Moffitt AM Report PEARLS 6/26: Approach to liver abscesses

  • Etiology:
    • Hematogenous seeding
    • Direct spread (from portal circulation, biliary infection)
  • Organisms:
    • Pyogenic
      • Monomicrobial vs. polymicrobial
      • *Klebsiella pneumonia is responsible for 50% of liver abscesses in Taiwan and is almost always monomicrobial
    • Amebic (E. histolytica)
    • Echinococcus
  • A GREAT table drawn up on the board by HH – a for sure PEARL!!
  Amebic liver abscess Pyogenic liver abscess
Location R lobe > L lobe Anywhere
Pleuropulmonary involvement 50% Rare
# of lesions Single Single or multiple
Aspirate Anchovy paste (cytolytic, so low WBC) Frank pus
  • Diagnosis:
    • *For E. histolytica, can send serologies (99% of pts with amebic liver abscess have +Abs!)
    • *For pyogenic abscesses, 50% of BCx are positive. Dx confirmed by aspiration
  • Treatment for pyogenic liver abscesses:
    • Empiric abx:
      • monotherapy with beta-lactam/beta-lactamase inhibitor (e.g. zosyn) or penem
      • OR, CTX + flagyl
    • Drainage!
      • If <5cm à percutaneous catheter drainage or needle aspiration
      • If >5cm à catheter drainage > needle aspiration
        • Keep drain in until drainage ceases
      • Consider surgical intervention if: multiple abscesses, loculated abscesses, inadequate response to percutaneous drainage within 7 days
      • See attached paper (thanks Kevin!) Rx of pyogenic liver abscess



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