Difference between revisions of "Hepatic abscess"

m (Rossdonaldson1 moved page Pyogenic liver abscess to Hepatic abscess)
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Please change the Main Title to "Hepatic Abscess"
 
 
 
==Background==
 
==Background==
 
*Uncommon overall, usually right liver lobe
 
*Uncommon overall, usually right liver lobe
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**Amebic
 
**Amebic
  
==Causes==
+
===Causes===
 
*Pyogenic abscesses
 
*Pyogenic abscesses
**Aerobic: Escherichia coli, Klebsiella, Pseudomonas
+
**Aerobic: [[Escherichia coli]], [[Klebsiella]], [[Pseudomonas]]
**Anaerobic: Entercoccus, bacteroides, anaerobic streptococci
+
**Anaerobic: [[Entercoccus]], [[bacteroides]], anaerobic [[streptococci]]
*Amebic
+
*[[Amebic]]
**Entamoeba histolytica
+
**[[Entamoeba histolytica]]
  
 
==Clinical Features==
 
==Clinical Features==
*RUQ Pain
+
*[[RUQ pain]]
*High fever
+
*High [[fever]]
*Nausea, vomiting, anorexia
+
*[[Nausea]], [[vomiting]], anorexia
 
*Clay-colored stool
 
*Clay-colored stool
 
*Dark urine
 
*Dark urine
*Jaundice
+
*[[Jaundice]]
*Often with R pleural effusions
+
*Often with R [[pleural effusions]]
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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**Elevated alkaline phosphatase levels (90%)
 
**Elevated alkaline phosphatase levels (90%)
 
*Coags
 
*Coags
*Blood cultures
+
*[[Blood cultures]]
 
*Ultrasound
 
*Ultrasound
 
**80-100% sensitivity
 
**80-100% sensitivity
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*IV antibiotics<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>
 
*IV antibiotics<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>
 
**Two or more antibiotics
 
**Two or more antibiotics
***Gram Negs: third or fourth generation cephalosporin (ceftriaxone) or aminoglycoside
+
***[[Gram Negs]]: third or fourth generation [[cephalosporin]] ([[ceftriaxone]]) or [[aminoglycoside]]
***Gram Pos: penicillin for streptococcal species (ampicillin)
+
***[[Gram Pos]]: [[penicillin]] for [[streptococcal]] species ([[ampicillin]])
****For PCN allergic, use Fluoroquinolones
+
****For PCN allergic, use [[fluoroquinolones]]
***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
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==Disposition==
 
==Disposition==
*Admit for IV antibiotics and drainage/sugery
+
*Admit for IV [[antibiotics]] and drainage/sugery
  
 
==See Also==
 
==See Also==
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==Sources==
 
==Sources==
UpToDate
 
MedlinePlus
 
Medscape
 
 
<references/>
 
<references/>
  
 
[[Category:GI]]
 
[[Category:GI]]
 
[[Category:ID]]
 
[[Category:ID]]

Revision as of 13:12, 3 February 2015

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

Clinical Features

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

  • 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

Abdominal Pain

Sources

  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.