Hepatic abscess: Difference between revisions

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==Background==
==Background==
*Uncommon overall, usually right liver lobe
*Uncommon overall - usually occurs in right liver lobe
*More abscesses -> more severe disease
**More abscesses more severe disease
*Camping history
*History of camping is common
*Endemic of Midwest
**Endemic of Midwest


===Types===
===Types===
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*Dark urine
*Dark urine
*[[Jaundice]]
*[[Jaundice]]
*Often with R [[pleural effusions]]
*Often with right [[pleural effusions]]


==Differential Diagnosis==
==Differential Diagnosis==
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==Diagnosis==
==Diagnosis==
*CBC
===Work-up===
**Elevated white blood count (70-80%)
*CBC - Elevated white blood count (70-80%)
*CMP
*BMP
*Liver Panel
*Liver Panel - Elevated alkaline phosphatase levels (90%)
**Elevated alkaline phosphatase levels (90%)
*Coags
*Coags
*[[Blood cultures]]
*[[Blood cultures]]
*Ultrasound
*Ultrasound (80-100% sensitivity)
**80-100% sensitivity
*CT ABD/Pelvis ('''Imaging study of choice''')
*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
**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==
==Management==
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==Disposition==
==Disposition==
*Admit for IV [[antibiotics]] and drainage/sugery
*Admit for IV [[antibiotics]] and surgical drainage


==See Also==
==See Also==

Revision as of 11:38, 22 August 2015

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

Clinical Features

Differential Diagnosis

Hepatic abscess

RUQ Pain

Diagnosis

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. 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.