• Liver

abscesses are the most common type of visceral abscess

• Incidence of liver abscess 2.3 cases per 100.000 populations
• Higher among men than women (3:1)
• Risk factors include : DM, underlying hepatobiliary or pancreatic disease and liver
transplant

• Association with colorectal neoplasia : fourfold higher diagnosed with pyogenic liver
abscess
• Causative pathogens : K. pneumonia stronger association with colorectal cancer à
occult colorectal neoplasia
• Mortality rate : 2-12 %; independent risk factor : need for open surgical drainage,
presence of malignancy and presence of anaerobic infection

• Pathogenesis :
• Portal vein pyemia usually related to bowel leakage and peritonitis; may also
accompanied bt pylephlebitis ( infective suppurative thrombosis of portal
vein)
• Direct spread from biliary infection
• Underlying biliary tract disease such as gallstones or malignancy obstruction (
40 to 60% of cases)
• Surgical or penetrating wounds
• Hematogenous seeding from systemic circulation
• Commonly involve right lobe of the liver

• Fever
• Abdominal pain ( usually localized to the right upper quadrant )
• Pain, guarding, rocking tenderness ( pain caused by gently rocking the
patient’s abdomen), rebound tenderness
• Hepatomegaly
• Jaundice
• Abscess rupture is a rare complication à abscess diameter > 6 cm and coexisting
cirrhosis ( main risk factor for rupture)à perihepatic or into the pleural space

• CT Scan : a fluid collection with surrounding edema; cystic appear as fluid collections
• Chest radiograph : elevated right diaphragm, right basal infiltrate or right sided
pleural effusion


Amoebic
• The protozoa passes from the colonic lesion via the portal vein into the liver, usually
into the upper and posterior portion of right lobe
• Liver infections begins with intrahepatic portal thrombosis and infarction, the
cytolytic activity starts and leads to liquefaction of the surrounding stromal and
parenchymal structures, resulting in formation of large single abscess
• 30% have more than one abscess


 • Liver is usually enlarged
• The liquefied material within the abscess is characteristically viscid an
semitransparent. Content is mixture of red bood cells, leucocytes, broken down liver
cells
• Looks reddish brown coloured ( chocolate sauce or anchovy sauce)


• Amoebic abscess develops after attack of amoebic dysentry
• May also develop even in a carrier who has not shown definite symptoms and signs
of amebic dysentery
• Anemia, loss of weight with typical symptoms
• Fever up to 39 ⁰C or even more particularly at night , associated with chills and
sweating
• Pain à right lower intercostal space ( usually related to the location of hepatic
abscess)


• Superior surface abscess may cause pain reffered to the right shoulder
• Tender hepatomegaly; tenderness and rigidity below the right costal margin; if left
lobe tender swelling in epigastrium
• One-third to half à history of previous diarrhea, clinical jaundice is rare, abnormal
pulmonary sign