A CLINICO-PATHOLOGICAL STUDY OF LIVER ABSCESS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 11
Abstract
BACKGROUND Liver abscess is a common condition in India. India has 2nd highest incidence of liver abscess in the world. Liver abscesses are caused by bacterial, parasitic or fungal infection. Pyogenic abscesses account for three-quarters of hepatic abscesses in developed countries, while amoebic liver abscess cause two-thirds of liver abscess in developing countries. Amoebiasis is presently the third most common cause of death from parasitic disease. Primary prevention by improving sanitation, health education, early diagnosis and prompt treatment may result in lowering mortality/ morbidity associated with the disease. Aims and Objectives- To assess the clinico-pathological and management outcomes in liver abscess patients admitted to General Surgery Department of MGM Hospital between September 2015 and October 2017. MATERIALS AND METHODS The present study was conducted in Mahatma Gandhi Memorial Hospital, Kakatiya Medical College, Warangal, between September 2015 and October 2017. It is a prospective observational study. Detailed history was taken according to the proforma. Patient was followed up conservatively and if complicated then interventional management was done. Patients will be followed up for a minimum period of 6 months. RESULTS Liver abscesses occurred most commonly between 30 - 60 years. Pain abdomen was the most common symptom present in all 100 cases. Alcohol consumption was the single most important aetiological factor for causation of liver abscesses. Raised WBC count, Alkaline phosphatase level, Diabetes, Hypoalbuminaemia and Prolonged prothrombin time were considered as the predictive factors of complicated (ruptured) liver abscess in this study. Amoebic serology when performed using ELISA was positive in significant number of cases making it a strong marker in diagnosing Amoebic liver abscess and also positive in 27 cases of pyogenic liver abscess suggesting significant incidence of mixed infection. The incidence of positive anti-HIV serology was only 3.0% in this study. CONCLUSION Liver abscess is a very common condition in India with male preponderance. Alcohol is the most common risk factor. Pain abdomen was the most common symptom. Alkaline phosphatase was the most consistent investigation. Most cases had right lobe involvement. Enterococcus was the most common organism. Multiple small abscesses and solitary abscess of volume < 200 cc can be managed successfully on conservative antimicrobial therapy alone, but recurrence rate was high. Ultrasound-Guided Percutaneous Aspiration and Pigtail Catheter drainage procedure is a safe and effective method of liver abscess management. Laparotomy and Drainage or Laparoscopy drainage remains the standard of care in ruptured liver abscess into the peritoneal cavity. Peritoneal rupture was the most common complication associated with Liver abscess.
Authors and Affiliations
Sriramoju Sreedhar, Akula Nynasindhu, Sahaja Sahaja
Keywords
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- EP ID EP411640
- DOI 10.14260/jemds/2018/313
- Views 75
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