Hepatic Abscess
Pathology (Branum et al., 1990; NIH 2009): A condition which pyogenic bacteria enters the blood flow system and gains access to the hepatic system through the portal vein or hepatic artery. This condition effects the liver as well as the gallbladder. E.coli is the most common bacteria found in the blood system.
Demographics (NIH, 2009): Occurs most commonly in the fourth to six decade of life. Hepatic abscess can occur as a result of abdominal abscess such as acute diverticulitis and inflammatory bowel disease. In nearly half of the cases, the cause is unknown.
Clinical Presentation (NIH, 2009): In early stages, the abscess may be asymptomatic. Common signs and symptoms include right abdominal pain, right shoulder pain, weight loss, fever, chills, hepatomegaly, diaphoresis, nausea, rales, pleural involvement, vomiting, anemia and jaundice. Fever and right upper quadrant pain are the most common clinical symptoms.
Differential Diagnosis (Branum et al., 1990; NIH 2009, Goodman & Snyder, 2007): thorough patient history, with focus on reviewing all red flags and constitutional signs and symptoms to check for systemic illness. If abscess is suspected, there should be an emphasis placed on constitutional signs and symptoms. Examination should also include palpation of the liver to determine if there is hepatomegaly, observation for ascites or jaundice (skin and eyes), test for asterixis, a measurement of the patient’s body temperature. Positional testing and lung auscultation should be performed to rule out musculoskeletal involvement and pleural involvement.
Bottom Line: Refer out
Abscess can lead to sepsis which can be fatal to the patient. If abscess is suspected, immediate physician referral is warranted.
Demographics (NIH, 2009): Occurs most commonly in the fourth to six decade of life. Hepatic abscess can occur as a result of abdominal abscess such as acute diverticulitis and inflammatory bowel disease. In nearly half of the cases, the cause is unknown.
Clinical Presentation (NIH, 2009): In early stages, the abscess may be asymptomatic. Common signs and symptoms include right abdominal pain, right shoulder pain, weight loss, fever, chills, hepatomegaly, diaphoresis, nausea, rales, pleural involvement, vomiting, anemia and jaundice. Fever and right upper quadrant pain are the most common clinical symptoms.
Differential Diagnosis (Branum et al., 1990; NIH 2009, Goodman & Snyder, 2007): thorough patient history, with focus on reviewing all red flags and constitutional signs and symptoms to check for systemic illness. If abscess is suspected, there should be an emphasis placed on constitutional signs and symptoms. Examination should also include palpation of the liver to determine if there is hepatomegaly, observation for ascites or jaundice (skin and eyes), test for asterixis, a measurement of the patient’s body temperature. Positional testing and lung auscultation should be performed to rule out musculoskeletal involvement and pleural involvement.
Bottom Line: Refer out
Abscess can lead to sepsis which can be fatal to the patient. If abscess is suspected, immediate physician referral is warranted.