Ver el código de «Hepatic abscess»

==Background==
[[File:Biliary system multilingual.png|thumb|Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.]]
[[File:Sobo 1906 389.png|thumb|Inferior view of the liver with surface showing lobes and impressions.]]
[[File:Liver vascular anatomy.png|thumb|Liver vascular anatomy.]]
*Uncommon overall - usually occurs in right liver lobe
**More abscesses → more severe disease
*History of camping is common
**Endemic of Midwest

===Types===
*Pyogenic (80%)
**Most common cause
**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
**Usually polymicrobial
*[[amebiasis|Amebic]] (10%)
**E. histolytica most common
**Usually not septic and sick, rarely needs drainage
*[[fungal infections|Fungal]] (<10%), [[candida|candidal]]
*Hydatid cyst ([[echinococcosis]])
**Associated with sheep farmers

==Clinical Features==
*[[RUQ pain]]
*High [[fever]]
*[[Nausea]], [[vomiting]], anorexia
*Clay-colored stool
*Dark urine
*[[Jaundice]] - seen with pyogenic, as opposed to amebic<ref>Oyama LC. 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 8. St. Louis, Mosby, Inc., 2013, (Ch) 90: p 1186-1205.</ref>
*Often with right [[pleural effusions]]

==Differential Diagnosis==
{{Liver abscess DDX}}

{{DDX RUQ}}

==Evaluation==
[[File:Leberabszess - CT axial PV.jpg|thumb|Liver abscess on axial CT image: a hypodense lesion in the liver with peripherally enhancement.]]
[[File:LargeHepaticAbscessMark.png|thumb|A large pyogenic liver abscess.]]
===Work-up===
*CBC - Elevated white blood count (70-80%)
*BMP
*[[LFTs]] - Elevated alkaline phosphatase levels (90%)
*Coags
*[[Blood cultures]]
*Amebic and echinococcal serologies
*[[RUQ ultrasound|Ultrasound]] (80-100% sensitivity)
*CT abd/pelvis ('''Imaging study of choice''')
**Triphasic CT scan to define the proximity of the [[abscess]] to the major branches of the portal and hepatic veins

===Evaluation===
*Diagnosis usually made on imaging studies

==Management==
*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
***[[Gram Negs]]: third or fourth generation [[cephalosporin]] ([[ceftriaxone]]) or [[aminoglycoside]]
***[[Gram Pos]]: [[penicillin]] for [[streptococcal]] species ([[ampicillin]])
****For penicillin allergic, use [[fluoroquinolones]]
***[[Anaerobes]]: [[metronidazole]] or [[clindamycin]]

*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 surgical drainage

==See Also==
*[[Right upper quadrant abdominal pain]]
*[[Amebiasis]]

==References==
<references/>

[[Category:GI]]
[[Category:ID]]