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    Liver Abscess Modul 2

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    ras emil sazura
    The document discusses liver abscesses, which occur when bacteria infect the liver. Biliary tract diseases are now the most common cause, as obstruction allows bacteria to proliferate. Infections in other organs can also lead to liver abscesses through septic emboli traveling through the portal vein. Approximately 4% result from connections between local infections and the liver through trauma can also cause abscesses. Symptoms include fever, abdominal pain, and jaundice. Diagnosis involves blood tests, imaging like CT scans, and identifying the bacteria through blood cultures. Treatment involves antibiotics, with drainage or surgery sometimes needed for severe or multiple abscesses.

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    Liver Abscess Modul 2

    Uploaded by

    ras emil sazura
    50 views3 pages
    The document discusses liver abscesses, which occur when bacteria infect the liver. Biliary tract diseases are now the most common cause, as obstruction allows bacteria to proliferate. Infections in other organs can also lead to liver abscesses through septic emboli traveling through the portal vein. Approximately 4% result from connections between local infections and the liver through trauma can also cause abscesses. Symptoms include fever, abdominal pain, and jaundice. Diagnosis involves blood tests, imaging like CT scans, and identifying the bacteria through blood cultures. Treatment involves antibiotics, with drainage or surgery sometimes needed for severe or multiple abscesses.

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    The document discusses liver abscesses, which occur when bacteria infect the liver. Biliary tract diseases are now the most common cause, as obstruction allows bacteria to proliferate. Infections in other organs can also lead to liver abscesses through septic emboli traveling through the portal vein. Approximately 4% result from connections between local infections and the liver through trauma can also cause abscesses. Symptoms include fever, abdominal pain, and jaundice. Diagnosis involves blood tests, imaging like CT scans, and identifying the bacteria through blood cultures. Treatment involves antibiotics, with drainage or surgery sometimes needed for severe or multiple abscesses.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    50 views3 pages

    Liver Abscess Modul 2

    Uploaded by

    ras emil sazura
    The document discusses liver abscesses, which occur when bacteria infect the liver. Biliary tract diseases are now the most common cause, as obstruction allows bacteria to proliferate. Infections in other organs can also lead to liver abscesses through septic emboli traveling through the portal vein. Approximately 4% result from connections between local infections and the liver through trauma can also cause abscesses. Symptoms include fever, abdominal pain, and jaundice. Diagnosis involves blood tests, imaging like CT scans, and identifying the bacteria through blood cultures. Treatment involves antibiotics, with drainage or surgery sometimes needed for severe or multiple abscesses.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Liver abscess

