Hepatic abscess: Difference between revisions
m (Rossdonaldson1 moved page Pyogenic liver abscess to Hepatic abscess) |
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==Background== | ==Background== | ||
*Uncommon overall, usually right liver lobe | *Uncommon overall, usually right liver lobe | ||
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**Amebic | **Amebic | ||
==Causes== | ===Causes=== | ||
*Pyogenic abscesses | *Pyogenic abscesses | ||
**Aerobic: Escherichia coli, Klebsiella, Pseudomonas | **Aerobic: [[Escherichia coli]], [[Klebsiella]], [[Pseudomonas]] | ||
**Anaerobic: Entercoccus, bacteroides, anaerobic streptococci | **Anaerobic: [[Entercoccus]], [[bacteroides]], anaerobic [[streptococci]] | ||
*Amebic | *[[Amebic]] | ||
**Entamoeba histolytica | **[[Entamoeba histolytica]] | ||
==Clinical Features== | ==Clinical Features== | ||
*RUQ | *[[RUQ pain]] | ||
*High fever | *High [[fever]] | ||
*Nausea, vomiting, anorexia | *[[Nausea]], [[vomiting]], anorexia | ||
*Clay-colored stool | *Clay-colored stool | ||
*Dark urine | *Dark urine | ||
*Jaundice | *[[Jaundice]] | ||
*Often with R pleural effusions | *Often with R [[pleural effusions]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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**Elevated alkaline phosphatase levels (90%) | **Elevated alkaline phosphatase levels (90%) | ||
*Coags | *Coags | ||
*Blood cultures | *[[Blood cultures]] | ||
*Ultrasound | *Ultrasound | ||
**80-100% sensitivity | **80-100% sensitivity | ||
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*IV antibiotics<ref>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.</ref> | *IV antibiotics<ref>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.</ref> | ||
**Two or more antibiotics | **Two or more antibiotics | ||
***Gram Negs: third or fourth generation cephalosporin (ceftriaxone) or aminoglycoside | ***[[Gram Negs]]: third or fourth generation [[cephalosporin]] ([[ceftriaxone]]) or [[aminoglycoside]] | ||
***Gram Pos: penicillin for streptococcal species (ampicillin) | ***[[Gram Pos]]: [[penicillin]] for [[streptococcal]] species ([[ampicillin]]) | ||
****For PCN allergic, use | ****For PCN allergic, use [[fluoroquinolones]] | ||
***Anaerobes: metronidazole or clindamycin | ***[[Anaerobes]]: [[metronidazole]] or [[clindamycin]] | ||
*Diagnostic aspiration and drainage of the abscess followed by placement of drainage catheter | *Diagnostic aspiration and drainage of the abscess followed by placement of drainage catheter | ||
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==Disposition== | ==Disposition== | ||
*Admit for IV antibiotics and drainage/sugery | *Admit for IV [[antibiotics]] and drainage/sugery | ||
==See Also== | ==See Also== | ||
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==Sources== | ==Sources== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 13:12, 3 February 2015
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
- Pyogenic
Causes
- Pyogenic abscesses
- Aerobic: Escherichia coli, Klebsiella, Pseudomonas
- Anaerobic: Entercoccus, bacteroides, anaerobic streptococci
- Amebic
Clinical Features
- RUQ pain
- High fever
- Nausea, vomiting, anorexia
- Clay-colored stool
- Dark urine
- Jaundice
- Often with R pleural effusions
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Workup
- 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
- IV antibiotics[1]
- Two or more antibiotics
- Gram Negs: third or fourth generation cephalosporin (ceftriaxone) or aminoglycoside
- Gram Pos: penicillin for streptococcal species (ampicillin)
- For PCN allergic, use fluoroquinolones
- Anaerobes: metronidazole or clindamycin
- Two or more antibiotics
- 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
- Admit for IV antibiotics and drainage/sugery
See Also
Sources
- ↑ 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.