Difference between revisions of "Hepatic abscess"

(Background)
Line 4: Line 4:
 
*Camping history
 
*Camping history
 
*Endemic of Midwest
 
*Endemic of Midwest
*Two types: pyogenic and amebic
+
 
**Pyogenic
+
===Types===
***More common of the two
+
*Pyogenic
***Associated with biliary tract obstruction (most common), cholangitis, diverticulitis, pancreatic abscess, appendicitis and inflammatory bowel disease.  
+
**More common of the two
***Possible arterial hematogenous seeding: sepsis, direct trauma or instrumentation
+
**Associated with biliary tract obstruction (most common), cholangitis, diverticulitis, pancreatic abscess, appendicitis and inflammatory bowel disease.  
**Amebic
+
**Possible arterial hematogenous seeding: sepsis, direct trauma or instrumentation
 +
*Amebic
  
 
==Clinical Features==
 
==Clinical Features==

Revision as of 02:52, 10 June 2015

Background

  • Uncommon overall, usually right liver lobe
  • More abscesses -> more severe disease
  • Camping history
  • 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

Clinical Features

Differential Diagnosis

Hepatic abscess

RUQ Pain

Diagnosis

  • 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

References

  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.