Abceso hepatico

Liver Abscess Prof. Ygber González de la Cruz, MD. MsC

Department of Medicine and Therapeutic. SMAHS-UTG

• A liver abscess is a pus-filled mass inside or attached to the liver. Common causes are an abdominal infection such as appendicitis or diverticulitis.

Liver Abscess

• Relative rare location• Described by Hippocrates (400 b.c)• First published review by Bright (1936)• Proposal for surgical drainage by

Ochsner. (1938)• Mortality went from 80 % to 5 %.

Liver Abscess

Pyogenic Abscess

Amebic Abscess

Fungal Abscess

Liver Abscess

• Liver invasion by bacteria:– Ascending infection in

the biliary tract (ascending cholangitis)

– Vascular seeding (portal or arterial)

– Direct invasion from a nearby source

– Traumatic implantation

Clinical Features

Symptoms• Pain Right  Hypochondrium referred to

Right shoulder• Pyrexia (39º C)• Profuse sweating and Rigors• Loss of Weight• Earthy Complexion

Clinical Features

Signs• Palor• Tenderness and rigidity in right

hypochondrium• Palpable Liver• Intercostal Tenderness• Basal Lung Signs

Lab studies

• FBC• LFT• Blood cultures• Abscess fluid culture• Stools microscopy• Serology

Imaging studies

• Sonar scanning• CT scan w/ contrast• Gallium and technetium scanning• CxR

• Antimicrobial treatment is a common adjunct to percutaneous or surgical drainage

• Surgical drainage was the standard of care until the introduction of percutaneous drainage techniques in the mid 1970s. With the refinement of image-guided techniques, percutaneous drainage and aspiration have become the standard of care

• Antibiotic therapy as a sole treatment modality is not routinely advocated, though it has been successful in a few reported cases.– It may be the only alternative in patients too ill to

undergo invasive procedures or in those with multiple abscesses not amenable to percutaneous or surgical drainage.

• In these instances, patients are likely to require many months of antimicrobial therapy with serial imaging and close monitoring for associated complications

Medical treatment

• Pyogenic Abscess

Betalactam/betalactamase inhibitor plus

Metronidazol or Clyndamicine• Amebic Abscess

Metronidazol• Fungal Abscess

Amphotericin B or Fluconazol