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home - Liver - Miscellaneous - Abscesses Written by Dr Sebastian Zeki

Recognises the importance of sepsis as a complication
Aware of the differential diagnosis and management of sepsis and its
possible sequelae

Knows the appropriate use of the appropriate antibiotics and their
complications Aware of prevention of nosocomial infection

Understands the principles and practice of diagnosis and treatment of

Prepared to involve and liaise with specialist sepsis support



Knows the importance of clinical nutrition and its disturbances in
patients with acute and chronic liver disease

Appreciates indications for enteral or parenteral support and
understanding of limitations of these interventions

Shows ability to make careful nutritional assessment
Can liaise with nutritional support team where appropriate


Understands prognostic scoring systems including Child - Pugh
MELD UKELD Maddrey and disease-specific scoring systems where
they exist

Builds the use of accredited quantitative scoring systems into routine
clinical liver practice clinical colleagues and junior staff

Shows consistent application of evidence-based in the
evaluation of liver disease and the determination of prognosis


Solitary + 1 lobe Emboli Pyogenic abscesses CBD CAAmpullary Ca(15% of cause) Cholangitis Cholecystitis Panc CA SOURCE Written by Dr Sebastian Zeki CXR-Elevated right hemidiaphragmRight basilar infiltrate Right-sided pleural effusionMRI and WC scan are less useful for distinguishing abscess from other causes of liver mass. Amoebic abscesses features: RUQ pain + fever-in 85%. Leukocytosis (>10,000/mm3) without eosinophilia. Elevated alkaline phosphatase occurs in 80%. Hepatic transaminases may also be raised. Faecal microscopy is +ve in 18%. Colonic ulcers occur in 55%. Dysentery can occur at the same time-uncommon. On USS lesions are solitary and large (right lobe) in 80%. Serology very sensitive. Treatment of Amoebic Abscesses:Antibiotics- metronidazole.Drainage by open surgery-if no response in 24 hours. Amoebic Abscess Complications:Brain abscess.Cardiac infection.Pleuropulmonary infection. Less than 20% aspirate yield2% die Via infection from PV Solitary + right lobe Small and multiple in both lobes Microbial culturesGram stain and MC&S (both aerobic and anaerobic) should be doneBlood cultures positive in 50%.Cultures obtained from existing drains are NOT useful as usually contaminated. Contiguous (15%) Colonic (30%) Biliary (35%) Antibiotics (usually 4-6 weeks) Eg. amoxicillin-clavulanate alone or a fluoroqu-nolone + metronidazole. + ERCP can be a useful tool for drainage of liver abscesses in patients with previous biliary procedures whose infection communicates with the biliary tree. 50% may need repeat needle aspiration Indications for Surgery:-Multiple abscesses.-Loculated abscesses.-Abscesses with viscous contents obstructing the drainage catheter.-Underlying disease requiring primary surgical management.-Inadequate response to percutaneous drainage within seven days. If percutaneous treatment, catheter drainage is preferred over needle aspiration Percutaneous catheter drainage or needle aspiration.Drainage catheters should remain in place until drainage is minimal (usually up to 7d). >5cm <5cm Liver Abscesses Treatment MRI may further distinguish VS VS Abscesses (look same on CT and USS):Fluid collection with surrounding edema, stranding and inflamm-tion that may contain loculated subcollections. Tumors: Appear solid with areas of calcific-tion.If necrosis and bleeding can have fluid-filled appearance Cysts appear as fluid collections without surrounding stranding or inflammation. Imaging Risk factors:Diabetes.Underlying hepatobiliary pathology.Pancreatic malignancy.Liver transplant. Organisms:The Streptococcus milleri group (S. anginosis, S. constellatus and S. intermedius)- can dissemi-nateOther gram-positive organisms (including S. aureus and S. pyogenes)-in 60%.Candida species (usually in chemo patients).Klebsiella pneumoniae.TB (uncommon).Burkholderia pseudomallei (Melioidosis)-consider if patient is from South East Asia and Northern