Gastroenterology Education and CPD for trainees and specialists

1. Which one of the following statements regarding pyogenic liver abscess is true?

1. Most of the PLA is mono-microbial
2. Treatment of PLA always include drainage of the abscess
3. Staph. aureus is the commonest organism
4. Colonoscopy is indicated if biliary sepsis is excluded
5. In 10% of cases no obvious cause of infection can be identified.

Explanation :Mostly poly microbial with both aerobes and anaerobes. Gram negative bacilli and streptococcus milleri group are important causes. In 40% of cases no obvious source of infection can be identified. Liver abscesses caused by Staphylococcus aureus are most common in children and patients with septicaemia and impaired immunity. A barium enema or colonoscopy is usually done to locate a source of infection in PLA unless a biliary or other source is apparent.

2. 1.Which one of the following statements regarding pyogenic liver abscess is false?

1. Biliary sepsis is the commonest source
2. Blood culture identifies the organism in 50% of cases
3. Surgery is needed for drainage in loculated abscess
4. Usually single abscess is seen
5. Abscess more than 5cm usually needs some form of drainage

Explanation :Biliary source of sepsis from gallstones, biliary stricture, ERCP and operation is the commonest cause. Blood culture may identify causative organism in 50% of cases and the yield increases to 90% if aspirated material is cultured. Surgical- open or laparoscopic drainage- may be required if there is inadequate response to percutaneous drainage, or in situations of multiple abscesses, if the abscesses are loculated, ruptured abscess, unresolved jaundice or renal impairment. Large pyogenic abscesses (5 cms or more) usually need drainage, in addition to antibiotics for effective resolution.

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MCQ On Pyogenic Liver abscess

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