Hepatic Abscess or Liver Abscess (Pyogenic, Hydatid, Amoebic abscess)

BONUS QUESTION: What is the name of the substance in Aspergillus than can cause HCC?
aflatoxin from Aspergillus
In this video we will be looking at hepatic abscesses or Liver abscesses. There are three types, pyogenic abscess, ameobic abscess (entameoba Histolytica) and finally you have the hydatid abscess.
Pyogenic is primarily bacterial abscess (e. coli, klebsiella, strep pnuemonia and some anerobes such as bacteroides).
Routes - infection can come through the portal vein that originates from the GIT tract. This may due to appendicitis, diverticulitis. The other route for pyogenic liver abscess is through the biliary tract. This is due to cholangitis as it ascends up through biliary tract. It can also spread through blood vessels or hematogenous spread. This happens any time there is bacteremia. Also it can be caused by trauma or it may be unknown called idiopathic or cryptic.
CLINICAL
Infectious symptoms - fever, constitutional symptoms, nausea vomiting, and leukocytosis. These are the signs of pyogenic liver abscess or hepatic abscess.
Liver/Bile Symptoms - Right upper quadrant pain that radiates to the intrascapular or left shoulder. Jaundice and tender hepatomegaly these are the signs and symptoms found in all the different types of hepatic abscess or liver abscess.
INVESTIGATIONS
Liver Function Tests - AST/ALT ALP Bilirubin will all be elevated and albumin will be low)
Ultrasound - you will see hypoechoic mass
CT Scan - Investigation of choice
Chest X-ray - signs of pneumonia or air under the diaphragm. Need to do for all the abscesses.
TREATMENT for pyogenic abscess
Antibiotics, analgesics, percutaneous aspiration, culture and sensitivity. This must be ultrasound or CT guided. Surgery if too severe.
AMOEBIC ABSCESS
Caused only by entameoba histolytica. Acquired by eating feces with. Goes to the liver through the portal vein. It can also go to brain liver and lungs.
SYMPTOMS
Similar to pyogenic abscess.
Signs of infection
Symptoms of Liver/Bile
A few extra symptoms to distinguish. Diarrhea because it goes into the cecum. Cough with anchovy taste phlegm which suggests the entameoba histolytica has caused bronchopleura fistula. Also some history of travel within that last 5 months
INVESTIGATIONS
LFT - Elevated
Ultrasound
CT Scan
Chest X-ray
To differentiate you can do microscopy with the stool. However you might not find anything because it may be cleared up and it is tough to differentiate from normal flora.
Stool antigen - need fresh sample
Culture - limited
serology testing
TREATMENT
Entameoba histolytica is a protozoa.
Responds to metronidazole.
Surgery for aspiration
HYDATID
ECHINOCOCCUS (tapeworm)
Acquired from infected food and feces.
If the hydatid abscess is small it will be asymptomatic. However, if hydatid asbcsess is greater then 5 cm then it will have symptoms based on mass effect. Symptoms depends on where it is located. If hydatid abscess found in lung then there will be cough hemoptysis.
INVESTIGATION for Hydatid abscess
Labs - serology
Ultrasound
CT/MRI
TREATMENT for Hydatid Abscess
Albendazole, mebendazole
PAIR - Puncture, Aspirate, Inject and Reaspirate
Risky because of anaphylaxis.
Surgery

[@Furfilise]

Thank you so much! I've been searching for many explaination and this is the best!

[@samirwadke]

Ideally, how much time does it take for a liver abscess to develop from the day of infection to grow up to 200ml ?

[@lorrainenkabinde6012]

My husband had liver absess. He had his operationlast year. Lately he complains about his feet, especially after walking long dis. Could this mean that his liver hasn't fully recovered?

[@rockstarmax]

Great Video

[@ekramalmu6435]

Very informative video, thank you so much doc

[@sandeshsandy6376]

Great video 👍👏👏

[@kalsangyangchen4679]

thank you so much for the information.i had presentation coming up and it help alot..grateful

[@MahtabAlam-ie3eb]

Sir I m from India. My mother has fever for last 15 days and physician was treating with C-tri injection (1mg) 14 injection for 7 days. In blood test there is no Typhoid, maleria, Dengu, Sugar.... everything is normal. Then doctor said to Ultrasound and report said that in right lobe of liver HYPOECHOIC MASS. EARLY ABSENCE?.
Now everyone in my family is fearing about Cancer. Sir plz tell me is this treatable?

[@MahtabAlam-ie3eb]

Abscess *

[@rakeshchaudhary3576]

Mahtab Alam
Hi

[@HamidKhan-mo6lx]

Do a triphasic CT abdomen. Hypoechoic mass can b anything

[@stnsafira]

in the CT picture, abses that big, would it be an amubic abses instead of a pyogenic one?

[@cotmd784]

what app do u use for the drawings?

[@heyitsdiamedico5538]

Thank you so much very helpful video

[@tshepiletlali]

Great video man

[@Fortheloveofcrafting]

Thank you. Very informative.

[@sarahmousa9148]

Excellent .
Thanks 🌸

[@karunayogi9209]

can you explain exact pathophysiology of pyogenic liver absces

[@niwawang4394]

There is another wonderful video explaining abscesses.

[@sumertawan]

Can I know what application you use for writing?

[@dr.iftamamfaiyaz]

Adobe Writer

[@derrickmawere2564]

Can I drink after 10yrs of amoebic liver abscess?

[@HafizahHoshni]

Thank you so much for your freaking absolutely amazing videos. 21/8/2019 😃😃

[@beatricefrask5230]

Thank you!!!

[@ltfkdk861]

what antibiotics used to treat pyogenic abscess?

[@rhondasmith7413]

My guess is broad spectrum for starters. Repeated labs to assess for effectiveness. Culture and sensitivity. of abscess drainage.

[@user-iu6to8hl2i]

Amoxicillin+ciprofloxacin+metronidazole
If penicillin resistant then second line is Ciprofloxacin+Clindamycin
Regards
Dr Raheela

[@user-iu6to8hl2i]

Triple regime is given in pyogenic abcess

[@user-iu6to8hl2i]

In Amoibic liver abscess metronidazole is given for ten days....Aspiration is done also

[@chetanchetan23]

thanks .....

[@amalramadan8995]

thanks :D