Ascending suppurative cholangitis Bacterial infection of biliary tree
Ascending (suppurative) cholangitis : • Bacterial infection of biliary tree due to common bile duct stone. • Charcot’s triad : 1 - fever and rigor. 2 - jaundice ; mild , intermittent. 3 - biliary colic & tender hepatomegaly. Complications : - gram negative septicemia → might lead to organ failure - multiple liver abscesses. Dx : - L. F. T……………. . obstructive picture - ultrasound …. dilated bile ducts - culture………. Isolation of an organism from blood on culture. Rx : 1 - Rehydration → I. V. Fluid. 2 - Antibiotics → cephalosporin. 3 - Drainage → ERCP (sphincterotomy) or PTC. 4 - C. B. D stone removal …… ERCP
Microorganisms : - E coli , Streptococcus milleri (commonly). - Streptococcus faecalis, Klebsiella , Proteus Sources of abscess ofand liver. Staphylococci could be via: 1 - Bile duct – ascending – ( commonest ). 2 - portal vein. 3 -peri-hepatic infective focus 4 - Haematogenous (e. g. : hepatic artery). Dx : - US and CT scan → multiloculated cystic mass lesion - X-Ray → might be beneficial…. . air/ fluid level Rx : 1) Antibiotics e. g. Aminoglycoside , cephalosporin plus 2) Drainage →Ultrasound-guided aspiration. or 3) Lapratomy for drainage ( It might be ).
Pyogenic liver abscess : • Single ( large ) or multiple ( small ). • Acute or chronic. Manifestation : -Fever & lethargy , malaise. - RUQ discomfort & ? pain. - Anorexia. - Unwell look. Patient at risk : 1) Sickler 2) elderly 3) malnourished 4) immune suppressed 5) diabetics 6) post traumatic & post op. patients
Microorganisms : - E coli , Streptococcus milleri (commonly). - Streptococcus faecalis, Klebsiella , Proteus Sources of abscess ofand liver. Staphylococci could be via: 1 - Bile duct – ascending – ( commonest ). 2 - portal vein. 3 -peri-hepatic infective focus 4 - Haematogenous (e. g. : hepatic artery). Dx : - US and CT scan → multiloculated cystic mass lesion - X-Ray → might be beneficial…. . air/ fluid level Rx : 1) Antibiotics e. g. Aminoglycoside , cephalosporin plus 2) Drainage →Ultrasound-guided aspiration. or 3) Lapratomy for drainage ( It might be ).
Amoebic liver abscess: • Tropical abscess. • Dysenteric abscess. 70% solitary large abscess , 30% multiple small abscesses. M. O. : Entamoeba histolytica. dysentery → liver → localized liquefaction → abscess. Course (out come) of the disease : 1 - Amoebic hepatitis. 2 - Amoebic abscess → chocolate pus (Anchovy paste) 3 - encapsulated → dormant. 4 - Burst to : → lung and plueral cavity. → peritoneal cavity. → hollow organs. → skin. Clinical features : 1) Aneamia 2) weight loss 3) pyrexia and night sweating 4) Pain in liver area and enlarged tender liver.
Microorganisms : - E coli , Streptococcus milleri (commonly). - Streptococcus faecalis, Klebsiella , Proteus Sources of abscess ofand liver. Staphylococci could be via: 1 - Bile duct – ascending – ( commonest ). 2 - portal vein. 3 -peri-hepatic infective focus 4 - Haematogenous (e. g. : hepatic artery). Dx : - US and CT scan → multiloculated cystic mass lesion - X-Ray → might be beneficial…. . air/ fluid level Rx : 1) Antibiotics e. g. Aminoglycoside , cephalosporin plus 2) Drainage →Ultrasound-guided aspiration. or 3) Lapratomy for drainage ( It might be ).
Dx : US. & CT. & X ray ; →CXR. → abdomen. - Isolation of organism from the stool+? from liver lesion (difficult from abscess because it is in periphery) -chocolate pus Rx : 1)Metronidazole 750 mg tds. for 7 – 10 days (mainly). 2)Aspiration under U/S. guidance (possible) 3)Laparoscopic or open drainage (might be needed). Indication for drainage : 1)No response to metronidazole after 5 days. 2)Too big size. 3)Bacterial supper added infection.
q Liver cysts ; → simple → hydatid (the commonest in the middle east) Simple liver cyst : Coincidal finding; - Regular , thin wall , unilocular - Homogenous. - No surrounding tissue response and no -variation in density within the cyst cavity. -CT: Sharply defined margin Has no measurable wall NO Septations Calcification Enhancement Mural nodules Rx : 1) No Rx if it is asymptomatic 2) Aspiration under U/S guidance ……? Possibility of recurrence. 3) Definitive Rx for large symptomatic → open or laparoscopic deroofing.
Polycystic liver disease: -Congenital. - Multiple. - Associated with polycystic formation in kidneys. - Often asymptomatic/ coincidental finding. - Discomfort. -Some time (severe pain) -due to hemorrhage into -a cyst →U/S or CT scan Rx : - Analgesia …if no response then - open or laparoscopic fenestration of the liver cysts.
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