Makindo Medical Notes

🩺 Liver Abscess = a pus-filled cavity in the liver. Remember: Klebsiella pneumoniae abscesses may spread to the eye causing endophthalmitis 👁️.

📖 About

• Pus-filled lesion(s) within the liver.
• ⚠️ Differentials: metastases, cysts, primary liver tumour.

🦠 Aetiology

• 🧫 Pyogenic (bacterial) – polymicrobial (E. coli, Klebsiella, Streptococcus, Staphylococcus). Often arises from cholangitis, cholecystitis, diverticulitis, appendicitis, or penetrating trauma.
• 🪱 Amoebic – Entamoeba histolytica (~10%). Common in endemic areas.
• 🍄 Fungal – Candida; more common in immunocompromised patients.
• 🐕 Echinococcus – hydatid cysts, especially in the Middle East.

📌 Causes & Features

Cause	Clinical	Diagnosis	Treatment
Pyogenic	Fever + rigors, RUQ pain → shoulder tip pain, jaundice, hepatomegaly, weight loss.	USS/CT, blood cultures, aspiration & culture.	IV antibiotics (e.g. meropenem → tailor), image-guided drainage, surgery if refractory.
Amoebic	Gradual fever, RUQ pain, ± diarrhoea, weight loss.	USS (often single right lobe abscess), serology (anti-amoebic Abs), aspiration if uncertain.	Metronidazole ➡️ then luminal agent (e.g. diloxanide). Drain if large/persistent.
Fungal	Fever, RUQ pain, weight loss. Common in immunocompromised.	CT (multiple abscesses), blood culture/biopsy.	Antifungals (e.g. amphotericin B, fluconazole), drainage if large.
Echinococcus	Often asymptomatic; cyst rupture → anaphylaxis (urticaria, angioedema, shock).	USS/CT, serology (ELISA, WB), PCR in difficult cases.	Surgical resection if possible; if not → percutaneous aspiration + ethanol injection ➡️ albendazole.

🧑‍⚕️ Clinical Features

• 🌡️ Fever, chills, sweats, malaise.
• 🤢 Anorexia, weight loss.
• RUQ tenderness, hepatomegaly.
• Right shoulder/pleuritic chest pain, cough, hiccups.
• ⚠️ Hydatid cyst rupture → urticaria, angioedema, anaphylaxis.

🔍 Differentials

• Hepatocellular carcinoma or liver mets.
• Simple liver cysts, polycystic liver disease.

⚠️ Complications

• Sepsis ± septic shock.
• Empyema or peritonitis (if rupture).
• Endophthalmitis (esp. Klebsiella).

🧪 Investigations

• 📊 Bloods: ↑ WCC, ↑ ALP (95%), ± ↑ AST/ALT, low albumin.
• Clotting: check PT.
• Blood cultures (aerobic & anaerobic).
• Imaging: USS/CT (right lobe most affected – drains portal venous flow from gut).
• Entamoeba: stool microscopy (low yield), serology (enzyme immunoassay, PCR).
• Echinococcus: serology (ELISA, WB), PCR if needed.

💊 Management

• Resuscitation: ABC, analgesia, IV fluids.
• Broad-spectrum IV antibiotics → adjust by cultures.
• Image-guided drainage (needle aspiration/catheter).
• Amoebic abscess → Metronidazole (curative in 90%), then luminal agent.
• Fungal → Amphotericin B or azole antifungals.
• Echinococcus → surgical resection if feasible; otherwise PAIR (Puncture, Aspiration, Injection of ethanol, Re-aspiration) + albendazole.