882. Clinicolaboratory Features, Radiological Distribution and Endoscopic Retrograde Cholangiopancreatography of 20 Cases of Liver Abscess
Session: Poster Abstract Session: Bone, Joint, and Soft Tissue Infection
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Posters
  • Poster.pdf (2.0 MB)
  • Background: Apart from extensive damage to the hepatic parenchyma, liver abscess is known to cause damage to the intrahepatic biliary radicles and the distal branches of the hepatic vein or the portal vein. 

    Methods: The aim of this study was investigate with ERCP, twenty cases of liver abscess, for presence of damage to the intrahepatic biliary radicles and terminal branches of hepatic and portal vein. Setting- Emergency Department of a North-Western Tertiary Care Center in India.

    Results: Of 20 cases, there were 17 males and 3 females and the mean age was 36±9.3 yrs (range=21-53 yrs). Twelve cases had amoebic liver abscess (ALA) and 8 had pyogenic liver abscess (PLA). Fever and pain abdomen were the most common clinical features in all and jaundice was seen in 15% only. Hepatomegaly was seen in 35% of cases only and 75% were consuming alcohol. Nausea, vomiting and diarrhea occurred in 10% cases each and right pleural effusion in 30%. Laboratory investigations showed; anemia in 83%, leukocytosis and raised aminotransaminases in 80%, raised alkaline phosphatase in 70% and hypoalbuminemia in 65%. Radiologically, abscess was located in the right lobe of liver in 15 cases, left lobe in 2 cases and in 3 cases the abscess was present in both lobes. Upon ERCP, a Bilio-vascular fistula could be demonstrated in 3 cases, of which 2 were ALA and 1 was PLA. All cases received a combination of antibiotic and Metrogyl and those demonstrating a Bilio-vascular Fistula on ERCP, a nosobiliary drainage was placed. Nineteen patients underwent per-cutaneous pigtail catheter drainage of the liver abscess. Analysis of the clinical and laboratory features of patients according to the aetiology revealed a higher occurrence of raised serum alkaline phosphatase in cases of PLA.

    Conclusion: ALA and PLA cannot be differentiated upon their clinical presentation and laboratory parameters alone except for the higher occurrence of a raised serum alkaline phosphatase in PLA cases. Bilio-vascular fistula occurs in some cases of liver abscess and is one of the reasons for the occurrence of jaundice.

    Navneet Sharma, MD1, Virendra SIngh, MD, DM2 and Ashish Bhalla1, (1)Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India, (2)Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India

    Disclosures:

    N. Sharma, None

    V. SIngh, None

    A. Bhalla, None

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