Pyogenic liver abscess: Changing patterns in approach

Abstract

Transperitoneal surgical drainage and antibiotics are the mainstay of treatment. Percutaneous drainage is recommended for high risk patients only.

Clinical, laboratory and management profile in patients of liver abscess in central India

“…Heneghan et al presented study on 11 patients with a mean age of 60.27 years 6 males and 5 females, present study showed and majority of patients were in their fourth decade with male dominancy being 81.90% (131) female 18.10% (29) cases. 3,4 Clinical presentation of Pyogenic liver abscess is non-specific and similar to that of other hepatobiliary inflammatory or infectious process. A combination of nonspecific systemic symptoms is the most common presentation, including fever and rigors, nausea and vomiting, right upper quadrant pain, Tender hepatomegaly, anorexia, weight loss, weakness and malaise.…”

“…Study presented by Malik AA et al showed Hemoglobin level of the less than 10 zgm% was found in 59% of patients, total leucocyte count more than 10 000/ cumm in 68% of patients, serum transaminases and alkaline phosphatase levels were elevated in 84% of patients, present study shows about 45.63% patients had Hb<10gms/dl, polymorph nuclear leukocytosis in 139 patients, raised SGPT in 136 patients and SGOT in 133 patients and enzymes (raised alkaline phosphatase in 17 patients), In Heneghan et al study 7(64%) patients were anaemic ↑ White cell count in 91% (10) cases and deranged liver function test in 10 cases(91%). 3,4 Newer radiological techniques such as ultrasound and CT scanning have greatly enhanced our ability to establish the diagnosis of hepatic abscess and have increased our understanding of the natural history of this process. Ultrasonography is the preferred initial tool for the diagnosis of liver abscess with a sensitivity of 85% to 95%.…”

“…5,[16][17][18] This is also evident from our series where 97 patients (60.63%) had USG guided aspiration and 31 patients (19.38%) had pigtail catheter drainage and were subjected to this mode of treatment, In Malik AA et al case study open surgical drainage was done in 127 cases, percutaneous drainage 26 cases and 16 cases were managed on iv antibiotics only with mortality in 19 patients, In Heneghan et al initially all patients were started with antibiotic therapy followed by USG guided percutaneous drainage in all patients out of which and only 2 patients required surgical intervention with no mortality. 3,4 Patients among them subsequently needed open surgical drainage because of inadequate response to percutaneous drainage. It is recommended that several factors be considered in choosing between surgical and percutaneous drainage.…”

“…Malik AA et al presented study on 160 patients for the management of the pyogenic liver abscess, who underwent different modes of management. 3 Open surgical drainage was done in 127 cases, percutaneous drainage 26 cases and 16 cases were managed on IV antibiotics only with mortality in 19 patients. Heneghan et al presented a case series on 11 patients over a period of 5 years to study the Modern management of pyogenic hepatic abscess.…”

Clinical and biochemical profile of liver abscess patients

“…11 Leucocytosis was observed in 68% of cases of PLA in a study done by Malik and his co-workers. 24 Khan et al showed 26.7% polymorphonuclearleucocytosis. 25 In present study, serum alkaline phosphatase was elevated in 96% patients with 95% and 100% frequency from ALA and PLA respectively which is in accordance with various previous studies.…”