Hepatic abscess - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T22:59:09Z

Prepared the page for translation

← Older revision		Revision as of 22:59, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	[[File:Biliary system multilingual.png\|thumb\|Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.]]		[[File:Biliary system multilingual.png\|thumb\|Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.]]
	[[File:Sobo 1906 389.png\|thumb\|Inferior view of the liver with surface showing lobes and impressions.]]		[[File:Sobo 1906 389.png\|thumb\|Inferior view of the liver with surface showing lobes and impressions.]]
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	*History of camping is common		*History of camping is common
	**Endemic of Midwest		**Endemic of Midwest


	===Types===		===Types===

	*Pyogenic (80%)		*Pyogenic (80%)
	**Most common cause		**Most common cause
	**Associated with biliary tract obstruction (most common), [[cholangitis]], [[diverticulitis]], pancreatic abscess, [[appendicitis]] and [[inflammatory bowel disease]].		**Associated with biliary tract obstruction (most common), [[Special:MyLanguage/cholangitis\|cholangitis]], [[Special:MyLanguage/diverticulitis\|diverticulitis]], pancreatic abscess, [[Special:MyLanguage/appendicitis\|appendicitis]] and [[Special:MyLanguage/inflammatory bowel disease\|inflammatory bowel disease]].
	**Possible arterial hematogenous seeding: [[sepsis]], direct [[trauma]] or instrumentation		**Possible arterial hematogenous seeding: [[Special:MyLanguage/sepsis\|sepsis]], direct [[Special:MyLanguage/trauma\|trauma]] or instrumentation
	**Usually polymicrobial		**Usually polymicrobial
	*[[amebiasis\|Amebic]] (10%)		*[[Special:MyLanguage/amebiasis\|Amebic]] (10%)
	**E. histolytica most common		**E. histolytica most common
	**Usually not septic and sick, rarely needs drainage		**Usually not septic and sick, rarely needs drainage
	*[[fungal infections\|Fungal]] (<10%), [[candida\|candidal]]		*[[Special:MyLanguage/fungal infections\|Fungal]] (<10%), [[Special:MyLanguage/candida\|candidal]]
	*Hydatid cyst ([[echinococcosis]])		*Hydatid cyst ([[Special:MyLanguage/echinococcosis\|echinococcosis]])
	**Associated with sheep farmers		**Associated with sheep farmers


	==Clinical Features==		==Clinical Features==
	*[[RUQ pain]]
	*High [[fever]]		*[[Special:MyLanguage/RUQ pain\|RUQ pain]]
	*[[Nausea]], [[vomiting]], anorexia		*High [[Special:MyLanguage/fever\|fever]]
			*[[Special:MyLanguage/Nausea\|Nausea]], [[Special:MyLanguage/vomiting\|vomiting]], anorexia
	*Clay-colored stool		*Clay-colored stool
	*Dark urine		*Dark urine
	*[[Jaundice]] - seen with pyogenic, as opposed to amebic<ref>Oyama LC. Disorders of the Liver and Biliary Tract, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 90: p 1186-1205.</ref>		*[[Special:MyLanguage/Jaundice\|Jaundice]] - seen with pyogenic, as opposed to amebic<ref>Oyama LC. Disorders of the Liver and Biliary Tract, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 90: p 1186-1205.</ref>
	*Often with right [[pleural effusions]]		*Often with right [[Special:MyLanguage/pleural effusions\|pleural effusions]]


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Liver abscess DDX}}		{{Liver abscess DDX}}
			<translate>

			</translate>
	{{DDX RUQ}}		{{DDX RUQ}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:Leberabszess - CT axial PV.jpg\|thumb\|Liver abscess on axial CT image: a hypodense lesion in the liver with peripherally enhancement.]]		[[File:Leberabszess - CT axial PV.jpg\|thumb\|Liver abscess on axial CT image: a hypodense lesion in the liver with peripherally enhancement.]]
	[[File:LargeHepaticAbscessMark.png\|thumb\|A large pyogenic liver abscess.]]		[[File:LargeHepaticAbscessMark.png\|thumb\|A large pyogenic liver abscess.]]

