PYOGENIC LIVER ABSCESS-converted.pdf.24/08/24

Pyogenic Liver abscess

1. PYOGENIC LIVER ABSCESS
Dr. M. RIZWAN
M.S.(U)
Assistant Professor
DEPT of SURGERY
R.A. & U.T.M.C.H
Welcome to another lecture
on
یحیق دبک لایبد

2. G. INTRODUCTION
❑Apyogenicliver abscess is a raredisease
characterized by:
❑Solitary/multiple collections ofpus within theliver
❑The infection is caused by bacteria and is usually
polymicrobial.

3. CAUSATIVE ORGANISM
E. coli –1/3
rd
cases
and
Staphylococcus
aureus
Haemolytic
streptococcus
Proteus
klebsiella
K. pneumoniaebeing
the common
causative organisms.

4. CLINICAL FEATURES
High fever, with rigors—90%.
Pain in the right hypochondrium—60%.
Nausea ,vomiting, anorexia
Weight loss.
Jaundice—occasionally—20%.
Intercostaltenderness.
Tender, soft liver —60%.
Features of toxicity.
Constitutional symptoms like Malaise, Lethargy,
Vomiting

5. 1.
Biliary
sepsis
35%;
comm
onest
route
2.
Portal
vein
sepsis
20%:
Appen
dicitis
diverti
culitis
3.Dist
ant
infecti
ons
(throu
gh
hepati
c
artery
15%)
Gener
alised
septic
emia
4.
Super
added
infecti
ons
5%:
5.
Crypto
genic
liver
absces
s 20%
6.
Traum
a
becom
ing
comm
on
cause
—4–
10%
7.
Direct
extens
ion:–
5%.
Advan
ce
cholec
ystitis
Sub-
hepati
c
absces
s
Aetiology

6. 1. BILIARY SEPSIS 35%; COMMONEST ROUTE.
a. Empyema
gallbladder.
b. Cholangitis.
c. After biliary
tract surgery.
d.
Instrumentation
e. Stone disease,
Caroli’s disease, biliary
ascariasis, biliary
enteric anastomosis.

7. 2. PORTAL VEIN SEPSIS 20%:
A. APPENDICITIS
2%.
B. DIVERTICULITIS.
C.
INFLAMMATORY
BOWEL DISEASE,
PANCREATITIS,
PERFORATION,
PID, COLORECTAL
CARCINOMA.
D. OMPHALITIS IN
NEWBORN.

8. 3. DISTANT INFECTIONS (THROUGH HEPATIC ARTERY 15%)

9. 4. SUPER ADDED INFECTIONS 5%:

11. 7. DIRECT EXTENSION:–5%.

13. PATHOLOGY
❑Due to laminar blood flow right lobe (75%) is
commonly involved
❑Left lobe (20%),
❑Caudate lobe (5%) are also often involved.
❑Usually solitary abscess —60%;
❑Occasionally it can be bilobarand multiple.
❑Cavitycontains puswith virulent organisms.
❑Usually abscess is acute.
❑In cryptogenic typechronic presentation is known
to occur.

14. ❑Ascitesand splenomegalyis not common.
❑It is more commonin diabetics.
❑Male to female ratio is 1:1.
❑It is more commonin old people after 55
yearsof age.
❑Blood culture commonly shows positivefor
bacteria
PATHOLOGY cont….

16. INVESTIGATION
❑CBC-↑ TLC= B/W = 12000-18000
❑LFT-↓ Albumin, ↑ alkaline phosphatase, N-
bilirubin= In90 % cases
❑Blood culture-is very relevant, +VE in 1/3 of
patient
❑Ultrasound abdomen, Sensitivity is 90% for USG
❑CT scan. Sensitivity is 97% for contrast CT scan.

17. ❑Chest X-ray shows:
▪Elevated diaphragm often with
▪Right sided pleural effusion.
•FNAB= Ultrasound guided aspirationof pus after
controlling PT.
•Liver scan

18. DIFFERENTIAL DIAGNOSIS

20. SYSTEMIC
ANTIBIOTICS
ULTRASOUND
GUIDED
ASPIRATION
PERCUTANEOUS
DRAINAGE
OPEN SURGICAL
DRAINAGE
TREATMENT OF
THE PRIMARY
CAUSES
TREATMENT

21. TREATMENT
❑Systemic antibiotics —combination of third
generation cephalosporinsand metronidazole.
❑Ultrasound guided aspiration/pigtail catheter—
Percutaneousdrainage is the treatment of choice at
present.
❑Drainage tube/ catheter are placed under US/CT
guidance into the liver abscess.
❑Pus culture and sensitivity: Pus should be sent for
culture and sensitivity.
❑Follow-up USG,

22. ❑LFT, Assessment
❑Assessment of quantity of daily drainage—should
be done to assess the response.
❑75% of pyogenicabscess is drained percutaneously.
❑Percutaneousaspiration without drainage tube
placement is also used;
▪But repeated guided aspirations are required;
▪Otherwise success rate is similar to drainage.

23. OPEN
SURGICAL
DRAINAGE

24. OPEN DRAINAGE IS INDICATED IN
Recurrent abscess,
Failure of percutaneousdrainage,
Large abscess of size more than 5 cm.
Open drainage is becoming less common at
present;
But in selected patients it may be a life-
saving essential therapeutic modality.
Treating the primary causes is very
essential.

25. APPROACHES OPEN SURGICAL DRAINAGE

26. COMPLICATIONS
Septicae
mia,
liver
failure.
Rarely
rupture
and
Peritoniti
s can
occur
Klebsiella
hepatic
abscess
can cause
dangerou
s
endogeno
us
endophth
almitis
commonl
y in
diabetic
patients
impairing
vision.

27. PROGNOSIS
❑Undrainedhepatic abscess mortalityreaches
up to 100 %
❑Prior to stopageof the antibiotics CT scan
should be repeated.
❑Patient should assessed carefully for 48 hours
after cessationof the antibiotics

28. THANK
YOU