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HPB Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
London Lucien Ooi Peng Jin, Teo Jin Yao
What are the likely sources for the liver abscess and how would you go about determining this and managing it?The most likely source of liver abscess formation would be from a primary pathology in the abdominal cavity. The most frequent causes are secondary to appendicitis, or gallstones disease. Occasionally, lesions like diverticular disease or colonic tumours may also be implicated.Abdominal imaging like US and CT would have excluded causes like gallstones and appendicitis. Once stable, the patient would need a colonoscopy to exclude diverticular disease or colonic tumours.
Intra-Abdominal Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
The mainstay of treatment is drainage. A common empirical antibiotic treatment regimen is ceftriaxone + metronidazole. Classically, a liver abscess is treated for 4–6 weeks but is not based on strong evidence. It may be reasonable to repeat imaging after 3 weeks of drainage and antibiotic treatment and decide further management on a case-by-case basis. Differential diagnosis of a pyogenic liver abscess is Candida liver abscess, amoebic liver abscess and echinococcal abscess. Hepatosplenic candidiasis with multiple small abscesses is a rare phenomenon and occurs in patients with haematologic malignancies during recovery of neutrophil counts following a neutropaenic episode. Surgical drainage may be indicated if there is an inadequate response to percutaneous drainage. Abscesses smaller than 5 cm may be too small to be drained. Discuss with the radiologist if instead a needle aspiration can be performed.
Entamoeba histolytica
Published in Peter D. Walzer, Robert M. Genta, Parasitic Infections in the Compromised Host, 2020
William A. Petri, Jonathan I. Ravdin
Liver Abscess. Approximately 10% of patients who have had invasive amebiasis will develop liver abscess, although only a minority of patients will have amebic dysentery or even have E. histolytica isolated from their stools at the time they present with an amebic liver abscess (210-212) (Table 7). A history of dysentery, which can be obtained in a large number of patients (210,211,213,214), is critical for arriving at a correct admitting diagnosis so that antiamebic chemotherapy can be rapidly started. In one series a correct admitting diagnosis was arrived at for only 16% of 48 patients subsequently found to have amebic liver abscesses (215).
Infections caused by hypervirulent Klebsiella pneumoniae in non-endemic countries: three case reports and review of the literature
Published in Acta Clinica Belgica, 2023
Wannes Van Hooste, Marthe Vanrentergem, Eric Nulens, Christophe Snauwaert, Deborah De Geyter, Rembert Mertens, Jens T. Van Praet
A 63-year-old male presented at the emergency ward because of a one-day fever (up to 40°C) and rigors. He reported headache, photophobia, phonophobia and nausea as additional complaints. He had a medical history of asthma, arterial hypertension, appendectomy, resection of a tubular adenoma and repair of an inguinal hernia. Two years before admission, he had been treated for a liver abscess. Clinical examination revealed no abnormalities. Blood results showed a marked neutrophilic leucocytosis (24,700/µl) and mildly raised CRP (47 mg/dl). CT scan of the brain, chest radiography and abdominal ultrasound were all normal. Analysis of cerebrospinal fluid obtained by lumbar puncture showed a neutrophilic pleocytosis (5644/µl), normal glucose level (56 mg/dl) and significantly raised total protein (248 mg/dL). An empirical treatment with high-dose IV ceftriaxone (2 g every 12 hours), high-dose IV amoxicillin (2 g every 4 hours) and IV acyclovir (10 mg/kg every 8 hours) was started. Blood and cerebrospinal fluid cultures were positive for K. pneumoniae, of which the antibiotic sensitivity is shown in Table 1. The patient improved rapidly and treatment with ceftriaxone was continued for 3 weeks.
Percutaneous ultrasound-guided radiofrequency ablation for patients with liver metastasis from pancreatic adenocarcinoma
Published in International Journal of Hyperthermia, 2022
Yu-qing Du, Xiu-mei Bai, Wei Yang, Zhong-yi Zhang, Song Wang, Wei Wu, Kun Yan, Min-hua Chen
No RFA treatment-related death was observed during the follow-up period. The occurrence of major complications was 17.4% (4/23 sessions). Two patients experienced bile fistula within 1 week after RFA treatment and recovered after 2–3 months. The treated liver tumors were located on the surface of the liver in both cases and were punctured with an RF electrode multiple times from one skin site during RFA treatment. Another major complication was liver abscess happened in two patients. These four patients all recovered after ultrasound-guided puncture and drainage. The occurrence of minor complications was 8.7% (2/23 sessions). Among them, one patient experienced minor abdominal effusion and the other patient experienced abdominal wall hematoma. Both of them recovered with conservative management.
Percutaneous thermal ablation of hepatic tumors: local control efficacy and risk factors for artificial ascites failure
Published in International Journal of Hyperthermia, 2021
Bo-wen Zhuang, Xiao-hua Xie, Dao-peng Yang, Man-xia Lin, Wei Wang, Ming-de Lu, Ming Kuang, Xiao-yan Xie
There were no severe electrolyte derangements, peritonitis, peritoneal bleeding or gastrointestinal tract injury events directly associated with the AA technique and there were no cardiopulmonary complications due to volume overload. The AA was partially shifted into the right pleural space in 15 (4.4%) of 341 patients as depicted on ultrasound images one day after ablation, and 6 patients underwent drainage. All patients showed complete absorption of AA and a shifted pleural effusion, as confirmed on 1-month follow-up images. The rate of major complications was 1.1% (three of 281 patients) in the AA success group and 1.7% (one of 60 patients) in the AA failure group. The major complication rates were not significantly different between the two groups (p = 0.541). In the AA success group, three major complications were observed in different patients. One patient developed a liver abscess and underwent percutaneous drainage and intravenous antibiotics. Severe hepatic bleeding occurred in one patient and hemostasis was successfully achieved after percutaneous ablation. One patient experienced acute pulmonary infection and recovered after antibiotic therapy. In the AA failure group, major complications occurred in one patient. The patient experienced colon perforation and recovered after emergency surgery. No AA or ablation related deaths occurred in either group.