1. NOW

2.  Abscesses of the liver are relatively rare
 Mortality rates decreased to 5-30%
• New radiologic techniques
• Improvement in microbiologic identification
• Advancement of drainage techniques
• Improved antibiotics
• Improved supportive care

3.  No sex predilection
 Age – mostly children and elderly
 Risk more in:-
• DM
• Liver transplants
• Immunosuppressed
 Mortality ranges from 5 – 30%

4.  Pyogenic abscess
• Polymicrobial
• Most common cause
 Amoebic abscess (Entamoeba histolytica)
 Fungal abscess (Candida species)

7.  MC symptoms :-
• Fever (either continuous or spiking)
• Chills
• Right upper quadrant pain
• Anorexia
• Malaise

8.  Cough or hiccoughs (diaphragmatic
irritation)
 Referred pain to the right shoulder
 Insidious course (weight loss, anemia)
• ?? malignancy
 Fever of unknown origin
 Acute systemic toxicity (Multiple
abscesses)
 Afebrile

9.  MC :- Fever, Tender hepatomegaly
 Mass +/-
 Decreased breath sounds
• Rt basilar lung zones
• Atelectasis, effusion
 Pleuralor hepatic friction rub
 Jaundice
• Biliary tract disease
• Multiple abscesses

10.  Biliary
Disease
 Cholecystitis
 Empyema
 A/c Gastritis
 Hepatocellular Carcinoma
 Hydatid Cysts
 Pneumonia

11.  CBC:-
• Anemia
• Neutrophilic leukocytosis
 LFT
• Albumin ↓
• Alkaline phosphatase ↑
• SGOT, SGPT, bilirubin levels ↑ (variable)
 Blood cultures (+ve 50%)
 Culture of abscess fluid
 ELISA for E histolytica

13.  CTscan
 USG
 CXR

14.  Drainage - percutaneous /surgical
 Antimicrobial treatment as adjunct
 Antibiotic therapy as standalone
• Unfit for invasive procedures
• Multiple abscesses
• Many months therapy
• Serial imaging and close monitoring

15.  Indications :-
• Signs of peritonitis
• Known abdominal surgical pathology (eg -
diverticular abscess)
• Failure of previous drainage attempts
• Complicated, multiloculated, thick-walled abscess
with viscous pus

16.  EMPERIC
• Beta-lactam/beta-lactamase inhibitor
• Carbapenems
• Second generation cephalosporins
+
• Anaerobic coverage (metronidazole /clindamycin)
 Change ≈ C&S report

17.  Amoebic :-
• Metronidazole
• Chloroquine ± emetine/dehydroemetine
 Fungal :-
• Amphotericin B (plain, lipid)
• Fluconazole

18.  4-6weeks of therapy - solitary lesions
 12 weeks - multiple abscesses
 Guide to the length of therapy :-
• clinical process
• radiographic progress

19.  Sepsis
 Empyema :-
• contiguous spread
• intrapleural rupture of abscess
– rupture of abscess
 Peritonitis
 Endophthalmitis (K pneumoniae
bacteremia)

20.  Untreated= fatal
 Bad prognosis :-
• Severity of underlying medical conditions
• Presence of complications
• Delay in diagnosis
• Bilirubin > 3.5 mg/dL
• Encephalopathy
• S.Albumin level of < 2 g/dL
• Multiple abscesses
• Malignant etiology
• High APACHE II score