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A - MSRA Gastrointestinal [7] > [2] Liver Abscess > Flashcards

[2] Liver Abscess Flashcards

1
Q

What do liver abscesses typically result from?

A

Polymicrobial bacterial infection spreading from the biliary or gastrointestinal tract to the portal or hepatic veins

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2
Q

How can bacterial infection spread from the biliary or GI tract to the portal and hepatic vein?

A

Either via contiguous spread or seeding

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3
Q

What are the common causes of liver abscesses?

A 
Cholecystitis
Cholangitis
Diverticulitis 
Appendicitis
Septicaemia
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4
Q

What are the most commonly isolated organisms involved in liver abscesses?

A

E. Coli
K. Pneumoniae
S. Constallatus

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5
Q

When might fungal cases of liver abscesses be present?

A

In immunocompromised patients

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6
Q

How do patients with liver abscesses typically present?

A

Fever
Rigors
Abdominal pain

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7
Q

When should pyogenic abscesses be considered?

A

In all patients presenting with pyrexia of unknown origin associated with associated abdominal pain or bloating

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8
Q

What are the other symptoms of liver abscesses?

A 
Bloating
Nausea
Anorexia
Weight loss
Fatigue 
Jaundice
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9
Q

What will be found on examination with liver abscesses?

A

RUQ tenderness, with or without hepatomegaly

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10
Q

How may a patient present with a ruptured liver abscess?

A

Signs of shock

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11
Q

What investigations should be done in suspected liver abscess?

A

Bloods

Imagingq

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12
Q

What may bloods show in liver abscesses?

A

FBC will show leucocytosis

LFTs are often abnormal, with raised ALP in most cases and deranged ALT and bilirubin in a proportion

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13
Q

What should all patients with liver abscesses have sent for microscopy?

A

Peripheral blood and fluid cultures

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14
Q

What imaging can be done in liver abscesses?

A

Ultrasound imaging

CT imaging with contrast

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15
Q

What will be shown on ultrasound imaging with liver abscesses?

A

Poorly-defined lesions with hypo- and hyper-echoic areas, with potential gas bubble and septations

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16
Q

What is the purpose of CT scan with contrast in liver abscesses?

A

It can provide further delineation

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17
Q

What may a CT scan with contrast show in liver abscesses?

A

Similar pattern from the collection as seen on ultrasound, with associated surrounding oedema

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18
Q

How should patients with liver abscesses be managed initially?

A

They should be fluid resuscitated and stabilised accordingly, and started on appropriate antibiotic therapy

19
Q

What antibiotic therapy should be given in liver abscesses?

A

Choice guided by sensitivities and local policy

20
Q

How can liver abscesses be managed definitively?

A

Most cases can be drained via image-guided aspiration of the abscess, with or without catheter drainage

21
Q

What image guidance is used in aspiration of liver abscesses?

A

Either ultrasound or CT

22
Q

When should the underlying cause of a liver abscess be managed?

A

Once the patient has been appropriately managed

23
Q

When is surgery indicated in liver abscesses?

A

Rarely indicated, predominantly if the abscess has ruptured, or refractory to antibiotic treatment

24
Q

What is an amoebic abscess?

A

The most common extra-intestinal manifestation of amebiasis infection

25
Q

What causes an amoebic abscess?

A

The organism Entamoeba histolytica

26
Q

How does amebiasis infection spread?

A

Via faeco-oral route

27
Q

What happens once the amebiasis infection is in the colon?

A

The trophozoite begins to invade the mucosa and spread to the liver via the portal system

28
Q

What % of the worlds population is estimated to be infected with the Entamoeba histolytica?

A

12%

29
Q

Where is infection with Entamoeba histolytica most common?

A

In developing regions such as South America, the Indian subcontinent, and Africa

30
Q

What are the clinical features of an amoebic abscess?

A 
Patients present with vague symptoms; 
Abdominal pain
Nausea
Fever or rigors
Weight loss
Bloating
31
Q

When should cases of amoebic abscesses be suspected?

A

In patients presenting with the symptoms and a history of recent travel (<6 months) to an endemic region

32
Q

What early clinical features may patients with amebiasis infection present with due to intestinal involvement?

A

Abdominal pain and diarrhoea

33
Q

What investigations should be done in suspected amoebic abscess?

A

Bloods

Ultrasound imaging

34
Q

What will bloods show in amoebic abscesses?

A

Leucocytosis with deranged LFTs

35
Q

What should all patients with amoebic abscesses have sent for microscopy?

A

Peripheral blood and fluid cultures

36
Q

What is the purpose of testing blood and stool samples in suspected amoebic abscesses?

A

To check for the presence of E. histolytica antibodies

37
Q

What will ultrasound imaging show in amoebic abscesses?

A

Poorly-defined lesions

38
Q

How can amoebic lesions seen on ultrasound be further characterised?

A

CT imaging

39
Q

How are most patients with amoebic cysts managed?

A

Antibiotics alone

40
Q

What antibiotic are used in the management of amoebic cysts?

A

Typically metronidazole or tinidazole

41
Q

When may surgical treatment of amoebic cysts be required?

A

Large cysts, or those which do not respond well to antibiotic therapy

42
Q

What is the surgical treatment for amoebic cysts?

A

Surgical drainage

43
Q

What can be prescribed to eradicate amoebiasis in the colon?

A

A luminal agent, such as paramomycin

A - MSRA Gastrointestinal [7] (44 decks)

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