Foreword
Liver abscess is not a common disease. There are two kinds of liver abscesses: pyogenic abscess due to bacterial infection and amebic abscesses due to infection with Entamoeba histolytica. Because of different etiology, the clinical presentation and treatment is also different; so we will discuss separately below.
Pyogenic liver abscess
Incidence : The incidence is not influenced by race and sex and the average age is around 60 to 80 years old.
Pathophysiology:
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biliary ascending infection
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portal vein
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hepatic artery
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direct extension
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trauma
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unknown
Clinical Presentation :
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Signs : tender hepatomegaly, jaundice
Symptoms : fever, right upper abdominal pain, nausea/vomiting, anorexia, chills, weight loss, and malaise
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at least 6 to 8-week course of appropriate antibiotics is recommended
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percutaneous drainage of liquefied abscess or multiple repeated percutaneous fine needle aspiration
Amebic abscess
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Incidence : The amebic infection is global. It is highest in tropical, subtropical countries, and in areas where sanitary conditions are poor. male predominant. Immunocompromised patients are predisposed to amebic abscess.
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Patholophysiology :
Most amebic infection comes from contaminated water and the organism migrate from mouth to liver through 3 routes:
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through portal circulation
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through lymphatic system
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directly spread out from colon wall to abdominal space then into liver
Symptom:
Pain, fever, right upper abdominal pain exacerbated by breathing or cough. Half patients suffer from weakness, weight loss, and diarrhea.
Sign :
Hepatomegaly accompanied by tenderness, jaundice is rare.
Treatment :
Majority of patients can be treated successfully by drug alone. Drainage is usually not necessary. Percutaneous puncture drainage or operation drainage is considered when there is secondary purulent infection and patients do not respond positively to the treatment.
Messages for liver abscess
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Avoid traction or folding of the drainage tube, the height of the bag can’t be higher than the drainage site. Notice the amount, color, and shape of drainage fluid.
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