Liver abscess overview: Difference between revisions

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{{Liver abscess}}
{{CMG}};{{AE}}{{YK}}


==Overview==
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]].  With treatment, the death rate is 10-30%.<ref name="MedlinePlus">{{cite web | url=http://www.nlm.nih.gov/medlineplus/ency/article/000261.htm | title='MedlinePlus Medical Encyclopedia: Pyogenic liver abscess'}}</ref>. Biliary tract disease is the most common cause but no cause identified in the majority of patients. There are nonspecific clinical findings hence a high degree of suspicion required for diagnosis. There are most often single, rather than multiple foci. Hyperbilirubinemia and elevated [[alkaline phosphatase]] in the majority of patients, but low specificity. [[E. coli]] is the most prevalent organism, followed by [[Klebsiella]], [[Streptococcus]], and [[Bacteroides]] species. Rare cause is bowel perforation following foreign body ingestion. Therapy for solitary liver abscess from causes other than bowel perforation is [[intravenous]] [[antibiotic]]s and percutaneous US- or CT-guided drainage. Therapy for liver abscess caused by bowel perforation or foreign body is open surgical drainage. Amebic liver abscess occurs in 94% of cases of [[amebiasis]]. Liver abscess is a relatively infrequent (1.7% according to Cho, D. et. al.), although possible, complication of [[percutaneous]] [[radiofrequency ablation]] of hepatic tumors.
==Historical Perspective==
Abscesses of liver are described since the time of Hippocrates.<ref name="pmid21938200">{{cite journal| author=Kawoosa NU, Bashir A, Rashid B| title=Spontaneous cutaneous rupture of a pyogenic liver abscess. | journal=Indian J Surg | year= 2010 | volume= 72 | issue= 4 | pages= 339-42 | pmid=21938200 | doi=10.1007/s12262-010-0131-3 | pmc=3002775 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21938200  }} </ref>. In 1938, Ochsner’s classic review heralded surgical drainage as the definitive therapy.
==Classification==
==Natural History, Complications and Prognosis==
Life-threatening [[sepsis]] can develop.  This condition can be life threatening some patients. The risk for death is higher in people who have many liver abscesses.
==Diagnosis==
===Chest X Ray===
Right [[pleural effusion]], elevated right hemidiaphragm, and subsegmental [[atelectasis]] on chest radiography. Findings on abdominal radiography nonspecific in 87% of cases.
===Ultrasound===
USG and CT are critical imaging tools. USG may demonstrate a peripheral echo-free halo, distal [[acoustic]] enhancement, and progressive change over a short period of time.
==Treatment==
===Medical Therapy===
Treatment usually consists of placing a tube through the skin to drain the abscess. Less often, surgery is required. [[Antibiotic]]s are used for about 4 - 6 weeks. Sometimes, antibiotics alone can cure the infection.  Commonly used antibiotics include [[penicillin]]s, [[aminoglycoside]]s, [[metronidazole]] and  [[cephalosporin]]s.
===Surgery===
Surgical options include percutaneous Drainage under USG or CT control and [[laparotomy]] in intra-abdominal disease.
===Primary Prevention===
Prompt treatment of abdominal and other infections may reduce the risk of developing a liver abscess. Many cases are not preventable.
==References==
{{reflist|2}}
{{WH}}
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[[Category:Gastroenterology]]
[[Category:Infectious disease]]
[[Category:Mature chapter]]
[[Category:Disease]]

Latest revision as of 19:24, 6 March 2017