Liver abscess Dr.Arunima.

P
2nd year PG scholar
Department of shalyatantra

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 Definition
• Liver abscess is a pus-filled pocket of fluid within the liver.

• A liver abscess can develop from several different sources, including

a blood infection, an abdominal infection, or an abdominal injury
which has been become infected.
• The annual incidence of liver abscess has been estimated at 2.3
cases per 100,000 populations and is higher among men than
women.
• It is common in India with 2nd highest incidence due to poor
sanitation, overcrowding and inadequate nutrition.

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AETIOLOGY

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TYPES

PYOGENIC

AMOEBIC

80%
FUNGAL

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 Pyogenic liver abscess
• Pathogens

• Escherichia coli
• Staphylococcus aureus and
• Haemolytic streptococcus
• Bacteroides and anaerobes
• Proteus and klebsiella

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Clinical features
• Fever-Hectic,
Picket fence pattern
• Chill and sweating
• Pain –continuous,
right subcoastal area or epigastrium
may radiate to flanks
referral pain in right shoulder

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 On examination
• Liver enlargement
• Liver tenderness

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Investigations
• Blood examination:
• WBC-12000-18000 per microliter
• Hypoalbuminemia
• Alkaline phosphatase
• Transaminases and lactic dehydrogenase

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 Radiographic findings
• Chest x-ray
• Cardio phrenic angle
obliterated
Barium enema x ray to
exclude diverticulitis

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USG
• Diagnoses, indicates position of abscess
with its stage of resolution of abscess

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CT Scan
• First method for detection of liver abscess

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Fine needle aspiration biopsy

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Treatment
• Antibiotic therapy
• Surgical drainage

• Antibiotic therapy-medicines focusing on gram negative bacteria

& enteric anaerobes

IV metronidazole and aminoglycoside

Ampicillin or pencillin-in pts with sepsis
Rx continued for 4-8 weeks
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 Surgical drainage
• Percutaneously under USG or CT

• Percutaneous needle aspiration

•
Percutaneous drainage requires local anaesthesia and minimal
sedation.
• PNA is advantageous in allowing smaller and multiple lesions to be
sampled for culture and to obviate the need for catheter placement,
which may be difficult under certain circumstances

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• Percutaneous catheter drainage

• PCD allows controlled drainage of large abscesses over a

period of time with minimal haemodynamic and physiological
stress to the patient. It is also the only definitive treatment for
those with no other surgical pathology.

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• RESECTION

• Liver resection is part of the surgical armamentaria.Specific

indications include liver carbuncle and associated
hepatolithiasis, especially in the left lobe, commonly found in
recurrent pyogenic cholangitis.
• liver lesion with concomitant infection requires treatment
of the sepsis before surgery is undertaken.

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 Amoebic abscess
• Complication of amoebic dysentery

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• Two stages
• amoebic hepatitis- due to increased lymphocyte, fatty
changes, lysis of hepatic cells
• amoebic abscess-entamoeba enter liver-portal thrombosis and
infarction-cytolytic activity-liquefaction of surrounding stromal
and parenchymal structures-formation of abscess
• Liver enlarged
• Contents mixture of RBCs, leukocytes, liver cells

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• Chocolate or reddish brown colour-anchovy sauce appearance
• Microscopically-central necrotic zone
• middle zone with destruction of
parenchymal cells
• outer zone fibrous capsule
• Pus is sterile if not associated with secondary infection

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complications
• Abscess-burst into pleural cavity, lung, peritoneal cavity
• When burst into pleural cavity empyema may result
• Burst into lung may cause broncho hepatic fistula, lung
abscess or pneumonia

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Clinical features
• Develops after attack of amoebic dysentery
• Mainly develops in carrier who has not shown definitive
symptoms and signs of amoebic dysentery
• Symptoms:
• Fever-may shoot up to 39degree Celsius, but less than
pyogenic type, associated with chills and sweating
• Pain-felt over right intercoastal spaces
• Slight bulging and pitting edema present
• Referred pain to right shoulder
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On examination

• Tender hepatomegaly
• Tenderness and rigidity may be felt below the right coastal
margin
• If left lobe affected-tender swelling in epigastric region

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 Special investigations
• Blood examination-leucocytosis in early stage, chronic
condition anaemia present
• Serological tests-to detect antibodies to entameoba
histolytica, antiboby titres will be high in these cases.
• Examination of stool: presence of amoeba in stool
• Sigmoidoscopy reveal amoebic ulcers
• Radiography-elevation and fixation of right cupola of
diaphragm
• Aspiration of abscess contents reveals 100% diagnosis
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Treatment
• Amoebicidal drugs-metronidazole-500-750mg,TDs-5-10 days
• Needle aspiration: done with support of radiological imaging
• Indications for aspiration
• persistence of clinical features of amoebic abscess following a
course of amoebicidal drugs
• clinical or radiographic presence of hepatic abscess
• Technique of aspiration-wide bore needle passes in between 9th
and 10th interspace between the anterior and posterior axillary
lines.
• Surgical drainage when associated with secondary infections and
in amoebic peritonitis 26
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 AYURVEDIC CORRELATION
• VIDRADHI(ABHYANTARA VIDRADHI)
• ITS IS MAHAMOOLA AND MAHARUJA

गुर्वसात्म्यवर्रुद्धान्नशुष्कसंसृष्टभोजनात् ll
अवतव्यर्ायव्यायामर्ेगाघातवर्दाविवभिः ll
पृथक् संभूय र्ा दोषािः कुवपता गुल्मरुवपणम् ll
र्ल्मीकर्त्समुन्नध्दमन्तिः कुर्वन्तन्त वर्द्रविम् ll
गुदे बन्तिमुखे नाभ्ां कुक्षौ र्ङ्क्षणयोिथा ll
र्ृक्कयोयवकृवत प्लीवि हृदये क्लोवि र्ा तथा ll
तेषां विङ्गावन जानीयाद्वह्यवर्द्रवििक्षणिः ll
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• Abhyantara vidradhi nidanas

Asatmya ,viruddha,shuska ,asamsrushta bhojana

• Ativyayama, vyavaya, vega dharana

Produces aggravation of doshas- गुल्मरुवपणम्

• Give rise to abscess inside abdomen(र्ल्मीकर्त्समुन्नध्दमन्तिः),

which may grow into groin ,kidney, liver or spleen and other
organs and near by structures

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Types
• Vataja
• Pittaja
• Kaphaja
• Raktaja

• Visesha lakshana-श्वासो यकृवत तृष्णा

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Sadhya asadhyata
• Vidradhi above nabhi asadhya
• Below nabhi sadhya
• Abscess located near heart ,umbilicus and tridoshaja is yapya

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Chikitsa
• Acc Su.Chi.16
• Shopha Chikitsa should be adopted here at first
• Pitta and rakta vidradhi Chikitsa can be adopted here.
• Varunadi gana Kashaya along ushakadi gana dravyas be given.
• Ghrita prepared with above said drugs can be used for
virechana.
• Madhushigru-for pana, lepana and bhojana with prakshepa
dravyas
• Shilajatu with pitta and raktahara drugs can be given.
• Siravyadhana in arm is indicated in raktaja and pittaja condition.
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conclusion
• These types of diseases which develop via pathogens could be
prevented by maintaining hygiene .
• People with attack of amoebic dysentery or other infections
could be cautious about its later outcome and by getting proper
management at proper time.

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