Liver abscess

Liver Abscess Management

1. LIVER ABSCESS/HEPATIC ABSCESS Dr.Ashish Behera Asst. Professor, Internal Medicine

2. Definition Liver abscesses are purulent collections in the liver parenchyma that result from bacterial, fungal, or parasitic infection . Infection can spread to the liver through the biliary tree, hepatic vein, or portal vein, by extension of an adjacent infection , or as a result of trauma . One or multiple abscesses can be present. Fungal liver abscess can occur in immunocompromised hosts. Amoebic liver abscess is a complication of amoebiasis .

3. Epidemiology 13% of the Intra-abdominal abscess 48% of the all visceral abscess 8 to 20 cases per 100,000 hospital admissions in the US and the UK Amoebiasis (and subsequent amoebic liver abscess) in developed countries is seen most commonly in immigrants and travellers from endemic areas. The incidence of liver abscess increases with age , occurring slightly more often in men > women Incidence - increasing while the mortality = stable or decreasing . The trend of increasing incidence may be due to the availability of more sensitive diagnostic tests than in the past (e.g., CT scan) or to the increasing prevalence of predisposing conditions.

4. Aetiology Pyogenic liver abscess Escherichia coli Klebsiella species(extra-hepatic complications,including endophthalmitis and central nervous system infections. ) Streptococcus( constellatus,angiosus , intermedius ) Enterococcus and anaerobes - Bacteroides fragilis & Fusobacterium necrophorum Staphylococcus aureus & Pseudomonas species Salmonella typhi Amoebic abscess Entamoeba histolytica Fungal Tubercular

5. Pathophysiology Spread of infection from 1 of the following sources: • Biliary tree • Portal vein • Hepatic vein • Extension of contiguous infection • Penetrating trauma.

6. Ascending infection of the biliary tree secondary to obstruction is now the most identifiable cause. Western countries-patients with malignant disease Asia- Gall stone disease

7. Presentation

8. DOUBLE TARGET SIGN

9. Aspiration has been indicated in the following circumstances especially in ALA • Lack of clinical improvement in 48 to 72 hours • Left lobe abscess • Large abscess having impending rupture / compression sign • Thin rim of liver tissue around the abscess (<10 mm ) • Seronegative abscesses • Failure in the improvement following non-invasive treatment after 4 to 5 days

10. ZONES IN LIVER ABSCESS

11. Prognostic markers : Independent risk factors for mortality in Amoebic Liver Abscess are • Bilirubin level > 3.5 mg/dl • Encephalopathy, • Volume of abscess cavity • Hypoalbuminaemia (serum albumin <2.0 g/dl )