The liver 2 Dr. noori Hanoon

Question 1

how the pt with amoebic liver abscess presented with ?

Answer 1

• common presentation is desentrny (gastroenteritis that results in diarrhea with blood) dysentric abscess
• pt may be presented with amebic abscess common site is paracecal in the liver

Question 2

how the dysentric abscess ?

Answer 2

70% of pt have solitary large abscess

30% multiple and small

Question 3

how pt get amoebic liver abscess?

Answer 3

by the ingestion of the cyst of Entamoeba histolytic that then develop into trophozoite in the colon then to the bowel then to the liver

Question 4

whats the course of the amoebic liver abscess ?

Answer 4

1- first there will be inflammation (amoebic hepatitis )
2- Amoebic abscess and its look like chocolate pus (anchovy paste )
3- encapsulated abscess — dormant
4- may burst and cause many complications

Question 5

what’re the complications that could happen if the amoebic abscess burst ?

Answer 5

1- infect the peritoneum cavity
2- hallow organs
3-skin
4-lung and the plural cavity

Question 6

what’re the signs and symptoms of the amoebic live abscess ?

Answer 6

1- pain in the liver area enlarge and tender liver
2- fever and night sweating
3- Anemia
4-weight loss

Question 7

how to diagnosis the amoebic liver abscess ?

Answer 7

-U/S ,CT, Chest Xray , abdominal X ray
-stool examination for the isolation of the organism
but taking a sample from the liver lesion (abscess)its difficult because its in the periphery

Question 8

what’re the treatment of the amoebic liver abscess?

Answer 8

1- mainly we give pt metronidazole 750mg X2 Daily for
(7-10)days ( is an antibioticIt is effective for dracunculiasis, giardiasis, trichomoniasis, and amebiasis )
2- possibly aspiration under U/S guidance
3- laparoscopy might needed or open

Question 9

what’re the types of the cysts ?

Answer 9

1- simple cyst unilocular

2- hydatid cyst most common in the Middle East multilocular

Question 10

what’re the features of the simple cyst ?

Answer 10

1- regular, define margin
2-thin wall and unilocular
3- homogenous
3- no variation in the density and no surrounding tissue response

Question 11

how the simple cyst seen in the CT ?

Answer 11

sharp defined margin no separation calcification enhancement mural nodules

Question 12

what’re the treatment of the simple cyst ?

Answer 12

1- nothing if it asymptomatic
2- aspiration under U/S guidance
3-for large and symptomatic the laparoscopy or open

Question 13

whats the cause of the polycycstic liver disease ?

Answer 13

congenital

Question 14

what’re the features of the polycycstic liver disease ?

Answer 14

• multiple cyst
• its asymptomatic
• may there will be discomfort
• pt may have sever pain due to the hemorrhage

Question 15

how to diagnosis the polycycstic liver disease ?

Answer 15

U/S ,CT

Question 16

TRT of the polycycstic liver disease ??

Answer 16

1- anaglgesis

2- if no response then laparoscopy or open

Question 17

whats the cause of the hydatid cyst disease?

Answer 17

-ingestion of the larva of Echincouccus granulosus that found in the dogs that reach the liver by portal circulation
- attack the liver 70%
lung 20%
and 10% the other organs

Question 18

enumerate the layers of the hydatid cyst ?

Answer 18

1- adventitia
2- ectocyct (laminated layer)
3- endocyct (germinal layer )

Question 19

what’re the content of the hydatid cyst fluid ?

Answer 19

1- crystal clear
2- active cyst have many small daughter cyst
3-no albumin
4- the specific gravity 1.005-1.009

Question 20

whats the symptoms of the hydatid cyst ?

Answer 20

1- asymptomatic
2- pressure menfistation as 
- discomfort 
- fulness
-jaundice
3- abdominal mass 
4- complications
-suppuration 
-rupture of the daughter  hydatid cyst 
(ether *intrabilliary : causing jaundice and acute cholengitis *peritoneal : as acute abdominal after minor injury 
*pleural cavity  )

Question 21

whats the course of the hydatid cyst disease ?

Answer 21

1- ether active cyst that enlarge in size na d become more superficial and float in the peritoneum
2- or died as calcified cyst
3-complication rupture or suppuration (infection)

Question 22

how to diagnosis the hydatid cyst disease ?

Answer 22

1- u/s to see the cyst multilucunar while the CT to see the cyst floating 
2- serology and immunological tests :
-ELISA test bt antibody against antigen 
-Casoni test 75%
-compliment fixation

Question 23

what’re the treatment of the hydatid cyst?

Answer 23

@SURGERY 
1-OPEN SURGERY  
a- derfooing (cut off )and evacuate the content 
b- excision of the cyst 
c-liver resection 

2- LAPAROSCOPY AND SCOLICIDAL AGENT :

• ethanol alchohol 95%
• hypertonic fluid
• sliver nitrite 0.5%
• povidine iodine

@MEDICATION

• mebandazole 40-50( anthelmintic reat a number of parasitic worm infestations)
• albendazole 10-15mg /kg
• praziquntal 40

Question 24

what’re the scolicidial agent ?

Answer 24

1- ethanol 95%
2- hypertonic fluid
3-sliver nitrite
4- povidine iodine 0.5%

Question 25

what’re the complication of the surgical treatment of the hydatid cyst ?

Answer 25

1- billiard leakage --fistula
2- cholangitis 
----
3-suppuration 
4-liver tissue damage and bleeding 
5- reccurance 
6- missed deep cyst 
----
7-injuries to the near organ 
8- contamination of the peritoneum cavity (albenazole and parziquntal )
----
9-anaplastic shock 
10- wound infection

Question 26

whats the tubercles liver abscess ?

Answer 26

its rare may found in endemic area

associated with pulmonary TB or lymphadintis TB

Question 27

how the pt presented with tubercles liver abscess ?

Answer 27

• present with non specific symptoms

- or after the diagnosis of the pulmonary TB or rExtra- pulmonary TB

Question 28

How to diagnosis the tubercles liver abscess ?

Answer 28

u/s and ct

Question 29

treatment of the tubercles liver abscess?

Answer 29

drainage and anti - TB 
PIER
-Pyrinzmid 
-isonisid 
-ethambtol 
-rifamicin