Hepatic Abscess

Hepatic Abscesses

Dr. Surendra Singh Rajpoot

A liver abscess occurs when bacteria or protozoa destroy hepatic tissue, producing a cavity, which fills with infectious organisms, liquelled liver cells, and leukocytes. Necrotic tissue then walls off the cavity from the rest of the liver. Liver abscess occurs equally in men and women, usually in those over age 50. Death occurs in 15% of affected patients despite treatment. Mainly define in two part: 1. Pyogenic Liver Abscesses 2. Amoebic Abscesses

Alternative Names:

1. Liver abscess 2. Bacterial liver abscess

Pyogenic liver abscess is a pus-filled area in the liver.or Pyogenic organism like E. Coli

Pyogenic Liver Abscess may result from: 1. Via portal vein as occurs in appendicitis or diverticulitis. 2. Via the biliary tree as in cholangitis. 3. Via hepatic artery as in sepsis or generalized septicemia. 4. Via direct extension from infection in the neighborhood such as advance cholecystitis, sub hepatic abscess . 5. Hepatic Trauma. The second most common cause is from generalized septicaemia.

Management of pyogenic liver abscess is based on two principal lines: 1. Antibiotic Therapy 2. Surgical Drainage

Some Homeopathic medicine: 1. 2. 3. 4.

HEPAR SULPHUR MERCURIUS SOLUBILIS MERCURIUS CORROSIVUS SILICEA TERRA

The mortality rate for undrained hepatic abscess may reach 100%. So careful management is absolutely essential. Response to treatment should be closely assessed by clinical, laboratory and radiologic investigation. Prior to stopping antibiotic therapy CT scan should be repeated to confirm resolution of the abscess. It must be remembered that patient should be observed carefully for 48 hours after cessation of antibiotics in order to detect recurrent fever.

 Amoebic Abscess caused by Entamoeba Histolytica.  Most common in the right lobe of liver.  The abscess consist three zone:  Necrotic Center.  Middle zone of destruction of paranchymal cell.  Outer zone of normal Hepatic cells.

 Two stages: Amoebic Hepatitis. Amoebic Abscess.

 Gross appearance:

The liver is enlarged. Liquefied material within the abscess. Content is mixture of R.B.C. Leucocytes, broken down liver cells. Pus of amoebic abscess is variously described as 'Chocolate sauce' or 'Anchovy sauce'

 Microscopically: 3 Zone

A central necrotic zone. A middle zone An outer zone.

 Complication: It is much better than Pyogenic abscess. If untreated it may burst. Burst in to Right pleural cavity. Right lung Peritoneal cavity. Empyema Lung abscess or Pneumonia.

 Amoebic Dysentery  Anaemia  Loss of weight.  Fever  Accompanied  Chill  Sweating  Liver pain

Amoebicidial Drug. Metronidazole Dehydroemetive Chloroquine Dudohydroxyquinolene Diloxanide Furate Needle Aspiration: Needle Aspiration is only employed in selected cases.  Indication for aspiration are: o Persistence of clinical features of amoebic abscess following a course of amoebicidal drugs. o Clinical or radiography evidence of presence of

1. HEPAR SULPHUR 3. MERCURIUS SOLUBILIS 5. MERCURIUS CORROSIVUS 4.

SILICEA TERRA

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