7. INFECTIOUS DISEASE AND HEPATOLOGY: M.SRI SAI PAVAN ROLL NO :79 8TH SEM




1) Do you think drinking locally made alcohol caused liver abscess in this patient due to predisposing factors present in it ??
Yes, may be the liver Abcess developed due to the chronic intake of contminated Toddy.

2) What is the etiopathogenesis  of liver abscess in a chronic alcoholic patient ? ( since 30 years - 1 bottle per day)
 Chronic alcohol intake especially the locally available contaminated drinks plays a major role in the formation of liver abscesses which can be either  Amoebic or Pyogenic liver abscess because of the adverse effects of alcohol over the Liver. 

3) Is Liver Abcess more common in Right Lobe ??
 50% of solitary liver abscesses occur in the right lobe of the liver (a more significant part with more blood supply), less commonly in the left liver lobe or caudate lobe.

4) what are the indications of Ultrasound-guided aspiration of Liver abscess ?
 Indications for USG guided aspiration of liver abscess

1. Large abscess more than 6cms
2. Left lobe abscess
3.Caudate lobe abscess
4. Abscess which is not responding to drugs
  B.LINK TO PATIENT DETAILS:
https://63konakanchihyndavi.blogspot.com/2021/05/case-discussion-on-liver-abcess.html
1)  Cause of liver Abcess in this  Patient??
 May be due to malnutrition and lack of personal hygeine is the cause of the infection in the patient resulting in liver abcess. The infection may be amoebic or any other bacterial infection.
2) How do you approach this Patient??
As the patient  presented with the  pain in the abdomen, first I would go for a USG abdomen and As USG showing hyperechoic mass on the liver I would also do LFT(Liverfunction Test)
As there is a mass as seen in USG and LFT is  also abnormal (Raised ALP), I would start empirical Treatment for both  Amoebic and pyogenic liver abscess. 
According to the response given to this Medical Treatment it will be decided whether aspiration is required or not.
3) why do we treat both amoebic and pyogenic liver abscess ??
Even though amoebic liver abscess is confirmed as a diagnosis there is a chance of super infection with bacterial organisms so there is a need for treating both amoebic liver abscess and pyogenic liver abscess

4) Is there a way to confirm definitely diagnosis in this patient ?
Amoebic liver abscess can be confirmed by serology for entamoeba

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