Objectives How to think and interpret the symptoms

Objectives • How to think and interpret the symptoms associated with a liver disease.

• Adel is a 20 y old male who came to the clinic complaining of fever.

• Fever is a general symptom, we need localizing or associated symptoms to think of the affected system. • Fever is also a manifestation of a variety of aetiologies. Therefore it does not indicate infection only. • What is the type of fever?

• When asked about other symptoms he mentioned feeling pain in the right upper quadrant of his abdomen.

• Think anatomically. What are the structures in this part of the body. • How do they present when diseased, eg. what is the type of pain.

• A week later his mother noticed that the sclera of his eyes was yellow (i. e. he had jaundice).

• Thus the affected system is the hepatobiliary system.

• Adel was diabetic for 7 years, on insulin therapy. Recently he had polyuria and he thought his diabetes was uncontrolled. • Always review other sytems. • Think of predisposing factors.

• A few days later he developed cough and stitching pain on breathing in his right lower chest. • Watch for complications.

• Adel was provisionally diagnosed as having an infection of the liver. • The next step is examination. • The positive findings were a temp. 39 o. C and pulse 100/min. He was sweaty and looked pale and jaundiced. On abdominal examination the liver was enlarged, soft and tender.

• On examining the chest, the spaces between the lower ribs on the right side were tender. •

Liver. Abscess

ILOs (Intended Learning Outcomes) By the end of this lecture you will be able to: • Describe the clinical picture of pyogenic infection of the liver (liver abscess). • Describe the clinical picture of amoebic liver abscess. • Differentiate between different infections of the liver. • Construct a plan for management for a patient with either disease.

Pyogenic Liver Abscess Pyogenic abscesses are uncommon Causes • Portal pyaemia • Unknown • Trauma • Bacteraemia • Direct extension

Clinical Picture

Investigations: • CBC • Liver function tests ALP (alkaline phosphatase) • Ultrasound • Blood culture • Chest X-ray.

Management • Aspiration under U/S for culture and sensitivity. • Antibiotics. • Drainage • Treatment of the underlying cause

• Fever is a general symptom • Unless in an immunocompromized patient symptomatic treatment is given till a provisional diagnosis is made. • Viral infections are not treated by antibiotics (antibacterial agents). • Search for a predisposing factor. • Put a plan for investigations according to the condition.