BY: Dr.

Muhammad Alauddin Sarwar

Resident: Mahayal General Hospital KSA and
Qatar Hospital Karachi, Pakistan.
 LIVER ABSCESS

Liver abscess is a collection of pus in the

liver caused by infection or infestation.
 Demography of Liver Abscess
The most common type of visceral abscess.
Areas of highest incidence (due to inadequate sanitation
and crowding) include most developing countries in the
tropics, particularly Mexico, India, and nations of Central
and South America, tropical Asia, and Africa.
Liver abscess occurs equally in men and women, usually
in those over age 50.
Death occurs in 15% of affected patients despite
treatment.
In a 4-year follow-up study of preschool children in a highly
endemic area of Bangladesh, 80% of children had at least one
episode of infection with E. histolytica and 53% had more than
one episode.
Harrison 2008
CLASSIFICATION OF LIVER ABSCESS
CAUSATIVE ORGANISMS OF LIVER ABSCESS
CAUSES OF PYOGENIC LIVER ABSCESS

emedicine.medscape.com, Updated September 23, 2008.

 PATHOLGY OF AMOEBIC LIVER ABSCESS
Ingestion of Mature Cysts

Host: Human
Digestive tract

Cysts
Food, Sexual
Water Practice
Cysts Cysts
Trophozites survive

Cysts

Faeces
Cysts, Trophozoites
 Fever Chills

Cough
CLINICAL Pain at
PRESENTATION RUQ

Malaise Anorexia

Individuals with solitary lesions usually have a more insidious

course with weight loss and anemia of chronic disease.
Multiple abscesses usually result in more acute presentations,
with symptoms and signs of systemic toxicity.
2001-2007, Global Healthcare Solutions
 CLINICAL PRESENTATION
Physical
Fever and tender hepatomegaly.(most common
signs)
A palpable mass need not be present.
May be decreased breath sounds in the right
basilar lung zones.
A pleural or hepatic friction rub (can be
associated with diaphragmatic irritation or
inflammation of Glisson capsule)
Jaundice may be present in as many as 25% of
cases and usually is associated with biliary tract
disease or the presence of multiple abscesses.
 LAB STUDIES
•Complete blood count
Anemia of chronic disease
Neutrophilic leukocytosis
•Liver function studies
Hypoalbuminemia and elevation of
alkaline phophatase (most common
abnormalities)
Elevations of transaminase and bilirubin
levels (variable)
•Blood cultures are positive in roughly 50%
of cases.
•Culture of abscess fluid should be the
goal in establishing microbiologic diagnosis.
 IMAGING STUDIES
CT evaluation with contrast and ultrasonography
are the modalities of choice as both screening
procedures and as techniques for guiding
percutaneous aspiration and drainage.

•CT scan (sensitivity 95-100%)

well-demarcated areas
hypodense to the surrounding
hepatic parenchyma.
CT scan is superior in its
ability to detect lesions
less than 1 cm.

2001-2007, Global Healthcare

 IMAGING STUDIES
•Ultrasound (sensitivity 80-90%)
Hypoechoic masses with irregularly
shaped borders. Internal
septations or cavity debris may be
detected.
allows close evaluation of the
biliary tree and simultaneous
aspiration of the cavity.
Portable

•Chest x-ray findings of basal atelectasis, right

hemidiaphragm elevation, and right pleural effusion are
present in approximately 50% of cases.

2001-2007, Global Healthcare

 MANAGEMENT OF LIVER ABSCESS

Three Fold
 MEDICAL/DRUG TREATMENT

Amebic
Absces
s OR OR

OR OR

Harrison 2008
 MEDICAL/DRUG TREATMENT

Once the sensitivity results are known, antibiotic therapy should be

amended accordingly. Duration of therapy is usually from 4-6 weeks or
longer depending on number of abscesses and the clinical response
 Per-Cutaneous Aspiration of Liver Abscesses
Indications for aspiration of liver abscesses are
(1)To rule out a pyogenic abscess, particularly in patients
with multiple lesions;
(2)Lack of a clinical response in 3–5 days
(3)Threat of imminent rupture; and
(4)To prevent rupture of left-lobe abscesses into the
pericardium.

Percutaneous drainage may be

successful even if the liver abscess has
already ruptured.

Harrison2008
 Per-Cutaneous Aspiration of Liver Abscesses

Prefer over PNA

emedicine.medscape.com American Journal of Roentgenology, Vol 170, 1035-1039,

Updated: Sep 23, 2008 Copyright © 1998 by American Roentgen Ray Society
 Surgical Drain of Liver Abscess

Current indications for surgical treatment include

•Signs of peritonitis
•Existence of a known abdominal surgical pathology (such
as diverticular abscess)
•Failure of previous drainage attempts
•Presence of a complicated, multiloculated, thick-walled
abscess with viscid pus
•Shock with multi-system organ failure (major),
•Respiratory-renal failure
•Septic shock
Contraindications
•Weight loss greater than 10 kg, (major)
•Albumin level less than 3 g/dL(moderate)
 PROGNOSIS
•If a liver abscess is left untreated, the prognosis is
uniformly fatal.
Indicators of a poor prognosis
•Hemoglobin less than 11 mg/dL (RR = 5.6)
•Bilirubin greater than 1.5 mg/dL (RR = 5.6)
•WBC greater than 15 (RR = 3.4)
•Albumin less than 2.5 g/dL, and
•Elevated prothrombin time.
•An underlying malignant etiology and
•An acute physiology and chronic health evaluation
(APACHE II) score greater than 9 increases the relative
mortality by 6.3-fold and 6.8-fold respectively.
•Jaundice…. a marker of multiple abscesses,
hyperbilirubinemia, and a serious underlying pathology.
alauddinsarwar@gmail.com
doctoralauddin@gmail.com