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.

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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.

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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.

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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.

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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.

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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.