Hepatic abscess

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Background

Pus filled area in the liver. Usually develops following peritonitis due to leakage of intraabdominal bowel contents that subsequently spread to liver via the portal circulation or via direct spread from biliary infection. It may also result from arterial hematogenous seeding in the setting of sepsis or from direct trauma to the liver or instrumentation.

Clinical Features

--Lower right chest pain or RUQ abdominal pain

--fever, chills

--nausea, vomiting, anorexia

--clay-colored stool

--dark urine

--jaundice

Differential Diagnosis

Workup

--CBC, CMP, LFTs, bilirubin, blood culture

--abdominal ultrasound

--abdominal CT with IV contrast

Management

--IV antibiotics- combination of 2 or more antibiotics- Flagyl and Clindamycin provide wide anaerobic coverage and penetration into the abscess. A 3rd generation Cephalosporin or Aminoglycoside for gram negative coverage. For PCN allergic, use Fluoroquinolones. This modality has been shown to be effective in patients with unilocular abscesses that are less than 3 cm in size.

--Diagnostic aspiration and drainage of the abscess followed by placement of drainage catheter. It is done under sonographic guidance for small or superficial abscesses or CT guidance for deep or multiple abscesses.

--Surgical drainage- for 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

Sources

UpToDate MedlinePlus Medscape