Difference between revisions of "Hepatic abscess"

(grammar, additional info, restructuring, references)
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Please change the Main Title to "Hepatic Abscess"
 
Please change the Main Title to "Hepatic Abscess"
  
==Background==<ref>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.</ref>
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==Background==
 
*Uncommon overall, usually right liver lobe
 
*Uncommon overall, usually right liver lobe
 
*More abscesses -> more severe disease
 
*More abscesses -> more severe disease
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**Amebic
 
**Amebic
  
==Causes==<ref>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.</ref>
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==Causes==
 
*Pyogenic abscesses
 
*Pyogenic abscesses
 
**Aerobic: Escherichia coli, Klebsiella, Pseudomonas
 
**Aerobic: Escherichia coli, Klebsiella, Pseudomonas

Revision as of 14:48, 2 February 2015

Please change the Main Title to "Hepatic Abscess"

Background

  • Uncommon overall, usually right liver lobe
  • More abscesses -> more severe disease
  • Camping history
  • Endemic of Midwest
  • Two types: pyogenic and amebic
    • 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

Causes

  • Pyogenic abscesses
    • Aerobic: Escherichia coli, Klebsiella, Pseudomonas
    • Anaerobic: Entercoccus, bacteroides, anaerobic streptococci
  • Amebic
    • Entamoeba histolytica

Clinical Features

  • RUQ Pain
  • High fever
  • Nausea, vomiting, anorexia
  • Clay-colored stool
  • Dark urine
  • Jaundice
  • Often with R pleural effusions

Differential Diagnosis

RUQ Pain

Workup

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

Management

  • IV antibiotics[1]
    • Two or more antibiotics
      • Gram Negs: third or fourth generation cephalosporin (ceftriaxone) or aminoglycoside
      • Gram Pos: penicillin for streptococcal species (ampicillin)
        • For PCN allergic, use Fluoroquinolones
      • Anaerobes: metronidazole or clindamycin
  • 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

  • Admit for IV antibiotics and drainage/sugery

See Also

Abdominal Pain

Sources

UpToDate MedlinePlus Medscape

  1. 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.