Liver Abscess Diagnose & Treatment .pptx

Liver Abscess Diagnose & Treatmen

1. Liver Abscess; Diagnosis A nd Treatment By Dr Bushra Qadir Consultant Gastroenterologist

2. Classification • The three major forms of liver abscess, classified by etiology, are as follows: • Pyogenic abscess, which is most often polymicrobial , accounts for 80% of hepatic abscess cases in the United States • Amebic abscess due to Entamoeba histolyticaaccounts for 10% of cases • Fungal abscess, most often due to Candida species, accounts for fewer than 10% of cases.

3. History The most frequent symptoms of hepatic abscess include the following : • Fever (either continuous or spiking) • Chills • Right upper quadrant pain • Anorexia • Malaise

4. Laboratory & Diagnostics Routine lab not diagnostic for both abcesses : WBC (↑) Anemia (normocytic normochromic) Sed rate (↑) LFT nonspesific : 90% high AP, AST/ALT ↑ but to a lesser degree Low albumin (<2mg%) poor prognostic factor.

5. Imaging Studies 1. Chest X-Ray: May show raised right hemi- diaphragm on 2. U/S initial test of choice : noninvasive, high sensitivity 80-90%; to distinguish cyst from solid lesion/visualizing biliary tree can guide needle aspiration of the abscess. Ultrasound of the liver may show a round or an oval hypoechoic area contiguous with the liver capsule and without significant wall echoes.

6. Other Investigations • Blood culture ( positive in 60 %) • Direct culture aspirated fluid ( positive in 70-80 %) are use ful for identification of the organism and determination of antibiotic susceptibility . • CT scan abdomen complimentary to ultrasound • If amebic abscess suspected then consider IHA ( indirect hemagglutination test ) has sensitivity and specificity more than 85 %.

7. Treatment Of Liver Abscess • Medical management • Aspiration or drainage of abscess • Surgical treatment

8. Treatment of Amebic Abscess Medical therapy : Metronidazoleis the agent of choice for treatment of amebic colitis. Doses of 750 mg three times daily for 10 days are extremely effective. The response to anti-amoebic drug is usually evident with in 48 -72 hrs with the subsided of toxemia.

9. Treatment of Amebic Abscess 2. Indications of Aspiration: • Routine aspiration of liver abscess is not indicated for therapeutic purposes. Anti-amebic therapy is equally effective as aspiration for uncomplicated abscess . • Consider aspiration of abscess: A) Lack of improvement after 48 -72 hrs of treatment B) Left lobe abscess • Abscess size more than 10cms • Abscess with impending rupture • Seronegative abscess

10. Treatment O f Pyogenic Abscess Medical management: E mpirical therapy should be started immediately after obtaining specimen. • Antibiotics should cover areobic and anaerobic bacteria. Management with antibiotis alone has been shown to be effective for small abscess < 5cms in diameter. • Commonly First line: Cefotaxime 2.0g IV q8h or Ceftriaxone 2.0g IV q24h plus Metronidazole 0.5g IV q8h or Piperacillin / tazobactam 3.375g IV q 6h

11. Duration of Therapy Intravenous antibiotic therapy directed at the specific organism should be administered until a clinical response to therapy is demonstrated followed by an oral regimen for upto6 weeks .

12. Complications Pleural or pericardial effusion Empyema Portal vein thrombosis =24 % Hepatic Vein thrombosis= 22 % Splenicvein thrombosis Rupture into the pericardium, thoracic and abdominal fistula formation, and sepsis

13. THANKS