SU28.10 | Liver Abscess, Hydatid Disease, Liver Injury and Liver Tumors — Summary & Reflection

KEY TAKEAWAYS

Surgical liver disease falls into four groups that share the liver's anatomy but demand different responses. Couinaud's eight segments and the dual (portal + arterial) blood supply underpin resection, abscess formation and bleeding. Amoebic abscess (Entamoeba histolytica, single right-lobe, anchovy-sauce pus) is treated medically with metronidazole plus a luminal agent, aspirating only when large or refractory; pyogenic abscess needs antibiotics, drainage and source control. Hydatid disease (Echinococcus granulosus) is treated with albendazole plus PAIR or surgery with a scolicidal — and is never aspirated blindly because of anaphylaxis and dissemination. Liver injury is managed non-operatively if the patient is haemodynamically stable and by laparotomy with packing if not. Liver tumours range from benign (haemangioma, FNH, adenoma) to malignant — HCC (cirrhosis/hepatitis, raised AFP), treated by resection or transplantation, and metastases. Ultrasound first, then CT, serology and AFP guide the diagnosis.

REFLECT

Imagine you are the first doctor to see the febrile traveller from the hook. Write down, in order, the three questions you would ask and the single first-line investigation you would request, and justify why you would not reach for a diagnostic needle until you knew whether the lesion was cystic. Then consider how your management would change if the same ultrasound instead showed a cyst with internal daughter cysts and a laminated membrane. How does naming the lesion change the very next thing you do?