liver abscess bacterial and amebic clinical presentation diagnosis and managment

1. Dr. Praveen K Malik
Assistant Professor, Medicine
ESIC Medical College and Hospital
Faridabad

2. TYPES OF LIVER ABSCESS

4. Hematogenous spread of bacteria
Contiguous spread(from local
sites of infection)
• Infection within peritoneal cavity

5. Appendicitis with
rupture
Subsequent
spread[peritonitis]
Portal vein
inflammation

10. It is believed that biliary
obstruction diminishes
host antibacterial defenses,
causes immune
dysfunction, and
subsequently increases
small bowel bacterial
colonization
Biliary system that
is colonized by
bacteria but is
unobstructed,
typically does not
result in cholangitis

11. The Bile Is
Normally Sterile
The most common organisms isolated in bile are Escherichia coli (27%), Klebsiella species
(16%), Enterococcus species (15%), Streptococcus species (8%), Enterobacter species (7%),
and Pseudomonas aeruginosa (7%)

12. •Portal pyemia
•Portal pylephlebitis or septic emboli(pelvic or GI infection)
•Injury to hepatic arterial system(cholecystectomy)
•Hepatic arterial thrombosis(liver transplant- 2weeks postoperatively)
•Traumatic causes
•Cryptogenic abscesses (elderly patients)

17. *Fever most common presenting symptom(FUO may be the only
presentation in elderly)
*Symptoms and signs involving right upper quadrant(especially in
involvement of biliary tract):
*Pain
*Guarding
*Punch tenderness
*Rebound tenderness
*Nonspecific symptoms- Chills, Anorexia, Nausea, Vomitting,
Weight loss
*50% patients of liver abscess have hepatomegaly

29. • Drainage is the mainstay of therapy for liver abscess
Drainage of
liver abscess
Percutaneous Surgical
Percutaneous abscess
Drainage uses imaging
guidance to place a
needle or catheter
through the skin into
the abscess to remove
or drain the infected
fluid. It offers faster
recovery than open
surgical drainage.

31. AMEBIASIS
Amebiasis is an infection
with intestinal protozoan
Entamoeba histolytica.
90% Amebiasis are
asymptomatic
10% present as dysentry
or liver abscess

34. CLINICAL PRESENTATION
Young patients with an
amebic liver abscess are
more likely than older
patient to present in acute
phase with prominent
symptoms of <10 days
duration .
• Fever
• Right upper
quadrant pain (dull
or pleuritic)-radiate
to shoulder
• Point tenderness
over the liver
• Right sided pleural
effusion
Jaundice is
rare in
amebic liver
abscess
Although initial site of
infection is the colon , fewer
than one third of patients
with an amebic abscess have
active diarrhea

36. ANCHOVY SAUCE APPEARANCE OF
ASPIRATED ABSCESS

37. COMPLICATIONS

40. There is no evidence
that aspiration, even
of large abscesses(up
to 10 cm ), accelerates
healing