Clinical profile of liver absecess, and role of nonoperative and surgical management
Naveen kushwah, Reeta kushwah
Background: Our tertiary centre is situated in the region where 70% of population belongs to rural areas, where they lack proper sanitation, health education, along with increasing incidence of alcoholics, immune-compromised states. Thus we get large number of patients with liver abscess every day in out-door and emergency basis.rnWith this changing scenario in incidence, environmental conditions, diagnostic methods, treatment and complications associated with liver abscess has inspired me to do in-depth study regarding clinical profile, risk factors, and diagnostic and management strategies of liver abscess.
Aims and Objectives: To study the clinical features and various techniques used in the management of liver abscess, To study the role of non-operative management in liver abscess, To study the role of surgical management in liver abscess.
Material and Methods: The study was conducted in the department of General Surgery, Gajra Raja Medical College, Gwalior (M.P.). All the patients who was admitted in J.A.H. Group of hospital, Gwalior from July 2013-July 2014, with the clinical features of liver abscess and confirmed by the USG abdomen were studied. The study of the data was performed to document the clinical presentation, aetiology, diagnostic work-up, treatment morbidity and mortality. Radiographically guided aspiration and drainage of abscess was performed under local anaesthesia with an 18-guage needle and a range of different sized drainage catheters (8-12Fr) placed or surgical intervention was done for any complicated condition. Pus aspirated at the time of initial abscess was routinely sent for microbial culture and sensitivity analysis. Following completion of their treatment regimen, all the patients were followed up clinically and radiologically. Patient included were: Male and female 15-50 years, Aspirable and non-aspirable liver abscess, Solitary or multiple liver abscess, With any complications.
Results and Conclusion: Liver abscesses occurred most commonly between 30-60 years. Most of the cases had an acute presentation. Males were affected more than females. Pain abdomen was the most common symptom present in all 100 cases.Fever being the most consistently occurring symptom. Alcohol consumption was the single most important etiological factor for causation of liver abscesses. Alkaline phosphatase is the most consistently elevated among all Liver Function Tests.Raised WBC count, Alkaline phosphatise level, Diabetes, Hypoalbuminaemia, Prolonged Prothrombin time were considered as the predictive factors of complicated (Ruptured) liver abscess in this study.rnDiabetes mellitus was more frequently associated condition in cases of liver abscess and especially Pyogenic liver abscess cases. Liver abscess usually present as a solitary abscess most commonly in the right lobe of liver. 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. Enterococcus was the most common organism isolated in pyogenic liver abscess. All cases of liver abscesses do not require invasive management. Multiple small abscesses and solitary abscess of volume < 200 cc can be managed successfully on conservative antimicrobial therapy alone but recurrence rate was high.rnUltrasound Guided Percutaneous Aspiration & Pig Tail 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 in this study, as we had no recurrence and mortality associated with it. Cryptogenic was the most common aetiology in Amoebic liver abscess as well as in Pyogenic liver abscess. Peritoneal rupture was the most common complication associated with Liver abscess. There was no Mortality rate in this study.rn
Naveen kushwah, Reeta kushwah. Clinical profile of liver absecess, and role of nonoperative and surgical management. International Journal of Multidisciplinary Research and Development, Volume 2, Issue 11, 2015, Pages 275-280