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Liver Abscess
Aka: Liver Abscess, Hepatic Abscess
- Causes
- Amebiasis or Entamoeba histolytica (10-15%)
- Fecal-oral transmission in endemic regions (asia, africa, latin america)
- Fungal including candida (<10%)
- Bacterial Infection (80%)
- Aerobic Gram Negative Bacteria (Enterobacteriaciae, esp. Klebsiella species)
- Streptococcus species
- Enterococcus
- Staphylococcus aureus
- Anaerobic Bacteria (Clostridium difficile)
- Syphilis (Treponema pallidum)
- NeisseriaGonorrhea
- Bartonella (AIDS)
- Yersinia enterocolitica (rare, except in Hemochromatosis)
- Pathophysiology
- Bacterial causes are associated with identified GI or biliary tract source in 50% of cases
- Sources
- Portal Vein infection
- Systemic bacteremia
- Ascending Cholangitis
- Direct extension
- Appendicitis
- Diverticulitis
- Ruptured Peptic Ulcer
- Empyema
- Majority of abscesses are single
- Subacute onset over weeks
- Symptoms
- Fever
- Chills
- Nausea
- Anorexia
- Weight loss
- Right Upper Quadrant Abdominal Pain (50%)
- Pain may radiate to right Shoulder
- Signs
- Hepatomegaly
- Right upper quadrant tenderness
- Jaundice
- Labs
- Complete Blood Count (CBC)
- Anemia
- Leukocytosis
- Liver Function Test abnormalities
- Alkaline Phosphatase increased
- Aspartate Aminotransferase (AST) elevated
- Alanine Aminotransferase (ALT) elevated
- Blood Cultures (50% sensitive)
- Obtain AmebiasisSerology on all patients
- Imaging
- CT Abdomen or RUQ Ultrasound
- Fluid filled Liver masses
- Management
- Initial empiric broad spectrum antibiotics
- Metronidazole 30-40 mg/kg/day divided every 8 hours IV (or 500 mg every 6-8 hours orally) AND
- Choose one second antibiotic
- Ceftriaxone 1-2 g IV every 24 hours OR
- Piperacillin-Tazobactam 3.375 g IV every 4-6 hours OR
- Ciprofloxacin 400 mg IV every 12 hours OR
- Levofloxacin 400 mg IV every 12 hours OR
- Ertapenem 1 g IV every 24 hours
- Focus antibiotic coverage with Blood Culture results
- After sufficient abscess drainage, antibiotic course of 4-5 days is typically adequate (up to 8-10 day course)
- Sawyer (2015) N Engl J Med 372:1996-2005 +PMID:25992746 [PubMed]
- Surgery or percutaneous drainage
- References
- (2019) Hepatic Abscess, Sanford Guide, accessed 9/26/2018
- Akhondi (2019) Liver Abscess, StatPearls +PMID:30855818