Difference between revisions of "Hepatic abscess"

(Text replacement - "PCN " to "penicillin ")
(Text replacement - "abscess " to "abscess ")
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==Differential Diagnosis==
 
==Differential Diagnosis==
{{Liver abscess DDX}}
+
{{Liver [[abscess]] DDX}}
  
 
{{DDX RUQ}}
 
{{DDX RUQ}}
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*Ultrasound (80-100% sensitivity)
 
*Ultrasound (80-100% sensitivity)
 
*CT ABD/Pelvis ('''Imaging study of choice''')
 
*CT ABD/Pelvis ('''Imaging study of choice''')
**Triphasic CT scan to define the proximity of the abscess to the major branches of the portal and hepatic veins
+
**Triphasic CT scan to define the proximity of the [[abscess]] to the major branches of the portal and hepatic veins
  
 
===Evaluation===
 
===Evaluation===
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***[[Anaerobes]]: [[metronidazole]] or [[clindamycin]]
 
***[[Anaerobes]]: [[metronidazole]] or [[clindamycin]]
  
*Diagnostic aspiration and drainage of the abscess followed by placement of drainage catheter
+
*Diagnostic aspiration and drainage of the [[abscess]] followed by placement of drainage catheter
 
**Sonographic guidance for small or superficial abscesses
 
**Sonographic guidance for small or superficial abscesses
 
**CT guidance for deep or multiple abscesses
 
**CT guidance for deep or multiple abscesses

Revision as of 10:57, 10 March 2017

Background

  • Uncommon overall - usually occurs in right liver lobe
    • More abscesses → more severe disease
  • History of camping is common
    • Endemic of Midwest

Types

  • Pyogenic
    • More common of the two
    • Associated with biliary tract obstruction (most common), cholangitis, diverticulitis, pancreatic abscess, appendicitis and inflammatory bowel disease.
    • Possible arterial hematogenous seeding: sepsis, direct trauma or instrumentation
  • Amebic
    • E. histolytica most common
    • Usually not septic and sick, rarely needs drainage

Clinical Features

Differential Diagnosis

{{Liver abscess DDX}}

RUQ Pain

Evaluation

Work-up

  • CBC - Elevated white blood count (70-80%)
  • BMP
  • Liver Panel - Elevated alkaline phosphatase levels (90%)
  • Coags
  • Blood cultures
  • Ultrasound (80-100% sensitivity)
  • CT ABD/Pelvis (Imaging study of choice)
    • Triphasic CT scan to define the proximity of the abscess to the major branches of the portal and hepatic veins

Evaluation

  • Diagnosis usually made on imaging studies

Management

  • Diagnostic aspiration and drainage of the abscess followed by placement of drainage catheter
    • Sonographic guidance for small or superficial abscesses
    • CT guidance for deep or multiple abscesses
  • Surgical drainage
    • Abscesses > 5cm
    • Abscesses not amenable to percutaneous drainage due to location
    • Failure of percutaneous aspiration and drainage
    • Coexistence of inra-abdominal disease that requires surgical management

Disposition

See Also

References

  1. Oyama LC. Disorders of the Liver and Biliary Tract, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 90: p 1186-1205.
  2. Guss DA, Oyama LA: Disorders of the Liver and Biliary Tract, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 88: p 1153-1171.