Hepatic Abscess

• • 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%

Epidemiology

• • Equal incidence among men and women

  • Median age onset: In fifth decade

Symptoms and Signs

• • Fever

  • Right upper quadrant pain

  • Jaundice

  • Dyspnea

Laboratory Findings

• • Leukocytosis

  • Elevated alkaline phosphatase

  • Elevated transaminases

  • Hypoalbuminemia

Imaging Findings

• • 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)

• • Other intra-abdominal sepsis

  • Other infections, eg, amebic or hydatid disease

  • Biliary obstruction

• • 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

Surgery

• • 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

Medications

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

Complications

• • Recurrent abscess

  • Liver failure

  • Bile leak

References