	===Work-up===		===Work-up===

	*CBC - Elevated white blood count (70-80%)		*CBC - Elevated white blood count (70-80%)
	*BMP		*BMP
	*[[LFTs]] - Elevated alkaline phosphatase levels (90%)		*[[Special:MyLanguage/LFTs\|LFTs]] - Elevated alkaline phosphatase levels (90%)
	*Coags		*Coags
	*[[Blood cultures]]		*[[Special:MyLanguage/Blood cultures\|Blood cultures]]
	*Amebic and echinococcal serologies		*Amebic and echinococcal serologies
	*[[RUQ ultrasound\|Ultrasound]] (80-100% sensitivity)		*[[Special:MyLanguage/RUQ ultrasound\|Ultrasound]] (80-100% sensitivity)
	*CT abd/pelvis ('''Imaging study of choice''')		*CT abd/pelvis ('''Imaging study of choice''')
	**Triphasic CT scan to define the proximity of the [[abscess]] to the major branches of the portal and hepatic veins		**Triphasic CT scan to define the proximity of the [[Special:MyLanguage/abscess\|abscess]] to the major branches of the portal and hepatic veins


	===Evaluation===		===Evaluation===

	*Diagnosis usually made on imaging studies		*Diagnosis usually made on imaging studies


	==Management==		==Management==

	*IV antibiotics<ref>Guss DA, Oyama LA: Disorders of the Liver and Biliary Tract, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 88: p 1153-1171.</ref>		*IV antibiotics<ref>Guss DA, Oyama LA: Disorders of the Liver and Biliary Tract, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 88: p 1153-1171.</ref>
	**Two or more antibiotics		**Two or more antibiotics
	***[[Gram Negs]]: third or fourth generation [[cephalosporin]] ([[ceftriaxone]]) or [[aminoglycoside]]		***[[Special:MyLanguage/Gram Negs\|Gram Negs]]: third or fourth generation [[Special:MyLanguage/cephalosporin\|cephalosporin]] ([[Special:MyLanguage/ceftriaxone\|ceftriaxone]]) or [[Special:MyLanguage/aminoglycoside\|aminoglycoside]]
	***[[Gram Pos]]: [[penicillin]] for [[streptococcal]] species ([[ampicillin]])		***[[Special:MyLanguage/Gram Pos\|Gram Pos]]: [[Special:MyLanguage/penicillin\|penicillin]] for [[Special:MyLanguage/streptococcal\|streptococcal]] species ([[Special:MyLanguage/ampicillin\|ampicillin]])
	****For penicillin allergic, use [[fluoroquinolones]]		****For penicillin allergic, use [[Special:MyLanguage/fluoroquinolones\|fluoroquinolones]]
	***[[Anaerobes]]: [[metronidazole]] or [[clindamycin]]		***[[Special:MyLanguage/Anaerobes\|Anaerobes]]: [[Special:MyLanguage/metronidazole\|metronidazole]] or [[Special:MyLanguage/clindamycin\|clindamycin]]

	*Diagnostic aspiration and drainage of the [[abscess]] followed by placement of drainage catheter		*Diagnostic aspiration and drainage of the [[Special:MyLanguage/abscess\|abscess]] followed by placement of drainage catheter
	**Sonographic guidance for small or superficial abscesses		**Sonographic guidance for small or superficial abscesses
	**CT guidance for deep or multiple abscesses		**CT guidance for deep or multiple abscesses
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	**Failure of percutaneous aspiration and drainage		**Failure of percutaneous aspiration and drainage
	**Coexistence of inra-abdominal disease that requires surgical management		**Coexistence of inra-abdominal disease that requires surgical management


	==Disposition==		==Disposition==
	*Admit for IV [[antibiotics]] and surgical drainage
			*Admit for IV [[Special:MyLanguage/antibiotics\|antibiotics]] and surgical drainage


	==See Also==		==See Also==
	*[[Right upper quadrant abdominal pain]]
	*[[Amebiasis]]		*[[Special:MyLanguage/Right upper quadrant abdominal pain\|Right upper quadrant abdominal pain]]
			*[[Special:MyLanguage/Amebiasis\|Amebiasis]]


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:ID]]		[[Category:ID]]
			</translate>

Rossdonaldson1 at 23:12, 13 November 2024

2024-11-13T23:12:18Z

← Older revision		Revision as of 23:12, 13 November 2024
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	==Background==		==Background==
			[[File:Biliary system multilingual.png\|thumb\|Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.]]
	[[File:Sobo 1906 389.png\|thumb\|Inferior view of the liver with surface showing lobes and impressions.]]		[[File:Sobo 1906 389.png\|thumb\|Inferior view of the liver with surface showing lobes and impressions.]]
	[[File:Liver vascular anatomy.png\|thumb\|Liver vascular anatomy.]]		[[File:Liver vascular anatomy.png\|thumb\|Liver vascular anatomy.]]

