Clinicopathological and Management of Liver Abscess in a Tertiary Care Center - Case Study Example

Clinicopathological study and management of liver abscess in a tertiary care center Liver abscess occurs in various types and are responsible for 20% mortality (). The major types of the liver abscess are the amoebic (ALA) and pyogenic (PLA), whose difference is less noticeable, unless during their diagnosis. Liver abscess presents both diagnosis and therapeutic challenges, making it result in often lethal consequences, mostly in the tropical countries. The occurrence of the Liver abscess has been associated both to biological and environmental factors, such that alcoholism history, history of previously suffering from diabetes mellitus as well as low economic status were some of the conditions associated with the prevalence of Liver abscess. The article below reviews a recent study in Liver abscess, focusing on its diagnosis, prevalence, associated factors and cost-effective treatment methods. Introduction Liver abscess is always fatal due to the fact that this condition presents both diagnosis and therapeutic challenges (). Most surprisingly, the condition has mostly been found to be prevalent in the developed nations, and mostly the tropical countries. The amoebic (ALA) and pyogenic (PLA) liver abscess represents the major known liver abscess, although there is no well devised clinical criteria that presently exists for diagnosing these types of liver abscess (71). Nevertheless ultrasonography add serological tests are the most used methods of diagnosing liver abscess, and their differential applications is defined by variants such as the age of the patients, residence or the history of recent travel to areas prone to endemic amoebiasis (71). Despite the complexity of this liver condition, associated with both its diagnosis and treatment, there has been a great advancement in the treatment of this condition. The most advanced treatment method is the minimal invasive drainage, which has taken the center-stage of experimentation and application for the treatment of this medical liver condition (72). Nevertheless, other methods of treating the liver abscess have been developed, experimented and advanced. Some of these treatment methods, for example the open surgery however have been limited in their application as interventions for treating the liver abscess, and instead have been reserved for the most complex cases (). Further advancements have been made in the diagnosis of this liver condition, with radiological imaging proving to increase its competence in the diagnosis of the condition. Most importantly, the radiological imaging have altered the manner in which the condition was diagnosed traditionally, through introducing new strategies that have proven to be more effective, such as the needle aspiration, percutaneous approach as well as the catheter drainage (). Thus, the major focus of the study was to investigate the relationship between the liver abscess and demographic patients’ particulars such as the socioeconomic status, sex, age, history of diabetes mellitus, source of drinking water, history of alcohol consumption and religion (72). In addition, the most effective method for application in the diagnosing of the liver abscess was also a subject of the study investigation, in addition to the investigation of the most cost-effective method of treating the liver condition. Methodology The methodology applied under this study entailed an inward study and monitoring of patients admitted to the inpatient wards of the General Surgery Department of N.R.S. Medical College (72). Different features were applied in the diagnosis of the liver abscess, which included the clinical features of the patients, serological investigations, patient history, and radiology and blood culture (72). The treatment of the patients was done applying one of the three liver abscess treatment procedures, with a view to establishing which of the treatment procedure emerged as more cost productive. Thus, some patients were subjected to open surgery, others to catheter drainage and yet others to the needle aspirations (72). The demographic features and the clinical features of the patients were recorded separately, such that the history, age, sex, socioeconomic status, religion, history of alcoholism and history of diabetes mellitus were recorded separately under the patient’s demographic features (). On the other hand, the clinical features and symptoms of the abdominal pains, weight loss, fever, jaundice, chest infection, anorexia and coughs were also recorded. The study was undertaken for a period of one-and-a-half year running from may 2007 to September 2009, and the patients’ conditions were recorded and the records maintained and updated on a daily basis. The clinical improvements based on the nature of the treatment offered were also recorded on a daily basis. The whole study recruited a total of 125 patients, who were subjected as the study sample (). Results The results of the study indicated that of the total sample population of 125 patients recruited in the study, 110 patients, who represented 88% of the total population were diagnosed with amoebic liver abscess (ALA), while the rest of the 15 patients, representing 22% of the total sample population were diagnosed with pyogenic liver abscess (PLA) (72). The blood culture was positive in one ALA patient and in 3 of the PLA patients, which then suggested the presence of E. coli in the blood of those patients. The treatment outcome on the other hand indicated that of the 110 patients ALA, 15 patients were treated with either medical or conservative treatment interventions, which produced a success rate of 70% (72). Additionally, 37 of the ALA patients were subjected to percutaneous needle aspiration, with the results being 67% success rate, while 37 more ALA patients were subjected to percutaneous catheter drainage and the result was 100% success rate (72). The last ALA groups of 21 patients were treated through surgical exploration and drainage, resulting in 65% success rate, while 7 patients who were treated surgically died. On the other hand, among the 15 PLA patients, 3 were treated using medical and conservative treatment recording a success rate of 50%, while 6 others were treated using needle aspirations and recorded a success rate of 50% too, and the last 6 patients were treated using the catheter drainage method, and recorded a success rate of 100% (73). Therefore, in total, 125 patients suffering from Liver abscess were treated under different methods, with ALA treatment recording a 93.6% success rate and 7 deaths, while all the PLA patients were treated and discharged successfully. Discussion and Conclusion The study found that in total, 33.64% patients suffering from the ALA had a history of diabetes mellitus, while a total of 60% of the patients suffering from PLA also had a history of suffering previously from diabetes mellitus (73). In his respect, diabetes mellitus is a factor associated with Liver abscess (). In addition, the study also reported that 63.64% of patients suffering from the ALA had a prior history of alcohol addition, while on the other hand 66.67% patients with PLA also had a prior history of alcohol addiction (). Alcohol addiction therefore is a factor associated with the high prevalence of Liver abscess (). The symptoms associated with the liver abscess include abdominal pain, fever and intercostals tenderness (). The graph below represents the symptoms associated with the liver condition and their rates of prevalence among the patients: The other interesting finding of the study was that 81.82% of all the patients recruited under the study sample were all from a lower socioeconomic status (73). This therefore means that liver abscess is highly prevalence in lower socioeconomic status areas. The major factors contributing to the high prevalence of this liver condition in the lower socioeconomic regions may include overcrowding of people and the intake of contaminated water as well as poor hygienic conditions (). In conclusion therefore, catheter drainage is the most cost-effective and also efficient method of treating liver abscess, while alcohol addition, diabetes mellitus and low socioeconomic status are factors predisposed to the liver abscess. References Jha, A. K. et al. (2015). Clinicopathological study and management of liver abscess in a tertiary care center. Journal Of Natural Science, Biology & Medicine, 6(1), 71-75. Mangukiya, D., Darshan, J., Kanani, V., & Gupta, S. (2012). A Prospective Series Case Study of Pyogenic Liver Abscess: Recent Trands in Etiology and Management. Indian Journal Of Surgery, 74(5), 385-390. Ng, W., Li, W., & Cheung, M. (2008). Audit of management of pyogenic liver abscess in a tertiary referral hospital. Surgical Practice, 12(1), 7-10. Sharma, B., Garg, V., & Reddy, R. (2012). Endoscopic Management of Liver Abscess with Biliary Communication. Digestive Diseases & Sciences, 57(2), 524-527. Short, M., & Desai, A. P. (2008). Laparoscopy and Transdiaphragmatic Thoracoscopy in Management of Ruptured Amebic Liver Abscess. Journal Of Laparoendoscopic & Advanced Surgical Techniques, 18(3), 473-476. Read More