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. HEPAR SULPHUR
2. MERCURIUS SOLUBILIS
3. MERCURIUS CORROSIVUS
4. 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
Than
ks