Liver Abscess Flashcards
Pyogenic Liver Abscess
The most common organisms found in pyogenic liver abscesses are Staphylococcus aureus in children and Escherichia coli in adults.
Management
amoxicillin + ciprofloxacin + metronidazole
if penicillin allergic: ciprofloxacin + clindamycin
Liver Abscess - Example Question
A 40-year-old man who recently had an appendicectomy presents to hospital unwell. He has generalised abdominal pain and pyrexia. Initial bloods are presented below.
Hb 134 g/l Na+ 139 mmol/l Bilirubin 18 µmol/l B12 900ng/l Platelets 490 * 109/l K+ 4.1 mmol/l ALP 120 u/l Folate 2.1µg/l WBC 23.2 * 109/l Urea 7.6 mmol/l ALT 35 u/l Iron 18µmol/l Neuts 19.8 * 109/l Creatinine 101 µmol/l γGT 30 u/l Lymphs 3.2 * 109/l Albumin 41 g/l Eosin 0.1 * 109/l
Automated lab haematinics show a grossly elevated serum B12 with normal folate and iron. Blood culture confirms gram-negative septicaemia. What is the likely diagnosis?
Atypical respiratory tract infection Infectious mononucleosis > Liver abscess Catheter associated urinary tract infection Infective endocarditis
The best answer is a liver abscess. A history of recent appendicectomy provides a clue, a liver abscess may form consequently to any form of intra-abdominal sepsis e.g. perforated appendix, biliary sepsis. Most commonly the causative organism is E. Coli or anaerobic organisms. Vitamin B12 is stored in the liver and can be released during infection.
Infectious mononucleosis is unlikely to cause a neutrophilia being a virus.
Liver Abscess - Example Question
A 71-year-old woman is admitted to the Acute Medical Unit with a two week history of worsening right upper quadrant pain and fever.
Bloods show the following:
Bilirubin 58 µmol/l ALP 301 u/l ALT 168 u/l γGT 252u/l Albumin 33g/l CRP 214 mg/l
A CT scan is arranged:
PASSMED PYOGENIC LIVER ABSCESS
What is the most appropriate intervention?
> Intravenous antibiotics + image-guided percutaneous drainage Intravenous antibiotics Mebendazole + image-guided percutaneous drainage Image-guided percutaneous drainage Surgical resection
Surgical resection would only be appropriate if intravenous antibiotics + image-guided percutaneous drainage failed to resolve the infection. If a hydatid cyst is suspected surgical resection if the first-line treatment. The appearance on the CT is however not consistent with this, as they tend to be much better circumscribed.
