Bacterial infection of biliary tree due to common bile duct stone Charcots triad 1 fever and rigor 2 jaundice mild intermittent 3 biliary colic amp tender hepatomegaly ID: 1047093
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1. 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
2. Dx : - US and CT scan → multiloculated cystic mass lesion - X-Ray → might be beneficial…..air/ fluid levelRx :Antibiotics e.g. Aminoglycoside , cephalosporin plus Drainage →Ultrasound-guided aspiration. or Lapratomy for drainage ( It might be ) .Microorganisms : - E coli , Streptococcus milleri (commonly) . - Streptococcus faecalis, Klebsiella , Proteus and StaphylococciSources of abscess of liver could be via:1- Bile duct – ascending – ( commonest ). 2- portal vein . 3-peri-hepatic infective focus4- Haematogenous (e.g.: hepatic artery) .
3. Pyogenic liver abscess : Single ( large ) or multiple ( small ) . Acute or chronic .Manifestation :Fever & lethargy , malaise . RUQ discomfort & ? pain. Anorexia . Unwell look .Patient at risk :Sickler 2) elderly 3) malnourished 4) immune suppressed 5) diabetics 6) post traumatic & post op. patients
4. Dx : - US and CT scan → multiloculated cystic mass lesion - X-Ray → might be beneficial…..air/ fluid levelRx :Antibiotics e.g. Aminoglycoside , cephalosporin plus Drainage →Ultrasound-guided aspiration. or Lapratomy for drainage ( It might be ) .Microorganisms : - E coli , Streptococcus milleri (commonly) . - Streptococcus faecalis, Klebsiella , Proteus and StaphylococciSources of abscess of liver could be via:1- Bile duct – ascending – ( commonest ). 2- portal vein . 3-peri-hepatic infective focus4- Haematogenous (e.g.: hepatic artery) .
5. 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 :Aneamia 2) weight loss 3) pyrexia and night sweating 4) Pain in liver area and enlarged tender liver .
6. Dx : - US and CT scan → multiloculated cystic mass lesion - X-Ray → might be beneficial…..air/ fluid levelRx :Antibiotics e.g. Aminoglycoside , cephalosporin plus Drainage →Ultrasound-guided aspiration. or Lapratomy for drainage ( It might be ) .Microorganisms : - E coli , Streptococcus milleri (commonly) . - Streptococcus faecalis, Klebsiella , Proteus and StaphylococciSources of abscess of liver could be via:1- Bile duct – ascending – ( commonest ). 2- portal vein . 3-peri-hepatic infective focus4- Haematogenous (e.g.: hepatic artery) .
7. 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 pusRx :Metronidazole 750 mg tds. for 7 – 10 days (mainly).Aspiration under U/S. guidance (possible)Laparoscopic or open drainage (might be needed).Indication for drainage :No response to metronidazole after 5 days .Too big size.Bacterial supper added infection .
8. 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 wallNO Septations Calcification Enhancement Mural nodulesRx :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 .
9. 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 scanRx : - Analgesia …if no response then - open or laparoscopic fenestration of the liver cysts.