatitis Bacterial agents associated with hepatitis Chronic or granulomatous hepatitis Leptospira interrogans , Neisseria meningitidis , Neisseria gonorrhoeae , Bartonella henselae , Borrelia burgdorferi , Salmonella species, Brucella species and Campylobacter species Mycobacteria species, Tropheryma whipplei , Treponema pallidum , Coxiella burnetii , and Rickettsia species

9. Liver abscess Pyogenic abscesses commonly involve enteric bacteria such as Escherichia coli and Klebsiella pneumoniae Amoebic abscesses occur due to Entamoeba histolytica , accounts for 10% of cases Fungal abscesses most often occur due to Candida species , accounts for fewer than 10% of cases

10. Pyogenic Liver Abscess Characterized by single or multiple collections of pus within the liver; if left untreated, it can be fatal due to development of peritonitis or sepsis Pathogenesis: Local spread from an adjacent site within the peritoneal cavity: Biliary tract, Ruptured appendicitis & hematogenous spread Cryptogenic: unknown cause (50%) Manifestations : Fever and right upper quadrant tenderness are the most consistent

11. Complications : Rupture of the liver abscess into adjacent organs or body cavities may result into pleuropulmonary and intra-abdominal abscesses Etiology : depends on primary source of infection Biliary tree : enteric gram negative aerobic bacilli ( E. coli and Klebsiella ) and enterococci Pelvic or intraperitoneal source : Bacteroides fragilis Hematogenous spread : S. aureus or a streptococcal species such as Streptococcus milleri group are commonly isolated Pyogenic Liver Abscess

12. Lab diagnosis of Pyogenic Abscess Specimens: Blood culture, liver aspirate Surgical drainage and administration of appropriate systemic antimicrobial therapy

13. Infections of the bile duct CHOLECYSTITIS CHOLANGITIS

14. Cholangitis etiology : Bacterial : when a microorganism invades the biliary tract and there is associated biliary obstruction (biliary stones ) Biliary parasites cause necrosis , inflammation, fibrosis , strictures , and cholangiectasis of the bile ducts Cholecystitis is characterized by right upper abdominal pain, nausea , vomiting , and occasionally fever Presence of gallstone causes blockade of bile flow , which may be a risk factor for the gallbladder to become infected by bacteria Infections of the bile duct

15. Etiology Of Infection CHOLANGITIS inflammation of the bile duct CHOLECYSTITIS inflammation of the gallbladder Bacteria that commonly cause cholangitis include Escherichia coli, Klebsiella, Enterococcus, Enterobacter, Pseudomonas , C . perfringens and Bacteroides Common biliary parasites , Fasciola hepatica , Fasciola gigantica Echinococcus granulosus , Ascaris Viruses : Hepatitis viruses & HIV B acteria , predominantly E. coli, Klebsiella , Streptococcus , and Clostridium species; and viruses such Epstein-Barr virus and HIV

16. Other Intra-abdominal infections Infection of the Peritoneum Arise when the normal anatomic barrier is disrupted This may occur due to rupture of appendix or diverticulum , weakening of the bowel wall (e.g . in inflammatory bowel disease) or with adjacent organ infection (e.g. pancreatitis) Following anatomical breach , the organisms from the bowel or adjacent organ enter the normally sterile peritoneal space Intraperitoneal infections occur in two stages— peritonitis and abscess formation

17. Peritonitis Peritonitis (inflammation of the peritoneum) is of two types—primary and secondary Primary (Spontaneous) Bacterial Peritonitis Secondary Bacterial Peritonitis Occurs in conjunction with cirrhosis of the liver or other conditions Results from spillage of bacteria from an adjacent intra-abdominal viscus such as intestine Presents with fever (most common) , ascites, and abdominal pain Epigastric pain from a ruptured gastric ulcer or right lower quadrant pain in case of appendicitis E. coli , however, gram-positive organisms such as streptococci, enterococci Mostly intestinal flora such as enteric gram-negative bacilli (e.g. E. coli ) and anaerobes (e.g. Bacteroides fragilis )

18. CAPD Peritonitis?? Peritonitis may also occur in patients who are undergoing continuous ambulatory peritoneal dialysis (CAPD ) CAPD-peritonitis usually involves skin organisms such as Staphylococcus species Peritoneal Abscess Peritonitis usually results in gram-negative sepsis; H ighly fatal It is more commonly seen with Bacteroides fragilis infection

19. Infection of Spleen Splenic Abscess Develop secondary to haematogenous spread rather than direct contagious spread Infective endocarditis is the most common primary source and streptococci are the most frequent organism to be recovered from splenic abscess followed by S. aureus Treatment includes splenectomy with adjunctive antibiotics

20. Spleen may become immunologically hyperactive in response to the filtering of blood-borne pathogens, which subsequently leads to splenomegaly Seen in: leishmaniasis , malaria, Schistosoma mansoni and S. japonicum infection, bacterial endocarditis, infectious mononucleosis, HIV, tuberculosis, and also in splenic abscess Infection of Spleen Infectious Splenomegaly

21. Infection of Pancreas (Pancreatitis) Gallstones and alcoholism being the most common causative agents Clinical types: Acute pancreatitis may manifest as: Mild interstitial form (80% of cases) or More severe form (necrotizing pancreatitis), 20 % of cases Late complication of acute necrotizing pancreatitis , occurring more than 4 weeks after the initial attack Clinical features : abdominal pain ( cardinal symptom ), fever, tachycardia, vomiting, sometimes with anorexia and diarrhea

22. Etiology (Infectious) Viruses— e.g. Mumps , cytomegalovirus, Epstein-Barr virus, varicella-zoster virus, hepatitis viruses , HIV, measles, and rubella virus Bacteria— e.g . Mycoplasma, Salmonella, Campylobacter and M. tuberculosis Parasites— Ascaris can cause pancreatitis resulting from the migration of worms in and out of the duodenal Papillae Other parasites include Clonorchis species, P . falciparum, Fasciola hepatica, and hydatid disease Fungi— Aspergillus and Candida Antibiotic is indicated only when bacterial infection is suspected (e.g . abscess) Treatment is based on the culture report of FNAC guided pancreatic specimen

23. MCQ’S

24. MCQ 1 CAPD-associated peritonitis is commonly caused by which group of organisms? A. Enteric Gram-negative bacilli B. Anaerobes C. Skin flora ( Staphylococcus species) D. Bacteroides fragilis

25. Which of the following infections is most frequently associated with splenic abscess? A. Infective endocarditis B. Appendicitis C. Liver abscess D. Peritonitis MCQ 2

26. A 65-year-old woman with gallstones develops fever, jaundice, and RUQ pain. Blood cultures grow Escherichia coli . What is the MOST likely mechanism for this infection? A. Hematogenous spread B. Transdiaphragmatic migration C. Ascending infection from bowel D. Direct extension from kidney MCQ 3

27. A 50-year-old man presents with signs of sepsis and an enlarged spleen. Blood cultures grow Staphylococcus aureus . Imaging confirms a splenic abscess. Which microbiological test is MOST helpful to identify the primary source of infection? A. Throat swab culture B. Sputum AFB C. Echocardiography D. Urine culture MCQ 4

28. Which of the following is the most common parasitic cause of liver abscess worldwide? A. Fasciola hepatica B. Echinococcus granulosus C. Entamoeba histolytica D. Toxoplasma gondii MCQ 5

29. THANK YOU