    The liver receives blood from both systemic and portal circulations. Increased
    susceptibility to infections would be expected given the increased exposure to
    bacteria. However, Kupffer cells lining the hepatic sinusoids clear bacteria so
    efficiently that infection rarely occurs. Multiple processes have been associated
    with the development of hepatic abscesses.
    Biliary tract disease is now the most common source of pyogenic liver abscess
    (PLA). Obstruction of bile flow allows for bacterial proliferation. Biliary stone
    disease, obstructive malignancy affecting the biliary tree, stricture, and
    congenital diseases are common inciting conditions. With a biliary source,
    abscesses usually are multiple, unless they are associated with surgical
    interventions or indwelling biliary stents. In these instances, solitary lesions can
    be seen.Infections in organs in the portal bed can result in a localized septic
    thrombophlebitis, which can lead to liver abscess. Septic emboli are released into
    the portal circulation, trapped by the hepatic sinusoids, and become the nidus for
    microabscess formation. These microabscesses initially are multiple but usually
    coalesce into a solitary lesion.Microabscess formation can also be due to
    hematogenous dissemination of organisms in association with systemic
    bacteremia, such as endocarditis and pyelonephritis. Cases also are reported in
    children with underlying defects in immunity, such as chronic granulomatous
    disease and leukemia.Approximately 4% of liver abscesses result from fistula
    formation between local intra-abdominal infections.
    Penetrating hepatic trauma can inoculate organisms directly into the liver
    parenchyma, resulting in pyogenic liver abscess. Nonpenetrating trauma can
    also be the precursor to pyogenic liver abscess by causing localized hepatic
    necrosis, intrahepatic hemorrhage, and bile leakage. The resulting tissue
    environment permits bacterial growth, which may lead to pyogenic liver abscess.
    These lesions are typically solitary.
    Pyogenic liver abscess has been reported as a secondary infection of amebic
    abscess, hydatid cystic cavities, and metastatic and primary hepatic tumors. It is
    also a known complication of liver transplantation, hepatic artery embolization in
    the treatment of hepatocellular carcinoma, and the ingestion of foreign bodies,
    which penetrate the liver parenchyma. Trauma and secondarily infected liver
    pathology account for a small percentage of liver abscess cases.
    The right hepatic lobe is affected more often than the left hepatic lobe by a
    factor of 2:1. Bilateral involvement is seen in 5% of cases. The predilection for
    the right hepatic lobe can be attributed to anatomic considerations. The right
    hepatic lobe receives blood from both the superior mesenteric and portal veins,
    whereas the left hepatic lobe receives inferior mesenteric and splenic drainage.
    It also contains a denser network of biliary canaliculi and, overall, accounts for
    more hepatic mass. Studies have suggested that a streaming effect in the portal
    circulation is causative.

    The most frequent symptoms of hepatic abscess include the following:

    Fever (either continuous or spiking)


    Chills
    Right upper quadrant pain
    Anorexia
    Malaise
    Cough or hiccoughs due to diaphragmatic irritation may be reported.
    Referred pain to the right shoulder may be present.
    Individuals with solitary lesions usually have a more insidious course with
    weight loss and anemia of chronic disease. With such symptoms,
    malignancy often is the initial consideration.
    Fever of unknown origin (FUO) frequently can be an initial diagnosis in
    indolent cases. Multiple abscesses usually result in more acute
    presentations, with symptoms and signs of systemic toxicity.
    Afebrile presentations have been documented.
    For physical findings,
    Fever and tender hepatomegaly are the most common signs.
    A palpable mass need not be present.
    Mid epigastric tenderness, with or without a palpable mass, is
    suggestive of left hepatic lobe involvement.
    Decreased breath sounds in the right basilar lung zones, with signs
    of atelectasis and effusion on examination or radiologically, may be
    present.
    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

    To diagnose this condition, a doctor may order a combination of blood cultures


    and imaging tests. The following tests may be used

    computed tomography (CT) scanto locate the abscess


    CT with intravenous contrastto pinpoint and measure the abscess (very
    useful when planning a surgery)
    blood testselevated white blood count and high neutrophil level indicate
    infection
    blood cultures for bacteriato identify the bacteria so your doctor knows
    what antibiotic to prescribe
    abdominal ultrasoundto visualize an abscess in the right upper quadrant

    Some people can be successfully treated for PLA with antibiotics alone. Most,
    however, will require drainage of the abscess. This involves inserting a needle or
    tube into the abscess and removing the pus. Your doctor may perform a liver

    biopsy at the same time to determine the overall health of your liver. This
    procedure is performed with the aid of a CT scan.
    Doctors try to treat PLA without surgery if possible to prevent the risk of bacteria
    spreading through the body. However, in more severe cases, surgery may be
    required to fully remove the abscess materials. After surgery you will be treated
    with antibiotics for several weeks to avoid recurring infection. According to the
    Cleveland Clinic Journal of Medicine (CCJM), both intravenous and oral
    medications may be used to treat and manage PLA. (CCJM, 2010) An initial
    course of intravenous antibiotics aids healing. Several weeks of taking a potent
    oral antibiotic contributes to healing after a post-surgical checkup.

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