Liver abscess: Difference between revisions
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** '''Cryptogenic''': second most common mechanism is "unknown" |
** '''Cryptogenic''': second most common mechanism is "unknown" |
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* Amebic: see ''[[Entamoeba histolytica]]'' |
* Amebic: see ''[[Entamoeba histolytica]]'' |
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| + | |||
| + | == Clinical Presentation == |
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| + | * Most common signs are fever, abdominal pain, leukocytosis, and an elevated alkaline phosphatase |
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| + | ** Often presents with fevers alone, however |
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| + | * May also have weight loss, diarrhea, RUQ tenderness, and jaundice |
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| + | * The classic triad is considered to be fever, jaundice, and RUQ tenderness |
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| + | |||
| + | == Investigations == |
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| + | * Blood cultures are about 50% sensitive |
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| + | * Imaging with ultrasound or CT is important |
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| + | * Consider ''E. histolytica'' serology to rule out amebic liver abscess, since the syndromes cannot reliably be distinguished clinically |
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== Management == |
== Management == |
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Revision as of 17:49, 13 February 2020
Background
Microbiology
- Pyogenic
- Gram-negative bacteria
- Escherichia coli
- Klebsiella species
- Less common: Pseudomonas aeruginosa, Proteus, Enterobacter, Citrobacter, and Serratia
- Gram-positive bacteria
- Streptococcus species, especially anginosus group
- Enterococcus species
- Other Viridans group streptococci
- Less common Staphylococcus aureus and Streptococcus pyogenes
- Anaerobes
- Bacteroides species
- Less common: Fusobacterium, anaerobic streptococci, Clostridium species, Lactobacillus
- Gram-negative bacteria
- Amebic
Etiology
- Pyogenic
- Biliary: most common mechanism, includes ascending cholangitis
- Hematogenous via hepatic artery: from bacteremia
- Hematogenous via portal vein: from an infection abdominal organ duch as diverticulitis, pancreatitis, or appendicitis
- Contiguous spread
- Trauma: including things like ingested toothpicks
- Cryptogenic: second most common mechanism is "unknown"
- Amebic: see Entamoeba histolytica
Clinical Presentation
- Most common signs are fever, abdominal pain, leukocytosis, and an elevated alkaline phosphatase
- Often presents with fevers alone, however
- May also have weight loss, diarrhea, RUQ tenderness, and jaundice
- The classic triad is considered to be fever, jaundice, and RUQ tenderness
Investigations
- Blood cultures are about 50% sensitive
- Imaging with ultrasound or CT is important
- Consider E. histolytica serology to rule out amebic liver abscess, since the syndromes cannot reliably be distinguished clinically
Management
- Get source control
- Treat for 4-6 weeks, ensuring radiological resolution of abscess
