Gastroenterology Book

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Liver Abscess

Aka: Liver Abscess, Hepatic Abscess
  1. Causes
    1. Amebiasis
    2. Bacterial Infection
      1. Aerobic Gram Negative Bacteria
      2. Streptococcus species
      3. Staphylococcus aureus
      4. Anaerobic Bacteria (Clostridium difficile)
      5. Syphilis (Treponema pallidum)
      6. NeisseriaGonorrhea
  2. Pathophysiology
    1. Sources
      1. Portal Vein infection
      2. Systemic bacteremia
      3. Ascending Cholangitis
      4. Direct extension
        1. Appendicitis
        2. Ruptured Peptic Ulcer
        3. Empyema
    2. Majority of abscesses are single
    3. Subacute onset over weeks
  3. Symptoms
    1. Fever
    2. Chills
    3. Nausea
    4. Anorexia
    5. Weight loss
    6. Right Upper Quadrant Abdominal Pain (50%)
      1. Pain may radiate to right Shoulder
  4. Signs
    1. Hepatomegaly
    2. Right upper quadrant tenderness
    3. Jaundice
  5. Labs
    1. Complete Blood Count (CBC)
      1. Anemia
      2. Leukocytosis
    2. Liver Function Test abnormalities
      1. Alkaline Phosphatase increased
      2. Aspartate Aminotransferase (AST) elevated
      3. Alanine Aminotransferase (ALT) elevated
    3. Blood Cultures (50% sensitive)
  6. Radiology
    1. Abdominal XRay
      1. Right diaphragm elevated
    2. CT Abdomen or RUQ Ultrasound
      1. Fluid filled Liver masses
  7. Management
    1. Empiric broad spectrum triple antibiotics
      1. Clindamycin or Metronidazole and
      2. Aminoglycoside and
      3. Consider Ampicillin
    2. Focus antibiotic coverage with Blood Culture results
    3. Surgery or percutaneous drainage

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