Liver Abcesses Flashcards
Why do liver abscesses occur?
Usually from polymicrobial bacterial infection spreading from the biliary or GI tract, either be
Is contiguous spread or from portal or hepatic veins.
What organisms are responsible for liver abscess?
Usually E. coli, K pneumoniae and S constellatus.
What are the clinical features of liver abscesses?
Fever Rigours Abdominal pain Nausea Anorexia Fatigue Jaundice
RUQ tenderness and hepatomegaly. If abscess has ruptured may show signs of shock.
What investigations should be performed for suspected liver abscess?
FBC to show leucocytosis and abnormal LFTs
Raised ALP
Peripheral blood and fluid cultures should be sent for microscopy
Ultrasound imaging will show poor defined lesions with gas bubbles and separations.
CT imaging with contrast can show a similar pattern to seen on USS with associated surrounding oedema,
How are liver abscess managed?
Fluid resuscitation and antibiotic therapy
Drain via image guided aspiration of abscess either USS or CT for source control. Address underlying cause.
What is an amoebic abscess?
A common extra intestinal manifestation of amebiasis infection, caused by entamoeba histolytica.
How does entamoeba histolytica spread?
Faecal oral route
Once in colon begins to invade mucosa and spread to liver via portal system
What are the clinical features of an amoebic liver abscess?
Vague symptoms of - Abdominal pain Nausea Fever Rigours Weight loss Bloating
Suspect in patient ps with history of recent travel.
What investigations are done for an amoebic liver abscess?
Bloods for leucocytosis
Deranged LFTs
Peripheral blood and fluid cultures for microscopy
Stool sample to check for E histolytica antibodies
USS to show poor defined lesions that can be characterised with CT
How are patient with amoebic liver abscess managed?
Antibiotics alone usually, metronidazole
If not responsive or cyst is v large, a luminal agent can be used to eradicate the presence of amoebiasis in the colon.
