Pyogenic Liver Abscess: Causes, Symptoms, and Diagnosis

Pyogenic Abscess

It is usually produced by staphylococcal infections. The organisms enter the soft tissue through an external wound (minor or major). It can also be due to cellulitis or haematogenous spread from a distant focus such as tonsillitis or caries tooth.

Pyogenic Abscess Pathophysiology

• Following injury, there is inflammation of the part brought about by the organism such as Staphylococcus.
• Pathological events are summarised.
• The end result is the production of pus composed of dead leukocytes, bacteria, and necrotic tissue. The area around the abscess is encircled by fibrin products and it is infiltrated with leukocytes and bacteria. It is called a pyogenic membrane.

Read And Learn More: General Surgery Notes

Pyogenic Abscess Symptoms

The patient feels ill and complains of throbbing pain at the site, which occurs due to pressure of the pus on the nerve endings. Fever, with or without chills and rigours, may be present.

Pyogenic Abscess Signs

1. Calor–heat: The affected part is warmer due to the local rise in temperature.
2. Rubor–redness: It is due to inflammation resulting in hyperaemia.
3. Dolour–pain: An abscess is extremely tender.
4. Tumour–swelling: It consists of pus. It is tensely cystic with surrounding brawny oedema.
5. Loss of function: The function of the part is impaired, due to pain.
6. Fluctuation: It may be elicited. However, in a deep-seated abscess (for example. breast abscess), it may be negative.

• • Untreated abscess tends to point spontaneously along the area of least resistance to the nearest epithelial surface, for example. skin, gut, oral cavity.
  • However, deep-seated abscesses such as breast abscesses may cause much tissue destruction before pointing.

Pyogenic Abscess Treatment

Incision and drainage (I and D) under general anaesthesia. General anaesthesia is preferred because in the presence of infection, local anaesthesia may not act and it would be difficult to break all the loculi of an abscess without causing pain.

Pyogenic Abscess Procedure

• A stab incision is made over the most prominent (pointing) part of the abscess. The pus which comes out is collected and sent for culture and sensitivity.
• A sinus forceps or a finger is introduced within the abscess cavity and all the loculi are broken down.
• Fresh oozing of the pus is an indication that the procedure is complete. The abscess cavity is irrigated with saline or a mild antiseptic agent like iodine solution.
• The cavity, if large, may need to be packed with roller gauze dipped in an iodine solution, which is removed 1–2 days later. Roller gauze packing prevents premature closure of the skin.
• Thereby facilitating healing from the depth of the cavity through granulation tissue formation. With appropriate antibiotics and proper dressings, the wound heals within 5–7 days.
• The antibiotic of choice is cloxacillin for staphylococcal abscesses. Dosage: 500 mg 6th hourly for 5–7 days.
• Modified Hilton’s method for I and D. This method is followed if the abscess is situated in the vicinity of important anatomical structures like vessels or nerves.
• The skin and superficial fascia are incised (instead of a stab incision), and the abscess is opened by sinus forceps to avoid damage to vital structures.

Pyogenic Abscess Differential Diagnosis

1. A ruptured aneurysm may present as a subcutaneous abscess with pain, redness, local rise of temperature, and sometimes even leukocytosis.

• A ruptured vertebral artery aneurysm in the posterior triangle and a popliteal artery aneurysm in the popliteal fossa have been incised, mistaking them for an abscess.
• Caution: When in doubt, aspirate with a wide bore needle before incising an abscess.

2. Soft tissue sarcoma in the thigh may be confused for a deep-seated abscess. However, throbbing pain, high-grade fever with chills and rigours, and short duration of the swelling clinch the diagnosis of an abscess.

Pyogenic Abscess Antibiotic

• It is an antibiotic-induced swelling (oma). Once an abscess is formed, antibiotics seldom affect a cure but partially sterilise the pus. Antibiotics also produce fibrosis, resulting in thickening of the abscess wall.
• Clinically, this may result in a hard lump. Common sites of antibioma are the breast, thigh, and ischiorectal fossa. Antibiotics in the breast may mimic carcinoma of the breast.