Live abscess
Introduction
Liver abscesses can be bacterial, parasitic, or fungal in origin.
Approximately 85% to 90% are bacterial or pyogenic.
Bacteria access the liver via the biliary tree or portal vein.
Other causes include
biliary obstruction,
diverticulitis,
trauma,
inflammatory bowel disease
The most common location of a pyogenic abscess is the right lobe.
Aetiology and Incidence
Liver gets infected by Entamoeba histolytica commonly
Chronic alcoholics - prone to get this infection
Entamoeba histolytica is endemic in many parts of the world
The amoebic cyst is ingested
Cyst develops into the trophozoite form in the colon
Reaches the liver through portal circulation
Pyogenic abscess may also occur due to the infection of streptococcus milleri and Escherichia coli.
Many a time the pyogenic infection follows amoebic infection
Clinical Features
Fever
Chills
Rigors
Toxicity
Right upper quadrant discomfort
Pain right hypochondrium
Diarrhea
weight loss
Intercostal tendreness
Swelling in the right hypochondrium or epigastrium
tender, enlarged liver.
Investigations
USGM of the liver
X-Ray of the chest to see whether there is any pneumonitis or effusion caused by the irritation of the nearby abscess, sometimes the liver abscess may rupture into the pleural cavity and the pleural cavity may be filled with amoebic or pyogenic pus
TC -Leukocytosis
LFT - Abnormal liver function tests (LFTs).
CT scan liver
Complications:
Pneumonitis
Pleural effusion
Rupture of the liver abscess into the pleural cavity - causing empyema
Rupture into the peritoneal cavity
Treatment
Metronidazole
Tinidazole
Diloxanide furoate (amycline)
Antibiotics like cephalosporins, aminoglycosides, tetracyclines
Ultrasound guided repeated aspiration
In rare cases it may need insertion of a drain.
Entamoeba histolytica:
The causative organism of Amebic dysentery; amebic liver abscess
Epidemiology:
Found worldwide, especially in tropical areas,
There is no animal reservoir.
Mode of transmission:
Ingestion of cysts.
Anal-oral transmission due to sexual practice is also a consideration.
C. Pathology:
Two-stage life cycle.
1. The trophozoite (ameba stage) is motile.
2. The cyst stage is nonmotile.
Trophozoites are found in the intestinal and extraintestinal lesions.
Cysts predominate in the stools, with somes trophozoites present.
- Amebic dysentery: Colonization of cecum & colon by Entamoeba histolytica is common. Localized necrosis results in "teardrop" or "flask shaped" ulcerations. Invasion into the portal submucosa is progressive after penetration of the submucosa. bloody diarrhoea
- Liver abscess:
- Penetration of the diaphragm can lead to lung disease.
- Most liver disease not preceded by dysentery.
