liver abcsess.pptx

liver abscess

1. Liver Abscess miss Kanchan Devi Assistant Professor Scpm College Of Nursing Gonda

2. Types of liver abscess Pyogenic liver abscess, which is most often polymicrobial Amoebic liver abscess due to Entamoeba histolytica Fungal abscess, most often due to Candida species

3. Introduction A liver abscess is a collection of pus in the liver caused by bacteria, fungi, or parasites. It may occur as a single lesion or as multiple lesions of different sizes. The abscess may contain thick, bad smelling pus or reddish-brown anchovy paste-like fluid with no odor. Occurs when bacteria/protozoa destroy hepatic tissue, produces a cavity which fills up with infective organisms, liquefied cells & leucocytes. Necrotic tissue then falls off the cavity from rest of the liver.

4. Definition A liver abscess is a collection of pus in the liver caused by bacteria, fungi, or parasites .

5. Risk factor Advanced age Having a long-term disease, (cancer, diabetes, tuberculosis) or splenectomy weak immune system , Taking Drugs: Such as steroids, chemotherapy, prolong use of antibiotics (fungal abscess). Drinking too much alcohol. Living in over crowding area poor sanitation Being malnourished Traveling to places where amebiasis is common . Eating foods and drinking liquids that are sold in the street

6. Causes Disorders or bacterial infection of following origins may invade liver to cause abscess Biliary disease (most common) e.g.: stones, cholangiocarcinoma, infection Colonic disease : diverticulitis , appendicitis, Crohn's disease Pancreatitis Infection of blood Intra-abdominal sepsis Endocarditic Dental infection (with streptococci) Traumatic Iatrogenic

7. Pathophysiology Due to etiological factor infection develops along the biliary and GIT Infecting organism reach to the liver through biliary system or lymphatic system Bacterial toxins destroying liver cells results necrotic tissues Leucocytes migrates into infected area Abscess cavity full of liquid containing living and dead leucocytes, liver cells and bacteria Liver abscess

8. Sign and symptoms Right upper abdominal pain Nausea and vomiting Weight loss Right chest pain Jaundice Fever and weakness Dark urine Joint pain Loss of appetite General discomfort

9. Diagnostic evaluation Blood test:- CBC , LFT, Bilirubin, blood culture Abdominal CT scan Abdominal ultrasound Liver biopsy

10. Medical Management Pyogenic liver abscess: Broad spectrum antibiotics should be started before waiting for culture results. Usually start treatment with tri-therapy included the use of penicillin, amino-glycoside and metronidazole. A third-generation cephalosporin can be considered in the elderly or if renal function is impaired. Antibiotic therapy can be modified once culture results are available. Treatment may be needed for up to 12 weeks and should be guided by the clinical picture and radiological monitoring.

11. Cont …… If Amoebic liver abscess: Metronidazole is the treatment of choice. Diloxanide furoate should be prescribed for 10 days to eliminate intestinal amoebae after the abscess has been successfully treated. Antifungal agents such as amphotericin B are used if fungal abscess is suspected.

12. Surgical Management Percutaneous aspiration can be carried out for small abscesses

13. cont …. Catheter drainage carried out for larger abscesses.

14. Cont ….. Open surgery may be necessary if Abscess ruptured Signs of peritonitis, Abscess 5 cm and Appendicitis.

15. Nursing Management Pain Management: Alleviation or reduction in pain Nutrition Management: Assisting with or providing a balanced dietary intake of foods and fluids. Infection Protection: Infection Control, Prevention and early detection of infection in a patient at risk.

16. Complications Return of Abscess Widespread infection in abdomen. Overwhelming sepsis. Rupture of the abscess into adjacent structures (pleural, peritoneal and pericardial spaces). Secondary infection of amoebic liver abscesses.