Abses Hepar

Erina Angelia
Perceptor : dr.Lukas.,Sp.PD
Definisi
• Abses hati adalah penumpukan cairan di parenkim hati yang
dihasilkan dari infeksi bakteri, jamur, atau parasit. Infeksi dapat
menyebar ke hati melalui empedu, vena hepatika, atau vena porta,
dengan perluasan infeksi yang berdekatan, atau sebagai akibat
trauma.

https://bestpractice.bmj.com/topics/en-us/640
 Etiologi

•Gram-positive cocci: Streptococcus species (especially S. intermedius group), enterococci, and Staphylococcus aureus.
•Anaerobes: Bacteroides species, Fusobacterium sp, Actinomyces sp, Clostridium sp, etc.
•Enterobacteriaceae (E. coli, Klebsiella spp., etc) and other Gram-negative bacilli.
•Yersinia enterocolitica: rare cause of liver abscess; if identified, consider underlying hemochromatosis.
•Candida species

•Entamoeba histolytica: amebic liver abscesses may complicate up to 10% of the cases of amebic colitis.
•Echinococcus granulosus: most common cause of hydatid cysts

https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540259/all/Hepatic_Abscess
Klasifikasi
The three major forms of liver abscess, classified by etiology, are
as follows:
• Pyogenic abscess, which is most often polymicrobial, accounts for
80% of hepatic abscess cases in the United States
• Amebic abscess due to Entamoeba histolytica accounts for 10% of
cases [2]
• Fungal abscess, most often due to Candida species, accounts for
fewer than 10% of cases

https://emedicine.medscape.com/article/188802-overview
Faktor Risiko
• Diabetes
• Liver cirrhosis
• Immunocompromised state
• Male sex
• Advanced age
• Proton-pump inhibitor use
Diagnosis Banding

•Acute Gastritis

•Bacterial Pneumonia

•Biliary Disease

•Cholecystitis

•Hepatocellular Carcinoma

•Hydatid Cysts

•Parapneumonic Pleural Effusions and Empyema Thoracis

https://emedicine.medscape.com/article/188802-differential
Diagnosis
Pemeriksaan Fisik
• Fever and tender hepatomegaly
• Peningkatan suara nafas paru di bagian kanan dengan atelektasis
maupun efusi dari pemeriksaan fisik dan radiologi
• A pleural or hepatic friction rub can be associated with diaphragmatic
irritation or Glisson capsule inflammation.
• Jaundice may be present in as many as 25% of cases and usually is
associated with biliary tract disease or the presence of multiple
abscesses.
Diagnosis
• Labs:
• For pyogenic liver abscess(es), positive blood cultures seen in up to 50%; alkaline phosphatase and
WBC counts frequently elevated.
• Hyperbilirubinemia with or without jaundice occurs in < 50% of patients.
• Imaging:
• Plain abdominal radiography: dx may be suggested on plain films (e.g., gas within the abscess)
• Preferred: CT, US and MRI are the imaging modalities of choice in suspected liver abscess or FUO.
• CT or US-guided percutaneous drainage or surgical drainage should be considered in all cases of
hepatic abscess for diagnostic confirmation and culture.
• Multiple, small abscesses may not be amendable to aspiration.
• Serology:
• Positive amebic or echinococcal serology helps differentiate parasitic liver abscess from pyogenic,
especially in nonendemic areas. Serology cannot distinguish between active and prior infection.
• Uncomplicated, small abscesses due to Entamoeba histolytica in endemic areas may not require
aspiration; consider empirical rx.
Terapi
Komplikasi

• Sepsis
• Empyema resulting from contiguous spread or intrapleural rupture of abscess
• Rupture of abscess with resulting peritonitis
• Endophthalmitis when an abscess is associated with K pneumoniae bacteremia