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.
--Lower right chest pain or RUQ abdominal pain
--nausea, vomiting, anorexia
--Primary biliary cirrhosis
--Hepatomegaly due to CHF
--PUD/Gastritis/perforated duodenal or gastric ulcer
--CBC, CMP, LFTs, bilirubin, coags, blood cultures
--abdominal ultrasound- 80-100% sensitivity
--abdominal 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
--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.
--Admit for IV antibiotics and drainage/sugery
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