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| {{SK}} Hepatic abscess | | {{SK}} Hepatic abscess |
| ==Overview== | | ==[[Liver abscess overview|Overview]]== |
| 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]]. With treatment, the death rate is 10-30%.<ref name="MedlinePlus">{{cite web | url=http://www.nlm.nih.gov/medlineplus/ency/article/000261.htm | title='MedlinePlus Medical Encyclopedia: Pyogenic liver abscess'}}</ref>
| | ==[[Liver abscess classification|Classification]]== |
| | ==[[Liver abscess pathophysiology|Pathophysiology]]== |
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| ==General Characteristics of Liver Abscess== | | ==[[Liver abscess causes|Causes]]== |
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| * Biliary tract disease is the most common cause but no cause identified in the majority of patients.
| | ==[[Liver abscess differential diagnosis|Differentiating Liver abscess from other Diseases]]== |
| * Nonspecific clinical findings - high degree of suspicion required for diagnosis
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| * Most often single, rather than multiple foci
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| * Hyperbilirubinemia and elevated alkaline phosphatase in the majority of patients, but low specificity.
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| * E. coli the most prevalent organism, followed by Klebsiella, Streptococcus, and Bacteroides species.
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| * Rare cause is bowel perforation following foreign body ingestion
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| * Therapy for solitary liver abscess from causes other than bowel perforation is intravenous antibiotics and percutaneous US- or CT-guided drainage
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| * Therapy for liver abscess caused by bowel perforation or foreign body is open surgical drainage
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| * Amebic liver abscess occurs in 94% of cases of amebiasis
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| * Liver abscess is a relatively infrequent (1.7% according to Cho, D. et. al.), although possible, complication of percutaneous radiofrequency ablation of hepatic tumors.
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| ==Types== | | ==[[Liver abscess epidemiology and demographics|Epidemiology and Demographics]]== |
| There are 3 major forms of liver abscess, classified by etiology:
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| # Pyogenic abscess, which is most often polymicrobial, accounts for 80% of hepatic abscess cases in the United States.
| | ==[[Liver abscess natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| # Amebic abscess due to [[Entamoeba histolytica]] accounts for 10% of cases.
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| # Fungal abscess, most often due to [[Candida]] species, accounts for less than 10% of cases.
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| ==Clinical Features==
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| * Symptoms
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| :* Pain Right [[Hypochondrium]] referred to Right shoulder
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| :* [[Pyrexia]] (100.4 F)
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| :* Profused sweating and Rigors
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| :* Loss of Weight
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| :* Earthy Complexion
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| * Signs
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| :* [[Pallor]]
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| :* Tenderness and rigidity in right hypochondrium
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| :* Palpable Liver
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| :* [[Intercostal]] Tenderness
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| :* Basal Lung Signs
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| ==Diagnosis== | | ==Diagnosis== |
| * Blood CP
| | [[Liver abscess history and symptoms|History and Symptoms]] | [[Liver abscess physical examination|Physical Examination]] | [[Liver abscess laboratory findings|Laboratory Findings]] | [[Liver abscess chest x ray|Chest X Ray]] | [[Liver abscess CT|CT]] | [[Liver abscess MRI|MRI]] | [[Liver abscess ultrasound|Ultrasound]] | [[Liver abscess other diagnostic studies|Other Diagnostic Studies]] |
| * [[Haemoglobin]] Estimation
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| * [[Stool]]s Examination ([[Trophozoite]]s and [[Cyst]]s)
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| * [[Radiography]]
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| * [[Aspiration]] Exploratory
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| * [[Medical ultrasonography]] and [[CT Scan]]ning
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| * [[Sigmoidoscopy]]
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| * [[Liver function tests]]
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| * [[Serological]] Tests
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| ===Diagnostic Findings===
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| * Right [[pleural effusion]], elevated right hemidiaphragm, and subsegmental [[atelectasis]] on chest radiography
| | ==Treatment== |
| * Findings on abdominal radiography nonspecific in 87% of cases
| | [[Liver abscess medical therapy|Medical Therapy]] | [[Liver abscess surgery|Surgery]] | [[Liver abscess primary prevention|Primary Prevention]] | [[Liver abscess cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Liver abscess future or investigational therapies|Future or Investigational Therapies]] |
| * US and CT are critical imaging tools
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| * US may demonstrate a peripheral echo-free halo, distal acoustic enhancement, and progressive change over a short period of time.
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| * On CT, abscesses may be single or multipe, round or oval, have an enhancing rim, complete or incomplete rim of edema, have smooth or nodular margins, intraabscess hemorrhage, peripheral biliary ductal dilatation, and may contain internal septations. Patterns are variable.
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| * Pretreatment amebic liver abscess appears as a heterogeneously low-signal intensity mass with sharp borders on T1 and as a hyperintense region with hyperintensity extending to the liver surface, corresponding to edematous hepatic parenchyma.
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| * Progression of edema is followed with T2-weighted imaging.
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| * Posttreatment amebic liver abscess becomes homogeneously hypointense on T1-weighted images.
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| * Maturation of the abscess wall during and after treatment is characterized by the appearance of concentric rings.
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| * Differential for MR findings for amebic liver abscess also includes bacterial abscess, hematoma and necrotic tumor.
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| (Images shown below are courtesy of RadsWiki)
| | ==Case Studies== |
| | | :[[Liver abscess case study one|Case #1]] |
| <gallery>
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| Image:Liver-abscess-001.jpg|CT image demonstrates a large abscess in the right hepatic lobe
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| Image:Liver-abscess-002.jpg|CT image demonstrates a large abscess in the right hepatic lobe
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| </gallery>
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| ==Pyogenic liver abscess==
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| ===Etiology===
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| * Streptococcus milleri
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| * [[E. coli]]
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| * Streptococcus fecalis
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| * [[Klebsiella]]
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| * [[Proteus vulgaris]]
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| * Opportunistic Pathogens ([[Staphylococcus]])
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| ===Clinical features=== | |
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| * Acute abscess
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| :* [[Fever]]
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| :* [[Lethargy]]
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| :* Discomfort in Right Upper Quadrant of abdomen | |
| :* [[Anorexia]]
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| :* Enlarged and Tender Liver
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| :* [[Pleural effusion]]
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| * Chronic Abscess
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| :* Fever
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| :* [[Abdominal discomfort]]
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| :* Enlarged Liver
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| ===Treatment===
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| * [[Antibiotics]]
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| :* [[Penicillin]]s
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| :* [[Aminoglycoside]]s
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| :* [[Metronidazole]]
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| :* [[Cephalosporin]]s
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| * Percutaneous Drainage under USG or CT Control
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| * [[Laparotomy]] in intraabdominal disease
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| ==References== | | ==References== |
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| {{Gastroenterology}} | | {{Gastroenterology}} |
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| [[ka:ღვიძლის აბსცესი]] | | [[ka:ღვიძლის აბსცესი]] |
| [[pl:Ropień wątroby]] | | [[pl:Ropień wątroby]] |
