Abscesses involving K pneumoniae have been associated with multiple cases of endophthalmitis.
- Pus-filled mass (es) inside the liver
- Differential can be metastases
- Amoebic abscess: Entamoeba Histolytica 10%
- Bacterial: Often polymicrobial. E.coli, Klebsiella, Staphylococcus (endocarditis), Streptococcus. Bacterial infection on background of Cholangitis and Cholecystitis with RUQ pain and jaundice or from diverticulitis or appendicitis or penetrating injury.
- Fungal abscess: Candida species, < 10% of cases. Immunocompromised.
- Echinococcosis: chronic infection caused by the larval stage of several animal cestodes (fl at worms) of the genus Echinococcus. It is common in many areas of the world, especially the Middle East.
- Fever, chills, tender RUQ pain, Sweats, Anorexia
- Right shoulder and pleuritic chest pain
- Cough or hiccoughs, Fever of unknown origin
- Echonicoccosis - cyst rupture will allergic reactions = urticaria, angioedema, or anaphylaxis
- Liver malignancy, Simple cysts
- Polycystic liver disease
- Sepsis, Empyema, or Peritonitis
- FBC: High WCC, U&E
- LFT: elevated ALP in 95% and AST/ALT in 50% and low albumin
- Check coagulation : Prothrombin time
- Blood cultures: should be sent - aerobic and anaerobic
- USS/CT : may detect abscess. The right lobe is more commonly affected. The right hepatic lobe drains the superior mesenteric and portal veins, whereas the left drains inferior mesenteric and splenic drainage. Lesions usually well-demarcated and imaging allows guided biopsy.
- Entamoeba Histolytica: Enzyme immunoassay should be performed to detect E histolytica but does not differentiate acute from old infections. Stool samples for E. histolytica trophozoites (positive in 10-15%)
- Echonicoccosis: Antibody assays (ELISA, latex agglutination, and Western blot): 90% sensitive and specific for liver cysts, but less accurate for cysts in other sites. A PCR assay is now available for problematic cases.
- ABC, pain relief, involve interventional radiologist to drain lesion
- Pyogenic: meropenem until sensitivities are known
- Amoebic abscess: give Metronidazole, which will be curative in 90%. (nitroimidazole, followed by a luminal agent.)
- Fungal abscess: give Amphotericin B.
- Percutaneous needle aspiration or catheter placement or drainage
- Echonicoccosis: liver involvement: Treatment of choice for echinococcal cysts is surgical resection. If resection is not feasible, perform percutaneous drainage
with instillation of 95% ethanol to prevent dissemination. Surgical therapy is followed by medical therapy with albendazole