1. Liver Abscess
Prof. Ygber González de la Cruz, MD. MsC
Department of Medicine and Therapeutic. SMAHS-UTG
2. • A liver abscess is a pus-filled mass
inside or attached to the liver. Common
causes are an abdominal infection such
as appendicitis or diverticulitis.
3. Liver Abscess
• Relative rare location
• Described by Hippocrates (400 b.c)
• First published review by Bright (1936)
• Proposal for surgical drainage by
Ochsner. (1938)
• Mortality went from 80 % to 5 %.
5. Liver Abscess
• Liver invasion by
bacteria:
– Ascending infection in
the biliary tract
(ascending cholangitis)
– Vascular seeding
(portal or arterial)
– Direct invasion from a
nearby source
– Traumatic implantation
6. Clinical Features
Symptoms
• Pain Right Hypochondrium referred to
Right shoulder
• Pyrexia (39º C)
• Profuse sweating and Rigors
• Loss of Weight
• Earthy Complexion
7. Clinical Features
Signs
• Palor
• Tenderness and rigidity in right
hypochondrium
• Palpable Liver
• Intercostal Tenderness
• Basal Lung Signs
10. • Antimicrobial treatment is a common adjunct
to percutaneous or surgical drainage
• Surgical drainage was the standard of care
until the introduction of percutaneous
drainage techniques in the mid 1970s. With
the refinement of image-guided techniques,
percutaneous drainage and aspiration have
become the standard of care
11. • Antibiotic therapy as a sole treatment modality is not
routinely advocated, though it has been successful in
a few reported cases.
– It may be the only alternative in patients too ill to
undergo invasive procedures or in those with
multiple abscesses not amenable to
percutaneous or surgical drainage.
• In these instances, patients are likely to require
many months of antimicrobial therapy with serial
imaging and close monitoring for associated
complications
12. Medical treatment
• Pyogenic Abscess
Betalactam/betalactamase inhibitor plus
Metronidazol or Clyndamicine
• Amebic Abscess
Metronidazol
• Fungal Abscess
Amphotericin B or Fluconazol
