Pyogenic liver abscess

A pyogenic liver abscess is a type of liver abscess caused by bacteria.

Etiology
E.g.: stones, cholangiocarcinoma E.g.: diverticulitis, appendicitis, Crohn's disease E.g.: penetrating injury, iatrogenic (radiofrequency ablation)
 * Biliary disease (most common)
 * Colonic disease
 * Cryptogenic disease
 * Pancreatitis
 * Infection of blood
 * Intra-abdominal sepsis
 * Infection of biliary system
 * Traumatic introduction

Common bacterial causes

 * Streptococcus milleri
 * E. coli
 * Streptococcus fecalis
 * Klebsiella pneumoniae
 * Proteus vulgaris
 * Bacteroides
 * Opportunistic Pathogens (Staphylococcus)

Clinical features

 * 1.Acute Abscess
 * Fever
 * Lethargy
 * Discomfort in Right Upper Quadrant Of Abdomen
 * Anorexia
 * Enlarged and Tender Liver
 * Pleural effusion


 * 2.Chronic Abscess
 * Fever
 * Abdominal discomfort
 * Enlarged Liver

Diagnosis

 * Blood CP (No Leucocytosis)
 * Haemoglobin estimation (anaemia)
 * Serum albumin levels (Falls rapidly)
 * USG and CT Scanning

Treatment

 * 1.Antibiotics
 * Penicillins
 * Aminoglycosides
 * Metronidazole
 * Cephalosporins
 * 2.Percutaneous Drainage under USG or CT Control
 * 3.Laparotomy in intraabdominal disease