Lectures

Pyogenic Liver Abscess

by Kevin Pei, MD
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    00:01 Let’s move on to a discussion of pyogenic abscesses. Unlike amebic abscesses, these are secondary to another infection. Whether it’s bacteremia or an abscess located somewhere else, it has gained access to the systemic circulation with subsequent seeding of the liver. Once again, physical findings for both abscesses are usually associated with right upper quadrant abdominal pain.

    00:26 Because there’s an ongoing infection, the patient may also report fevers and chills.

    00:31 In very severe cases, patients may present with septic shock, low blood pressure, and organ damage.

    00:38 Routine chemistries may be normal. You may find an increased WBC or leukocytosis.

    00:45 There are variable changes in the liver function test. Here’s a CT scan demonstrating a liver abscess in the left lower of the lobe. Take a look at the black arrow.

    00:58 For amebic abscesses, the treatment is usually metronidazole or commonly known as Flagyl.

    01:08 For pyogenic, this usually requires drainage and antibiotics. I remember because pyogenic abscesses may be related to a secondary infection elsewhere. Of course, treatment of the secondary infection is also very important. Remember some of the important clinical pearls. Hepatic adenomas are at risk for rupture and can cause significant bleeding.

    01:33 In these patients, surgery is usually recommended. For your test, hepatic adenomas are associated with oral contraceptives, whereas the other benign tumors are not.

    01:47 Thank you very much for joining me on this discussion of benign liver tumors.


    About the Lecture

    The lecture Pyogenic Liver Abscess by Kevin Pei, MD is from the course General Surgery.


    Included Quiz Questions

    1. Direct extension from contiguous organs
    2. The portal vein
    3. The hepatic artery
    4. The hepatic vein
    5. The biliary duct
    1. Amebic abscesses can be treated with Metronidazole.
    2. Amebic abscesses should always be treated by incision and drainage.
    3. Pyogenic liver abscesses can be treated with Metronidazole.
    4. Liver adenomas should always be treated by incision and drainage.
    5. Treatment usually involves liver lobectomy

    Author of lecture Pyogenic Liver Abscess

     Kevin Pei, MD

    Kevin Pei, MD


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