Surgical management of infectious processes of the liver
This presentation is the property of its rightful owner.
Sponsored Links
1 / 16

Surgical Management of Infectious Processes of the Liver PowerPoint PPT Presentation


  • 131 Views
  • Uploaded on
  • Presentation posted in: General

Surgical Management of Infectious Processes of the Liver. Houssam G. Osman, M.D. HPB surgery Associate Director, HPB Fellowship Methodist Dallas Medical Center, Dallas ACOS: In-Depth Review - 2014 Kansas C ity, MO. PYOGENIC LIVER ABSCESS. Secondary to bacterial infection

Download Presentation

Surgical Management of Infectious Processes of the Liver

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Surgical management of infectious processes of the liver

Surgical Management of Infectious Processes of the Liver

Houssam G. Osman, M.D.

HPB surgery

Associate Director, HPB Fellowship

Methodist Dallas Medical Center, Dallas

ACOS: In-Depth Review - 2014

Kansas City, MO


Pyogenic liver abscess

PYOGENIC LIVER ABSCESS

  • Secondary to bacterial infection

    Etiology / route of dissemination

  • Biliary : cholangitis , ERCP

  • Portal: intra-abdominal; appendicitis, diverticulitis

  • Arterial: IVDU, pneumonia, endocarditis

  • Adjacent organ: cholecystitis

  • Direct trauma: after ablation on TACE

    Keep underlying tumor at the back of your mind specially if you don’t find a source!


Pyogenic liver abscess1

PYOGENIC LIVER ABSCESS

Clinical presentation

  • Fever

  • Abdominal pain

  • Nausea, vomiting, weight loss

  • Sepsis


Pyogenic liver abscess2

PYOGENIC LIVER ABSCESS

Diagnostic workup

  • Labs: leukocytosis and elevated LFTs

  • US

  • CT

  • MRI

  • Blood culture

  • Workup for source


Pyogenic liver abscess3

PYOGENIC LIVER ABSCESS

Treatment:

  • Antibiotics

    - IV

    - prolong course

  • Percutaneous approach

    - drain placement

    - aspiration (may need multiple trips to IR)

  • Surgical drainage/debridement/resection

    - failure of percutaneous approach

    - intra-peritoneal rupture

    - need for operative intervention to address other abdominal process


Hydatid liver disease

HYDATID LIVER DISEASE

  • Echinococcusspecies

  • Humans become accidental intermediate hosts when they become infected after ingesting ova passed in dog feces¹

  • Liver is the most common involved organ²

  • It may take months to years for individual to become symptomatic after infection

    ¹William R. Jarnagin and Leslie H. Blumgart, MD. Blumgart's Surgery of the Liver, Pancreas and Biliary Tract, 5th Edition

    ²Shaw JM, Bornman PC, Krige JEJ: Hydatid disease of the liver. S Afr J Surg. 44:70-77 2006


Hydatid liver disease1

HYDATID LIVER DISEASE

Potential complication

  • Rupture

    - peritoneal cavity

    - pleural space

    - biliary tree

  • Secondary infection

  • Mass effect

Corona M et al, Case report: Percutaneous treatment of multiple honeycomb-like liver hydatid cysts (type III CE2, according to WHO classification). Indian J Radiol Imaging. 2012 Jan;22(1):23-6. doi: 10.4103/0971-3026.95399.


Hydatid liver disease2

HYDATID LIVER DISEASE

Clinical presentation

  • Asymptomatic

  • RUQ pain

  • Allergic reaction and anaphylactic shock


Hydatid liver disease3

HYDATID LIVER DISEASE

Diagnostic work up

  • Laboratory

    - eosinophilia > 3% ¹

    - LFTs may be normal

    - serology; electrophoresis, ELIZA

  • CT/MRI

    - multiple types

    -hydatid sand, honeycomb

    ¹Pitt HA, et al.: Management of hepatic echinococcosis in Southern California. Am J Surg

William R. Jarnagin and Leslie H. Blumgart, MD. Blumgart's Surgery of the Liver, Pancreas and Biliary Tract, 5th Edition


Hydatid liver disease4

HYDATID LIVER DISEASE

Treatment

  • Conservative

    - asymptomatic small cyst < 5 cm¹

  • Surgery

    - conservative

    - radical

    - avoid spillage

  • Percutabeous

  • Medication (Albendazole)

    - perioperative

    - definitive

    ¹Buttenschoen K, Buttenschoen D: Echinococcusgranulosus infection: the challenge of surgical treatment. Langenbecks Arch Surg. 388:218-230 2003


Amebic liver abscess

AMEBIC LIVER ABSCESS

  • Entamoebahistolytica

  • Most common extra-intestinal location

  • Fecal-oral transmission

    Killed Napoleon!!


Amebic liver abscess1

AMEBIC LIVER ABSCESS

Presentation

  • Asymptomatic

  • Abdominal pain and fever

    Unlikely to have concomitant colitis


Amebic liver abscess2

AMEBIC LIVER ABSCESS

Diagnosis:

  • US

  • CT

  • Serology

    ? Role of aspiration

William R. Jarnagin and Leslie H. Blumgart, MD. Blumgart's Surgery of the Liver, Pancreas and Biliary Tract, 5th Edition

Courtesy Professor A.K. El Dory, Ain Shams University, Cairo.


Amebic liver abscess3

AMEBIC LIVER ABSCESS

Treatment:

  • Metronidazole

  • Therapeutic aspiration

    - imminent rupture

    - failure or contraindication of medical treatment

    - secondary bacterial infection


Liver fluke

LIVER FLUKE

Fasciolahepatica

  • Fecal-oral transmission

  • Inhabit hepatocytes, bile duct, and gallbladder

  • Presentation: abdominal pain, fever, hemobilia

  • Diagnosis: CT, serology

  • Treatment

    - Triclabendazole

    - ERCP if biliary obstruction


Liver fluke1

LIVER FLUKE

Clonorchissinensis

  • Fecal –oral transmission

  • Oriental cholangiohepatitis

  • CT, serology

  • Praziquantel


  • Login