Liver abscess: Difference between revisions
From IDWiki
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== Management == |
== Management == |
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* Get source control |
* Get source control |
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| + | * Antibiotics should be broad-spectrum, such as [[Is treated by::piperacillin-tazobactam]], [[Is treated by::ertapenem]] or [[Is treated by::meropenem]], [[Is treated by::ceftriaxone]] plus [[Is treated by::metronidazole]], or [[Is treated by::ciprofloxacin]] plus [[Is treated by::metronidazole]] |
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| − | * Treat for 4-6 weeks, ensuring radiological resolution of abscess |
+ | * Treat for 4-6 weeks total, ensuring radiological resolution of abscess |
| + | ** Can step down to oral therapy after 2 to 3 weeks if responding appropriately |
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[[Category:Intra-abdominal infections]] |
[[Category:Intra-abdominal infections]] |
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Revision as of 17:55, 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
- Antibiotics should be broad-spectrum, such as piperacillin-tazobactam, ertapenem or meropenem, ceftriaxone plus metronidazole, or ciprofloxacin plus metronidazole
- Treat for 4-6 weeks total, ensuring radiological resolution of abscess
- Can step down to oral therapy after 2 to 3 weeks if responding appropriately