Rossdonaldson1 at 23:04, 13 November 2024

2024-11-13T23:04:32Z

← Older revision		Revision as of 23:04, 13 November 2024
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	==Background==		==Background==
	[[File:Sobo 1906 389.png\|thumb\|Inferior view of the liver with surface showing lobes and impressions.]]		[[File:Sobo 1906 389.png\|thumb\|Inferior view of the liver with surface showing lobes and impressions.]]
			[[File:Liver vascular anatomy.png\|thumb\|Liver vascular anatomy.]]
	*Uncommon overall - usually occurs in right liver lobe		*Uncommon overall - usually occurs in right liver lobe
	**More abscesses → more severe disease		**More abscesses → more severe disease

Rossdonaldson1 at 22:57, 13 November 2024

2024-11-13T22:57:54Z

← Older revision		Revision as of 22:57, 13 November 2024
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	==Background==		==Background==
			[[File:Sobo 1906 389.png\|thumb\|Inferior view of the liver with surface showing lobes and impressions.]]
	*Uncommon overall - usually occurs in right liver lobe		*Uncommon overall - usually occurs in right liver lobe
	**More abscesses → more severe disease		**More abscesses → more severe disease

Rossdonaldson1: /* Evaluation */

2021-07-08T19:05:16Z

Evaluation

← Older revision		Revision as of 19:05, 8 July 2021
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	==Evaluation==		==Evaluation==
	[[File:Leberabszess - CT axial PV.jpg\|thumb\|Liver abscess on axial CT image: a hypodense lesion in the liver with peripherally enhancement.]]		[[File:Leberabszess - CT axial PV.jpg\|thumb\|Liver abscess on axial CT image: a hypodense lesion in the liver with peripherally enhancement.]]
			[[File:LargeHepaticAbscessMark.png\|thumb\|A large pyogenic liver abscess.]]
	===Work-up===		===Work-up===
	*CBC - Elevated white blood count (70-80%)		*CBC - Elevated white blood count (70-80%)

Rossdonaldson1: /* Evaluation */

2021-07-08T19:04:13Z

Evaluation

← Older revision		Revision as of 19:04, 8 July 2021
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	==Evaluation==		==Evaluation==
			[[File:Leberabszess - CT axial PV.jpg\|thumb\|Liver abscess on axial CT image: a hypodense lesion in the liver with peripherally enhancement.]]
	===Work-up===		===Work-up===
	*CBC - Elevated white blood count (70-80%)		*CBC - Elevated white blood count (70-80%)

ClaireLewis at 21:00, 29 September 2019

2019-09-29T21:00:05Z

← Older revision		Revision as of 21:00, 29 September 2019
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	*Pyogenic (80%)		*Pyogenic (80%)
	**Most common cause		**Most common cause
	**Associated with biliary tract obstruction (most common), cholangitis, diverticulitis, pancreatic abscess, appendicitis and inflammatory bowel disease.		**Associated with biliary tract obstruction (most common), [[cholangitis]], [[diverticulitis]], pancreatic abscess, [[appendicitis]] and [[inflammatory bowel disease]].
	**Possible arterial hematogenous seeding: sepsis, direct trauma or instrumentation		**Possible arterial hematogenous seeding: [[sepsis]], direct [[trauma]] or instrumentation
	**Usually polymicrobial		**Usually polymicrobial
	*Amebic (10%)		*[[amebiasis\|Amebic]] (10%)
	**E. histolytica most common		**E. histolytica most common
	**Usually not septic and sick, rarely needs drainage		**Usually not septic and sick, rarely needs drainage
	*Fungal (<10%), candidal		*[[fungal infections\|Fungal]] (<10%), [[candida\|candidal]]
	*Hydatid cyst (echinococcosis)		*Hydatid cyst ([[echinococcosis]])
	**Associated with sheep farmers		**Associated with sheep farmers

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	*CBC - Elevated white blood count (70-80%)		*CBC - Elevated white blood count (70-80%)
	*BMP		*BMP
	*~~Liver Panel~~ - Elevated alkaline phosphatase levels (90%)		*[[LFTs]] - Elevated alkaline phosphatase levels (90%)
	*Coags		*Coags
	*[[Blood cultures]]		*[[Blood cultures]]
	*Amebic and echinococcal serologies		*Amebic and echinococcal serologies
	*Ultrasound (80-100% sensitivity)		*[[RUQ ultrasound\|Ultrasound]] (80-100% sensitivity)
	*CT ~~ABD~~/~~Pelvis~~ ('''Imaging study of choice''')		*CT abd/pelvis ('''Imaging study of choice''')
	**Triphasic CT scan to define the proximity of the [[abscess]] to the major branches of the portal and hepatic veins		**Triphasic CT scan to define the proximity of the [[abscess]] to the major branches of the portal and hepatic veins

