Diferencia entre revisiones de «Hepatic abscess»
(Prepared the page for translation)
 
(No se muestran 17 ediciones intermedias de 8 usuarios)
Línea 1: Línea 1:
<languages/>
<translate>
==Background==
==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


{{Liver abscess DDX}}
[[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), [[Special:MyLanguage/cholangitis|cholangitis]], [[Special:MyLanguage/diverticulitis|diverticulitis]], pancreatic abscess, [[Special:MyLanguage/appendicitis|appendicitis]] and [[Special:MyLanguage/inflammatory bowel disease|inflammatory bowel disease]].
**Possible arterial hematogenous seeding: [[Special:MyLanguage/sepsis|sepsis]], direct [[Special:MyLanguage/trauma|trauma]] or instrumentation
**Usually polymicrobial
*[[Special:MyLanguage/amebiasis|Amebic]] (10%)
**E. histolytica most common
**Usually not septic and sick, rarely needs drainage
*[[Special:MyLanguage/fungal infections|Fungal]] (<10%), [[Special:MyLanguage/candida|candidal]]
*Hydatid cyst ([[Special:MyLanguage/echinococcosis|echinococcosis]])
**Associated with sheep farmers
 


==Clinical Features==
==Clinical Features==
*[[RUQ pain]]
 
*High [[fever]]
*[[Special:MyLanguage/RUQ pain|RUQ pain]]
*[[Nausea]], [[vomiting]], anorexia
*High [[Special:MyLanguage/fever|fever]]
*[[Special:MyLanguage/Nausea|Nausea]], [[Special:MyLanguage/vomiting|vomiting]], anorexia
*Clay-colored stool
*Clay-colored stool
*Dark urine
*Dark urine
*[[Jaundice]]
*[[Special:MyLanguage/Jaundice|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 R [[pleural effusions]]
*Often with right [[Special:MyLanguage/pleural effusions|pleural effusions]]
 


==Differential Diagnosis==
==Differential Diagnosis==
</translate>
{{Liver abscess DDX}}
<translate>
</translate>
{{DDX RUQ}}
{{DDX RUQ}}
<translate>
==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===


==Diagnosis==
*CBC - Elevated white blood count (70-80%)
*CBC
*BMP
**Elevated white blood count (70-80%)
*[[Special:MyLanguage/LFTs|LFTs]] - Elevated alkaline phosphatase levels (90%)
*CMP
*Liver Panel
**Elevated alkaline phosphatase levels (90%)
*Coags
*Coags
*[[Blood cultures]]
*[[Special:MyLanguage/Blood cultures|Blood cultures]]
*Ultrasound
*Amebic and echinococcal serologies
**80-100% sensitivity
*[[Special:MyLanguage/RUQ ultrasound|Ultrasound]] (80-100% sensitivity)
*ABD/Pelvis CT
*CT abd/pelvis ('''Imaging study of choice''')
**Imaging study of choice
**Triphasic CT scan to define the proximity of the [[Special:MyLanguage/abscess|abscess]] to the major branches of the portal and hepatic veins
**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==
==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>
*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]]
***[[Special:MyLanguage/Gram Negs|Gram Negs]]: third or fourth generation [[Special:MyLanguage/cephalosporin|cephalosporin]] ([[Special:MyLanguage/ceftriaxone|ceftriaxone]]) or [[Special:MyLanguage/aminoglycoside|aminoglycoside]]
***[[Gram Pos]]: [[penicillin]] for [[streptococcal]] species ([[ampicillin]])
***[[Special:MyLanguage/Gram Pos|Gram Pos]]: [[Special:MyLanguage/penicillin|penicillin]] for [[Special:MyLanguage/streptococcal|streptococcal]] species ([[Special:MyLanguage/ampicillin|ampicillin]])
****For PCN allergic, use [[fluoroquinolones]]
****For penicillin allergic, use [[Special:MyLanguage/fluoroquinolones|fluoroquinolones]]
***[[Anaerobes]]: [[metronidazole]] or [[clindamycin]]
***[[Special:MyLanguage/Anaerobes|Anaerobes]]: [[Special:MyLanguage/metronidazole|metronidazole]] or [[Special:MyLanguage/clindamycin|clindamycin]]


*Diagnostic aspiration and drainage of the abscess followed by placement of drainage catheter
*Diagnostic aspiration and drainage of the [[Special:MyLanguage/abscess|abscess]] followed by placement of drainage catheter
**Sonographic guidance for small or superficial abscesses
**Sonographic guidance for small or superficial abscesses
**CT guidance for deep or multiple abscesses
**CT guidance for deep or multiple abscesses
Línea 55: Línea 90:
**Failure of percutaneous aspiration and drainage
**Failure of percutaneous aspiration and drainage
**Coexistence of inra-abdominal disease that requires surgical management
**Coexistence of inra-abdominal disease that requires surgical management


==Disposition==
==Disposition==
*Admit for IV [[antibiotics]] and drainage/sugery
 
*Admit for IV [[Special:MyLanguage/antibiotics|antibiotics]] and surgical drainage
 


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


==Sources==
*[[Special:MyLanguage/Right upper quadrant abdominal pain|Right upper quadrant abdominal pain]]
*[[Special:MyLanguage/Amebiasis|Amebiasis]]
 
 
==References==
 
<references/>
<references/>


[[Category:GI]]
[[Category:GI]]
[[Category:ID]]
[[Category:ID]]
</translate>

Revisión actual - 22:59 4 ene 2026


Background

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.
Inferior view of the liver with surface showing lobes and impressions.
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


Clinical Features


Differential Diagnosis

Hepatic abscess

RUQ Pain


Evaluation

Liver abscess on axial CT image: a hypodense lesion in the liver with peripherally enhancement.
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
  • 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

  • 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

  1. ↑ 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.
  2. ↑ 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.
Obtenido de «https://www.wikem.org/w/index.php?title=Hepatic_abscess&oldid=378986»