III. 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

IV. 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

V. Signs

  1. Hepatomegaly
  2. Right upper quadrant tenderness
  3. Jaundice

VII. Radiology

  1. Abdominal XRay
    1. Right diaphragm elevated
  2. CT Abdomen or RUQ Ultrasound
    1. Fluid filled Liver masses

VIII. 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

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window