Kxl328: /* Types */

2018-10-07T01:13:28Z

Types

← Older revision		Revision as of 01:13, 7 October 2018
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	===Types===		===Types===
	*Pyogenic		*Pyogenic (80%)
	**Most common cause		**Most common cause
	**Associated with biliary tract obstruction (most common), cholangitis, diverticulitis, pancreatic abscess, appendicitis and inflammatory bowel disease.		**Associated with biliary tract obstruction (most common), cholangitis, diverticulitis, pancreatic abscess, appendicitis and inflammatory bowel disease.
	**Possible arterial hematogenous seeding: sepsis, direct trauma or instrumentation		**Possible arterial hematogenous seeding: sepsis, direct trauma or instrumentation
	*Amebic		**Usually polymicrobial
			*Amebic (10%)
	**E. histolytica most common		**E. histolytica most common
	**Usually not septic and sick, rarely needs drainage		**Usually not septic and sick, rarely needs drainage
	*Hydatid cyst		*Fungal (<10%), candidal
			*Hydatid cyst (echinococcosis)
	**Associated with sheep farmers		**Associated with sheep farmers

Aganapathy: /* Differential Diagnosis */

2017-09-18T23:12:28Z

Differential Diagnosis

← Older revision		Revision as of 23:12, 18 September 2017
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	===Types===		===Types===
	*Pyogenic		*Pyogenic
	**~~More~~ common ~~of the two~~		**Most common cause
	**Associated with biliary tract obstruction (most common), cholangitis, diverticulitis, pancreatic abscess, appendicitis and inflammatory bowel disease.		**Associated with biliary tract obstruction (most common), cholangitis, diverticulitis, pancreatic abscess, appendicitis and inflammatory bowel disease.
	**Possible arterial hematogenous seeding: sepsis, direct trauma or instrumentation		**Possible arterial hematogenous seeding: sepsis, direct trauma or instrumentation
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	**E. histolytica most common		**E. histolytica most common
	**Usually not septic and sick, rarely needs drainage		**Usually not septic and sick, rarely needs drainage
			*Hydatid cyst
			**Associated with sheep farmers

	==Clinical Features==		==Clinical Features==
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Liver [[abscess]] DDX}}		{{Liver abscess DDX}}

	{{DDX RUQ}}		{{DDX RUQ}}
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	*Coags		*Coags
	*[[Blood cultures]]		*[[Blood cultures]]
			*Amebic and echinococcal serologies
	*Ultrasound (80-100% sensitivity)		*Ultrasound (80-100% sensitivity)
	*CT ABD/Pelvis ('''Imaging study of choice''')		*CT ABD/Pelvis ('''Imaging study of choice''')

Ostermayer: Text replacement - "abscess " to "abscess "

2017-03-10T10:57:26Z

Text replacement - "abscess " to "abscess "

← Older revision		Revision as of 10:57, 10 March 2017
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Liver abscess DDX}}		{{Liver [[abscess]] DDX}}

	{{DDX RUQ}}		{{DDX RUQ}}
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	*Ultrasound (80-100% sensitivity)		*Ultrasound (80-100% sensitivity)
	*CT ABD/Pelvis ('''Imaging study of choice''')		*CT ABD/Pelvis ('''Imaging study of choice''')
	**Triphasic CT scan to define the proximity of the abscess to the major branches of the portal and hepatic veins		**Triphasic CT scan to define the proximity of the [[abscess]] to the major branches of the portal and hepatic veins

	===Evaluation===		===Evaluation===
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	***[[Anaerobes]]: [[metronidazole]] or [[clindamycin]]		***[[Anaerobes]]: [[metronidazole]] or [[clindamycin]]

	*Diagnostic aspiration and drainage of the abscess followed by placement of drainage catheter		*Diagnostic aspiration and drainage of the [[abscess]] followed by placement of drainage catheter
	**Sonographic guidance for small or superficial abscesses		**Sonographic guidance for small or superficial abscesses
	**CT guidance for deep or multiple abscesses		**CT guidance for deep or multiple abscesses