Giới thiệu
- Liver abscess may result from peritonitis & bowel leakage via portal circulation, direct spread from biliary disease, or from hematogenous seeding
Nguyên nhân
Causative Organisms
- Most pyogenic liver abscesses are polymicrobial (eg enteric facultative & anaerobic species)
- Common etiologic agents of pyogenic liver abscess are E coli, K pneumoniae, Proteus sp & other Enterobacteriaceae, Pseudomonas sp, Streptococcus sp, S aureus, Enterococci, B fragilis, F necrophorum
- Usual pathogens in patients w/ underlying biliary disease: Enterococci, enteric Gram-negative bacilli
- Usual pathogens in patients w/ underlying colonic or biliary source of infection: Anaerobes, coliforms
- S aureus may be isolated from patients w/ liver abscess resulting from hematogenous spread of microbes from a distant source
- Entamoeba histolytica if amoebiasis is a potential consideration
Signs and Symptoms
- Classical presentation: Fever, jaundice, right upper quadrant symptoms (pain, guarding, rocking & rebound tenderness)
- Liver abscess diagnosis is not excluded w/ negative right upper quadrant findings
- Chills, malaise, fatigue, anorexia, weight loss, abdominal pain, vomiting
- Cough or hiccups from diaphragmatic irritation
- Pain referred to the right shoulder
Other Clinical Presentations
- Patients w/ liver abscess may occasionally be afebrile
- Elderly patients often present insidiously w/ low-grade fever, dull abdominal pain & other non-specific systemic symptoms
- Patients w/ multiple abscesses tend to present more acutely than those w/ a solitary abscess
Yếu tố nguy cơ
- Biliary tract disease is the most common cause of bacterial liver abscess
- Suppurative cholangitis following biliary obstruction (eg from stones, malignancy, stricture, congenital conditions), recurrent pyogenic cholangitis
- Post-op complication in patients who have undergone endoscopic sphincterotomy for bile duct stones or surgical biliary-intestinal anastomosis
- Cholecystitis, infections in organs in the portal bed
- Penetrating & blunt trauma to the liver
- Subphrenic or perinephric abscess may result in direct spread of infection from a contiguous focus
- Systemic bacteremia eg endocarditis, pyelonephritis that may result in spread of organisms to the liver through the hepatic artery
- Systemic illnesses including diabetes mellitus, malignancy, cirrhosis, cardiopulmonary disease, severe malnutrition, inflammatory disease
- Immune system deficiencies eg chronic granulomatous disease, hematologic malignancy, liver transplant
- Severe periodontal disease especially in alcoholics
- Amoebic liver abscess should be considered in patients from endemic areas or have traveled to an endemic area
- 10 times more common in men as in women
- Inmates of residential institutions, patients w/ underlying immunosuppression & men who have sex w/ men are at increased risk
- Other possible factors include pancreatoduodenectomy, chemoembolization or radiofrequency ablation in the presence of infected bile, necrosis of a primary tumor, or superinfection of metastases