Pyogenic Abscesses
• Localized pyogenic liver infections are the most common pyogenic liver infections caused by bacteria coming through the bile duct and less hematogenous route.
• The causative agent often comes to the liver by the ascending route (cholecystitis, cholangitis).• They are mostly located in the right lobe and tend to be multiple.
• The most common Gr (-) enteric bacilli, especially E.coli, are isolated, but they are usually polymicrobial.
• Clinically, fever and abdominal pain are common symptoms. Jaundice may occur in abscesses originating from the biliary system.
• USG is performed first in imaging. CT is more valuable in detecting the lesion.
• Drainage is required along with broad-spectrum antibiotics in treatment.
Amoeba Abscess
• It is a localized infestation caused by Entomoeba histolytica trophozoites coming from the portal vein. Patients may have a history of amoebic colitis.• It is mostly single and localizes to the right lobe (under the diaphragm).
• The most common symptoms are fever and right upper quadrant pain, jaundice is rare.
• USG is performed first in imaging. CT is more valuable in detecting the lesion.
• Definitive diagnosis is made serologically by indirect hemagglutination or ELISA.
• Metronidazole (effective in both colitis and liver abscess) is used in the treatment.
Percutaneous drainage should only be performed in large abscesses and if there is a risk of rupture.
• The most common complication of amoeba abscess is pleuropulmonary involvement.
Hydatid cyst
• It is a zoonotic infestation caused by Echinococcus granulosus and most commonly affecting the liver.• It may remain asymptomatic for a long time; It can cause abdominal pain and disturbances in LFT as a result of pressure on the environment.
• They are often detected by USG/CT performed for another purpose.
• Definitive diagnosis is made serologically by indirect hemagglutination or ELISA.
• Cyst puncture is not performed for diagnostic purposes.
• The main treatment is surgery. (In some cases, percutaneous drainage and injection of scolocidal agent into the cyst can be applied)
• Albendazole/mebendazole is used as medical treatment.
• The most important and frequent complication of hydatid cyst is rupture of the biliary tract.
Fasciola Hepatica
• It is a zoonotic liver infestation originating from sheep and cattle.• It is transmitted by undercooked freshwater vegetables (metacercariae).
• Trematodes penetrate the intestinal wall and enter the liver and settle in the biliary tract.
• Fever, abdominal pain, hypereosinophilia and urticaria may be seen in the acute period.
• In the chronic period, it can cause obstructive jaundice, cholangitis and pancreatitis.
• Diagnosis is made by detecting fasciola egg in a stool or gallbladder sample.
• In the treatment, triclabendazole is most commonly used in both acute and chronic phases.