Pathologies

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Presents as pain in the right hypochondrium with hectic fever.

A liver abscess is an accumulation of pus in a necrotic cavity of the liver. A pyogenic liver abscess is caused by bacteria that can reach the liver in different ways:

- from the portal area: appendicitis, diverticulitis;

- from the gallbladder or bile ducts: as in empyema of the gallbladder and cholangitis;

- from the arterial area: as in sepsis.

The causative germs are usually Escherichia coli or other classical intestinal bacteria. The diagnosis can be difficult because the symptoms are sometimes not very pronounced. Typical symptoms are: pain in the right hypochondrium; hectic fever with leukocytosis and toxic condition of the patient. Clinical examination reveals liver palpitations. Diagnosis is made by ultrasound or CT scan with intravenous contrast, hemocultures, or ultrasound or CT-guided puncture with culture. Treatment consists of broad-spectrum antibiotics. If the patient remains highly toxic, percutaneous ultrasound or CT-guided puncture and drainage is indicated. Surgical drainage of a liver abscess is rarely necessary.

An amoebic liver abscess is caused by the anaerobic parasite Entamoeba histolytica. It occurs in the tropics and causes amoebic dysentery (bloody stools) as a result of contaminated water or food. The pathogenic parasite reaches the bloodstream from the intestine, so that in addition to a liver abscess, lung or brain abscesses can also occur. The liver abscess is usually solitary and located in the right lobe of the liver. The clinic of an amoebic liver abscess is similar to that of a pyogenic liver abscess. The diagnosis is made by serology and stool examination. Treatment consists of metronidol. Percutaneous drainage is rarely necessary.

The disease is caused by a parasite with the shape of a small tapeworm: usually Echinococcus granulosus. It is a parasite of dogs and foxes. Humans can be infected by ingesting contaminated food, such as blueberries, blackberries and insufficiently washed vegetables. The incubation period can last years. The parasite migrates from the intestine via the portal vein to the liver. There it forms a hydatid cyst, the inner wall of which is covered with multiple embryonic tapeworm heads. The outer wall of the cyst can calcify. The echinococcus cyst usually occurs solitary in the right lobe of the liver. Multiple cysts are possible in 30% of cases.

The liver cyst can cause pain in the right hypochondrium and can lead to hepatomegaly. Rupture of the cysts to the bile ducts can occur in 20% of cases, resulting in painful jaundice. Echinococcus multilobularis is a more aggressive parasite that also has localizations in the lungs. It can give an image of a primary liver neoplasm in the liver. The diagnosis is made on the basis of CT or MRI scan. Biochemically there is eosinophilia and the diagnosis can be made on the basis of serology. Treatment consists of surgical resection with pre- and postoperative administration of mebendazole or albendazole. In that case, a cystectomy is performed, in which the germinative layer of the echinococcal cyst is resected after intraoperative sterilization of the contents with hypertonic sodium chloride, to prevent dissemination.

Presents as frequent incidental finding in the liver.

Solitary liver cysts are very common and are usually found incidentally on imaging. A distinction must be made with PCLD, in which by definition more than twenty cysts are present. Solitary biliary cysts do not cause symptoms. Consequently, atypical upper abdominal complaints cannot be attributed to an incidentally found liver cyst. Large cysts can sometimes compress the surrounding organs due to their volume. This results in a rapid feeling of satiety. Very rarely, such a cyst can become infected.

The diagnosis is made by ultrasound, or a CT or MRI scan. A distinction must be made between a cystadenoma and cystadenocarcinoma (very rare). Percutaneous or CT-guided puncture aspiration usually gives very rapid recurrence, unless alcoholization occurs. Very rarely surgery is necessary, in which a marsupialation or fenestration is performed.

Presents as an incidental finding in the liver.

This involves a tangle of blood vessels with fibrous tissue, probably congenital. It occurs in 4% of the population. It is a benign tumor that does not cause any symptoms and does not need to be treated. The diagnosis is made by the typical characteristics on CT or MRI scan. Very rarely there may be platelet consumption or it may concern enlarged lesions (giant hemangioma).

Presents in women using oral contraception.

The liver cell adenoma occurs mainly in young women using oral contraception. Very rarely it is provoked by the intake of anabolic steroids in men. The diagnosis is made by the typical characteristics on CT or MRI scan. The lesion does not contain bile ducts and porat fields. Recently, different histological types have been distinguished. Lesions containing beta-catenin mutation are precancerous.

Liver adenoma can be complicated by bleeding. Rarely, it can degenerate if it is larger than five centimeters. When the diagnosis is made, oral contraception must be stopped. Then one can wait six to twelve months. If the lesion is still larger than five centimeters after this period, it must be resected. In men, the chance of complications is very high and surgery must always be performed.

Very rarely, more than ten adenomas can occur (polyadenomatosis). This is sometimes accompanied by liver steatosis in young women. The approach is similar to the solitary adenoma. In case of overweight, the patient is advised to lose weight.

Presents as an incidental finding in the liver.

This is a local hyperplasia in response to a defect in a large arterial blood vessel. The lesion is usually solitary. The diagnosis is made by the typical characteristics on a CT or MRI scan, for example the central star-shaped structure. FNH does not cause any complaints and is not complicated. Consequently, there is no indication for resection.

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