Clinical profile and management of pyogenic liver abscesses in a tertiary care hospital

Background: Pyogenic Liver abscesses are potentially life threatening if left untreated. They pose a major Diagnostic and therapeutic challenge to modern world. Interventional radiology is becoming standard of care for liver Abscesses.Methods: All patients of pyogenic liver abscess admitted to Government Medical College and hospital Jammu, J and K, India from October 2018 to November 2019 were prospectively studied. Demographics, presentation, lab reports and management strategies were evaluated.Results: Total of 60 patients of pyogenic liver abscesses were studied with 81.7% males. Alcohol was found to be most common risk factor with 55% of patients being alcoholic. Right lobe of liver was involved in 66.7% of patients. Segment VI and VII were involved in 50% of patients. The most common clinical symptom was right upper quadrant pain (98.3%), followed by fever (91.7%). The most common clinical sign was right upper quadrant tenderness (91.7%). Percutaneous drainage with catheter placement was the most common and successful modality of management associated with least hospital stay.Conclusions: Pyogenic liver abscess is a rare but serious problem. Early diagnosis and treatment are necessary to avoid mortality. Percutaneous drainage along with I.V antibiotics is the best form of management.

Huge pyogenic liver abscess (PLA) in an elderly patient with diabetes following the pancreaticoduodenectomy / 中华内分泌外科杂志

We described an elderly female with type 2 diabetes referred to our hospital with fever,nausea and upper abdominal pain.The patient had got duodenal tumor and received the pancreaticoduodenectomy (PD) 12 years ago.The laboratory examinations revealed white blood cells (WBC) increasing and severe hypocalcemia.Abdominal computed tomography (CT) revealed a huge gas-forming pyogenic liver abscess (PLA) in left lobe of the liver.The patient got cured after correction of calcium metabolism disorders,treatment with antibiotic and receiving percutaneous tube drainage.We concluded that we should remain on high alert of those patients with DM and the history of cancer,when he or she gets fever of unknown origin and abdominal tenderness.PLA should be considered.

The clinical and ultrasound features of Klebsiella pneumoniae liver abscess in diabetes mellitus patients with different levels of HbA1c / 重庆医学

Objective To compare the clinical and ultrasound features of Klebsiella pneumoniae liver abscess(KPLA) in dia‐betes mellitus(DM ) patients with different levels of HbA1c .Methods Totally 146 patients with diabetes mellitus of Klebsiella pneumoniae liver abscesses(KPLA‐DM )were divided into three groups on the basis of their levels of HbA1c:complete glycemic controlled (HbA1c≤7% );good glycemic controlled (7% 9% ) .The patients′characteristics ,clinical features ,ultrasound features and complications among the three groups were compared .Results Compared with patients in complete glycemic controlled group and good glycemic controlled group ,patients in bad glycemic controlled group had lower onset age and longer length of hospital stay(P<0 .05) ,are more susceptible to underlying diseases such as hyperlipoi‐demia and chronic renal failure(P<0 .05) ,had more life‐threatening clinical crisis ,and had higher infection rate(P<0 .05) .KPLA‐DM could be characterized by patchy ,mass like enhancement echoultrasound image .Patients in bad glycemic controlled group al‐so had higher risk of biliary pneumatosis ,hepatic venous thrombosis and gas‐forming pyogenic liver abscess than other two groups (P<0 .05) .Conclusion The ultrasound image of KPLA has characteristics .The occurrence of hepatic venous thrombosis and gas‐forming observed by ultrasound is associated with bad glucose control in KPLA‐DM patients ,which suggests that there may be oth‐er complications such as metastatic infection .

A Case of Sub Hepatic Perforated Appendicitis Presented as Multiple Gas Containing Subcapsular Hepatic Abscesses.

Appendicitis is the most common acute surgical condition of the abdomen. The diagnosis of acute appendicitis can often be made clinically. When the appendix is situated in an abnormal position, the diagnosis of acute appendicitis becomes difficult. Delayed diagnosis or misdiagnosis of subhepatic appendicitis might lead to perforations of the appendix, which is a clinical emergency. Liver abscess as a complication of appendicitis was first described in 1898 by Dieulafoy. The majority of pyogenic liver abscesses are caused by infection originating in the biliary or intestinal tracts. Pyogenic liver abscess is a rare complication of acute appendicitis. Multiple pyogenic liver abscesses are not frequently reported in the literature, but the overall mortality is high, if left with no treatment or not treated early. We have reported a case of subhepatic perforated appendix presented with multiple subcapsular liver abscesses.

Processamento do milho grão sobre desempenho e saúde ruminal de cordeiro / Processing of corn grain on feedlot and rumen health in lambs

Vinte e dois cordeiros machos não castrados, Dorper x Santa Inês, com aproximadamente 90 dias de idade e peso vivo médio inicial de 27,0±4,4kg, foram alimentados com uma dieta com elevada proporção de concentrado com 20% de pelete proteico-mineral (Grano Entero(r)), 5% de feno de capim coast-cross e 75% de milho, na forma de milho grão inteiro (MGI), milho grão moído (MGM) ou milho grão úmido (MGU), para avaliação de desempenho no confinamento por um período de 14 dias de adaptação às dietas e às instalações e de 65 dias de confinamento. Em seguida, os animais foram abatidos com peso vivo médio final (PVF) de 47,97±5,13kg e o conteúdo gástrico foi avaliado para quantificação de protozoários, e foi realizada avaliação papilar. O delineamento experimental foi o de blocos casualizados. Não houve diferença entre os tratamentos (P>0,05) quanto ao ganho de peso médio diário, eficiência alimentar, ingestão diária de matéria seca, características da carcaça e da carne. Os animais tratados com MGI tiveram maior conteúdo gástrico, menor pH ruminal, maior AP (% da superfície de absorção) e maior área papilar em comparação com os outros tratamentos. Os animais tratados com MGI tiveram melhores resultados para o peso final, mas para os demais parametros estudados não foi observada diferença.

