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Hepatic Abscess or Liver Abscess (Pyogenic, Hydatid, Amoebic abscess)

BONUS QUESTION: What is the name of the substance in Aspergillus than can cause HCC? aflatoxin from Aspergillus In this video we will be looking at hepatic abscesses or Liver abscesses. There are three types, pyogenic abscess, ameobic abscess (entameoba Histolytica) and finally you have the hydatid abscess. Pyogenic is primarily bacterial abscess (e. coli, klebsiella, strep pnuemonia and some anerobes such as bacteroides). Routes - infection can come through the portal vein that originates from the GIT tract. This may due to appendicitis, diverticulitis. The other route for pyogenic liver abscess is through the biliary tract. This is due to cholangitis as it ascends up through biliary tract. It can also spread through blood vessels or hematogenous spread. This happens any time there is bacteremia. Also it can be caused by trauma or it may be unknown called idiopathic or cryptic. CLINICAL Infectious symptoms - fever, constitutional symptoms, nausea vomiting, and leukocytosis. These are the signs of pyogenic liver abscess or hepatic abscess. Liver/Bile Symptoms - Right upper quadrant pain that radiates to the intrascapular or left shoulder. Jaundice and tender hepatomegaly these are the signs and symptoms found in all the different types of hepatic abscess or liver abscess. INVESTIGATIONS Liver Function Tests - AST/ALT ALP Bilirubin will all be elevated and albumin will be low) Ultrasound - you will see hypoechoic mass CT Scan - Investigation of choice Chest X-ray - signs of pneumonia or air under the diaphragm. Need to do for all the abscesses. TREATMENT for pyogenic abscess Antibiotics, analgesics, percutaneous aspiration, culture and sensitivity. This must be ultrasound or CT guided. Surgery if too severe. AMOEBIC ABSCESS Caused only by entameoba histolytica. Acquired by eating feces with. Goes to the liver through the portal vein. It can also go to brain liver and lungs. SYMPTOMS Similar to pyogenic abscess. Signs of infection Symptoms of Liver/Bile A few extra symptoms to distinguish. Diarrhea because it goes into the cecum. Cough with anchovy taste phlegm which suggests the entameoba histolytica has caused bronchopleura fistula. Also some history of travel within that last 5 months INVESTIGATIONS LFT - Elevated Ultrasound CT Scan Chest X-ray To differentiate you can do microscopy with the stool. However you might not find anything because it may be cleared up and it is tough to differentiate from normal flora. Stool antigen - need fresh sample Culture - limited serology testing TREATMENT Entameoba histolytica is a protozoa. Responds to metronidazole. Surgery for aspiration HYDATID ECHINOCOCCUS (tapeworm) Acquired from infected food and feces. If the hydatid abscess is small it will be asymptomatic. However, if hydatid asbcsess is greater then 5 cm then it will have symptoms based on mass effect. Symptoms depends on where it is located. If hydatid abscess found in lung then there will be cough hemoptysis. INVESTIGATION for Hydatid abscess Labs - serology Ultrasound CT/MRI TREATMENT for Hydatid Abscess Albendazole, mebendazole PAIR - Puncture, Aspirate, Inject and Reaspirate Risky because of anaphylaxis. Surgery