-Hepatic abscesses may be bacterial, parasitic, or fungal in origin.
-the most common identifiable cause of hepatic abscess is acute cholangitis resulting from biliary obstruction due to a stone, stricture or neoplasm
-Pyogenic liver abscesses are the most common liver abscesses seen in the United States.
-Abscesses are most commonly single, but more than one may be present.
-The right lobe is usually involved.
Causes: suppurative process, infection from appendicitis, diverticulitis, bacterial endocarditis, renal infection, lung infection, infected indwelling catheters,
Symptoms & Signs
Fatigue,fever, right upper quadrant pain, chills, jaundice, weight loss, elevated hemidiaphragm
Labs: Leukocytosis with a left shift, positive blood cultures, elevated AP level
Imaging: Chest radiographs, Ultrasonography, CT, or MRI of the liver
Hepatic candidiasis: CT liver shows multiple ‘bulls-eyes’
Bacterial abscess: Empiric antibiotic therapy should cover gram-negative and anaerobic organisms
Fungal abscess: Amphotericin B, Fluconazole
Amebiasis: Metronidazole or tinidazole
Surgery: percutaneous drainage, open debridement, lobectomy
-With drainage and antibiotics, the cure rate is about 90%.
-The overall mortality rate of 15%
-The mortality rate is about 40% in patients with malignant disease.
Fungal abscesses are associated with mortality rates of up to 50%
- What is the most common presenting sign of liver abscess? Fever
- What is the single most reliable laboratory finding in patients with liver abscess? Elevated serum alkaline phosphatase
- What is the most useful diagnostic aid in evaluating liver abscess? Ultrasound liver