Twenty-two males not neutered, Dorper x St. Agnes, with approximately 90 days of age and average live weight of 27.0±4.4kg were fed with a diet wich contained high concentrate with 20% protein pellet-mineral (Grano Entero (r)), 5% grass hay coast-cross and 75% corn in the form of whole kernel corn (MGI), ground corn grain (MGM) or high moisture corn (MGU) for performance evaluation in confinement for a period of 14 days of adaptation to the diets and facilities and 65 days of confinement. Then the animals were slaughtered at average final weight (PVF) of 47.97±5.13kg and gastric content was evaluated for quantification of protozoa, and a papillary review was conducted. The experimental design was in randomized blocks. There was no difference between treatments (P>0.05) for average daily weight gain, feed efficiency, daily dry matter intake, carcass characteristics and meat. MGI-treated animals had higher gastric contents, the lower ruminal pH greater AP (% of surface absorption) and the larger papillary area was compared with other treatments. Animals treated with MGI had better results for the final weight gain, but for the other parameters studied, no difference was observed.

Disseminated Gonococcal Infection Presenting as Bacteremia and Liver Abscesses in a Healthy Adult / 감염과화학요법

Herein, we describe a bacteremia caused by Neisseria gonorrhoeae that presented as liver abscesses. The patient had no risk factors for disseminated gonococcal infection. Periodic fever, skin rashes, and papules were present and the results of an abdominal computed tomography scan indicated the presence of small liver abscesses. The results of blood culture and 16S rRNA sequencing of the bacterial isolates confirmed the presence of N. gonorrhoeae. The patient improved with antibiotic therapy.

Estudio y tratamiento de los abscesos hepáticos / Study and treatment of liver abscesses

Liver abscess is an unusual but potentially lethal disease. We should be especially cautious in patients diagnosed with biliary pathology or immunosuppression, with right upper quadrant pain, fever or jaundice. The study should include images, cultures and serology for Entamoeba histolytica in certain scenarios. The treatment of pyogenic liver abscess is based on prolonged antibiotic therapy and usually in the drainage of the collection, which can be percutaneous, open or endoscopic. In case of amoebic liver abscesses, drug treatment -in two phases- achieve the parasitic removal at tissue and luminal levels, keeping the drain choice for larger abscesses.

El absceso hepático es una patología poco prevalente pero potencialmente letal. Se debe tener una alta sospecha en pacientes con patología de la vía biliar o inmunosupresión, que presenten dolor en hipocondrio derecho, fiebre o ictericia. El estudio debe incluir imágenes, cultivos y eventualmente serología para Entamoeba histolytica en determinados escenarios. El tratamiento de los abscesos hepáticos piógenos se basa en antibioterapia prolongada y habitualmente en el drenaje de la colección, el cuál puede ser percutáneo, abierto o endoscópico. En el caso de los abscesos hepáticos amebianos el tratamiento farmacológico, en dos fases, logra la eliminación parasitaria a nivel tisular y luminal, reservando el drenaje para los de gran tamaño.

Pseudotumoral hepatic tuberculosis with pericardial abscess.

We report the postmortem findings in a 28-year-old immunocompetent male patient, a rare case of tuberculous liver abscesses with concomitant pericardial abscess in the absence of pleuropulmonary or splenic involvement, who continued to be a diagnostic dilemma. This case report illustrates the difficulty in reaching the correct diagnosis in case of hepatic masses, which are most often confused with carcinoma of the liver, primary or metastatic and, hence, have been aptly referred to as pseudotumoral hepatic tuberculosis in the past.

Acute schistosomiasis mansoni: revisited and reconsidered

Acute schistosomiasis is a systemic hypersensitivity reaction against the migrating schistosomula and eggs. A variety of clinical manifestations appear during the migration of schistosomes in humans: cercarial dermatitis, fever, pneumonia, diarrhoea, hepatomegaly, splenomegaly, skin lesions, liver abscesses, brain tumours and myeloradiculopathy. Hypereosinophilia is common and aids diagnosis. The disease has been overlooked, misdiagnosed, underestimated and underreported in endemic areas, but risk groups are well known, including military recruits, some religious congregations, rural tourists and people practicing recreational water sports. Serology may help in diagnosis, but the finding of necrotic-exudative granulomata in a liver biopsy specimen is pathognomonic. Differentials include malaria, tuberculosis, typhoid fever, kala-azar, prolonged Salmonella bacteraemia, lymphoma, toxocariasis, liver abscesses and fever of undetermined origin. For symptomatic hospitalised patients, treatment with steroids and schistosomicides is recommended. Treatment is curative in those timely diagnosed.