ABSES HATI

Dr. dr. Shahrul Rahman, Sp.PD, FINASIM

Departemen Ilmu Penyakit Dalam
Fakultas Kedokteran
Universitas Muhammadiyah Sumatera Utara
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Abses Hati adalah infeksi pada hati yang disebabkan oleh
karena bakteri, parasit, jamur maupun nekrosis steril
yang bersumber dari sistim gastrointestinal yang ditandai
dengan adanya proses supurasi dengan pembentukan pus
yang terdiri dari jaringan nekrotik, sel sel inflamasi atau sel
darah didalam parenkim hati

Abses Hati Amebik Abses Hati Piogenik

Angka kejadian abses hati piogenik lebih tinggi

dibandingkan abses hati amuba. Angka kejadian abses hati
amuba hanya sekitar 20% dari semua abses hati
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Etiology

Bacterial, parasitic, or fungal in origin.

85% to 90% bacterial or pyogenic.
Bacteria access the liver via the biliary tree or
portal vein.
Other causes include
biliary obstruction,
diverticulitis,
trauma,
inflammatory bowel disease
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Incidence
Liver gets infected by Entamoeba histolytica commonly
The most common location of a pyogenic abscess is the
right lobe.
Chronic alcoholics - prone to get this infection
Entamoeba histolytica is endemic in many parts of the
world
Pathophysiology
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 by
streptococcus milleri and Escherichia coli.
Many a time the pyogenic infection follows amoebic
infection
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 Clinical Features
Often the diagnosis of a bacterial
abscess is suggested
clinically.
Fever
Pain right hypochondrium
Chills
Rigors
Toxicity
Right upper quadrant discomfort
Diarrhea
weight loss
Intercostal tenderness
Swelling in the right hypo
chondrium or epigastrium
tender, enlarged liver.

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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
TC -Leukocytosis
LFT - Abnormal
liver function tests
(LFTs)
CT scan liver 9
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 CT :
a heterogeneous lesion
irregular margins
peripheral contrast enhancement.
Internal septations

The radiologic differential diagnosis

includes
cystic or necrotic metastases (ovarian or
leiomyosarcoma)
hydatid and echinococcal cysts.
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CT scan showing liver abscess
The abscess is
shown as a
darker area in
the liver
shadow

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Complications:

Pneumonitis
Pleural effusion
Rupture of the liver abscess into the pleural cavity - causing
empyema
Rupture into the peritoneal cavity

Treatment
percutaneous or surgical drainage (Ultrasound guided repeated
aspiration)
antibiotics.
Metronidazole
Antibiotics like cephalosporins, aminoglycosides, tetracyclines
In rare cases it may need insertion of a drain.
mortality rate is almost 100% if the abscess remains untreated
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 Management of pyogenic
liver abscess

Antibiotics: Before obtaining positive cultures from blood or pus, broad-spectrum

antibiotics should be started to cover Gram-negative and Gram-positive aerobes
and anaerobes. Initial therapy with amoxicillin, an aminoglycosides, and
metronidazole or a third generation cephalosporin and metronidazole generally
covers the causative organisms most commonly found, although this regimen may
be varied according to geographic differences and antimicrobial treatment policies.
Initially, antibiotics should be administered parenterally, and after 2 weeks of
systemic therapy, appropriate oral agents may be used for a further 4 weeks.11 In
patients with multiple PLAs that are too small to drain, antibiotics may be the only
treatment possible. In addition, efforts must be made to identify any underlying
biliary obstruction, which needs to be overcome for the antibiotic therapy to
succeed.

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Pleural Effusion secondary to amoebic liver
abscess

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An amoebic liver abscess causing
a bulge in the dome of the
diaphragm

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Amoebic liver
abscess burst
into the right
pleural cavity

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