Which of the following statement is true regarding pyogenic liver abscess: September 2009

Ans. C: Usually a large and single abscess is seen in cases of direct spread Pyogenic liver abscess: Usually seen in elderly patients Can be multiple or solitary (mostly) Arise as a result of biliary sepsis Moality is high as diagnosis is often delayed Commonest organisms involved - E. coli, Klebsiella, Proteus and Bacteroides species. Etiology: Poal pylophlebitis - appendicitis, diveiculitis or pelvic infections Biliary disease - cholecystitis, ascending cholangitis or pancreatitis Trauma - blunt or penetrating Direct extension - empyema of the gall bladder, subphrenic or perinephric abscess Septicaemia Infected liver cysts or tumours Clinical features: Patients are generally systemically unwell Severe abdominal pain usually localised to right hypochondrium Swinging pyrexia, rigors and weight loss 25% present with jaundice Examination shows an hypochondrial or epigastric mass 30% has a pleural effusion Investigation: Serology shows a raised WCC, increased ESR and deranged LFTs Chest X-ray often shows a raised right hemidiaphragm and pleural effusion Ultrasound will localised the abscess and will guide drainage CT useful if diagnosis in doubt or if there are multiple abscess Management: Patients should be staed on appropriate antibiotic Percutaneous drainage under ultrasound guidance is the initial treatment of choice If biliary obstruction is present, consider decompression Surgery may be required if - Failure of resolution with percutaneous drainage Intraperitoneal rupture Laparoscopic drainage may succeed after failure of percutaneous route