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  • • Etiologies include:

    • -Benign or malignant obstruction with cholangitis

      -Extrahepatic abdominal sepsis

      -Trauma or surgery to right upper quadrant

      -Hepatic artery thrombosis or hepatic artery chemotherapy

    • Multifocal abscesses: Usually due to biliary obstruction and cholangitis

    • Unifocal abscess: Usually due to hematogenous spread from abdominal sepsis

    • Risk factors:

    • -Metastatic cancer

      -Diabetes

      -Alcoholism

    • Mortality, 15%

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Epidemiology

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  • • Equal incidence among men and women

    • Median age onset: In fifth decade

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Symptoms and Signs

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  • • Fever

    • Right upper quadrant pain

    • Jaundice

    • Dyspnea

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Laboratory Findings

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  • • Leukocytosis

    • Elevated alkaline phosphatase

    • Elevated transaminases

    • Hypoalbuminemia

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Imaging Findings

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  • US and CT: Multifocal or unifocal hepatic abscesses unilocular in appearance and contrast enhancement peripherally by CT

    Chest film: Right lower lobe infiltrate (atelectasis, effusion, etc)

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  • • Other intra-abdominal sepsis

    • Other infections, eg, amebic or hydatid disease

    • Biliary obstruction

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  • • History and physical exam

    • CBC

    • Liver function tests

    • CT scan with contrast

    • CT-guided aspiration of abscess for culture

    • ERCP or percutaneous transhepatic cholangiogram if biliary obstruction suspected

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Surgery

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  • • CT-guided aspiration and drainage for abscesses > 2-3 cm and fewer than 3 total abscesses

    • Surgical drainage if patient has continued signs of sepsis despite antibiotics and CT-guided drainage or if fevers persist for 2 weeks, or if pus is too viscous for drainage

    • Treat biliary obstruction if present

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Medications

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  • • Empiric antibiotic therapy to cover GI flora with double coverage until culture results are available

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Complications

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  • • Recurrent abscess

    • Liver failure

    • Bile leak

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References

Johannsen EC et al. Pyogenic liver abscesses. Infect Dis Clin North Am. 2000;14:547.  [PubMed: 10987109]
Chen SC et al: Predictors of mortality in patients with pyogenic liver abscess. Neth J Med 2008;66:183.
Hsieh HF, et al: Aggressive hepatic resection for patients with pyogenic liver abscess and APACHE II score ≥ 15. Am J Surg 2008;196:346.  [PubMed: 18718219]
Molle I et al: Increased risk and case fatality rate of pyogenic liver abscess in patients with liver cirrhosis: a nationwide study in Denmark. Gut 2001;48:260.  [PubMed: 11156650]

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