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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
Clinical Features
Differential Diagnosis
Diagnosis
- CBC
- Elevated white blood count (70-80%)
- CMP
- Liver Panel
- Elevated alkaline phosphatase levels (90%)
- Coags
- Blood cultures
- Ultrasound
- 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
- ↑ 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.