Pyogenic Liver Abscess: Causes, Symptoms, And Diagnosis

Pyogenic Liver Abscess: Causes, Symptoms, And Diagnosis

Pyogenic abscess: Pyogenic Abscess is the most common form of an abscess, subcutaneous, deep or it can occur within the viscera such as the liver or kidney.

Pyogenic Abscess Etiopathogenesis

• Pyogenic Abscess is usually produced by staphylococcal infections.
• The organism enters in the soft tissue by an external wound, minor or major.
• Pyogenic Abscess can also be due to hematogenous spread from a distant focus like tonsillitis or carious tooth, etc.
• Pyogenic abscess can also be due to cellulitis.
• Following an injury, there is inflammation of the part brought about by the organisms.
• The result is the production of pus, which is composed of dead leukocytes, bacteria, and necrotic tissue.
• The area around the abscess is encircled by firin products and it is infiltrated with leukocytes and bacteria. It is called a pyogenic membrane.

Pyogenic Abscess Management

• When pus is not localized: Conservative treatment is needed.
  Proper antibiotics and anti-inflammatory agents.
• When pus is localized: There is a golden rule that “Pus should be drained”.

Incision and drainage(IandD) under general anesthesia.

• General anesthesia is preferred because of the presence of infection.

Pyogenic Abscess Infection

Pyogenic Abscess Free or liberal incision:

• Pyogenic Abscess is made on the most prominent part to avoid damage to healthy tissue. The incision should be adequate for easy drainage of pus.
• In case, if nerve and vessels are present below or surrounding the abscess, an incision parallel to the nerve and vessel is given to avoid these structures.

Pyogenic Abscess Incision by Hilton method:

• This method is used when there are plenty of nerves and vessels around the abscess cavity, which could be injured.
• In this method, an incision is given on the most prominent and most dependent part.
• A pair of artery forceps or sinus forceps is introduced and then the blades are open.
  It is swiped in the abscess cavity to break abscess loculi.
• After the removal of forceps, figer is introduced to explore the abscess cavity.

Pyogenic Abscess Counter Incision

• When a prominent part is not the most dependent
  part, a counter incision is made on the most dependent part to facilitate pus-drainage under gravity.
  In the case of counterintuition, sinus forceps are introduced on the most dependent part rather than the most prominent part.

Pyogenic Abscess Drainage:

• A corrugated rubber drain is usually used for drainage of pus.
• Pyogenic Abscess is removed when pus stops coming out.

Follow-up: Proper antibiotics and analgesics are given.