Tuesday, December 2, 2008

Day #145 - Pyogenic Liver Abscess

Today we heard about a great case of pyogenic liver abscess. I wanted to clarify a few points of discussion.

Pathogenesis (most common in blue):
  • Ascention of pathogens up biliary tree
  • Ascention of pathogens through portal circulation. Often in the context of an intraabdominal nidus of infection like diverticulitis. May be in context of septic portal thrombophlebitis
  • Cyptogenic
  • Direct innoculation from trauma or iatrogenic
  • Hematogenous spread from systemic infection
  • Direct spread from gallbladder infection

Pathogens
  • Gpc - strep milleri and other alpha haemolytic strep.
  • Gnr - ecoli and klebsiella. Anaerobes (which often won't grow in culture)

Treatment:

Pyogenic - use emperic coverage that will cover most pathogens above - I.e. Pip/tazo or ceftriaxone/metronidazole. Narrow spectrum to culture results not forgetting anaerobes

Drainage - either IR or surgical -- "Never let the sun set on undrained pus"

Amoebic - metronidazole 750po TID x 10 days followed by luminocidal agent

Hydadid - Specialized surgical care.

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