TAILIEUCHUNG - Chapter 121. Intraabdominal Infections and Abscesses (Part 7)

Fever is the most common presenting sign of liver abscess. Some patients, particularly those with associated disease of the biliary tract, have symptoms and signs localized to the right upper quadrant, including pain, guarding, punch tenderness, and even rebound tenderness. Nonspecific symptoms, such as chills, anorexia, weight loss, nausea, and vomiting, may also develop. Only 50% of patients with liver abscesses, however, have hepatomegaly, right-upper-quadrant tenderness, or jaundice; thus, half of patients have no symptoms or signs to direct attention to the liver. Fever of unknown origin (FUO) may be the only manifestation of liver abscess, especially in the. | Chapter 121. Intraabdominal Infections and Abscesses Part 7 Fever is the most common presenting sign of liver abscess. Some patients particularly those with associated disease of the biliary tract have symptoms and signs localized to the right upper quadrant including pain guarding punch tenderness and even rebound tenderness. Nonspecific symptoms such as chills anorexia weight loss nausea and vomiting may also develop. Only 50 of patients with liver abscesses however have hepatomegaly right-upper-quadrant tenderness or jaundice thus half of patients have no symptoms or signs to direct attention to the liver. Fever of unknown origin FUO may be the only manifestation of liver abscess especially in the elderly. Diagnostic studies of the abdomen especially the right upper quadrant should be a part of any FUO workup. The single most reliable laboratory finding is an elevated serum concentration of alkaline phosphatase which is documented in 70 of patients with liver abscesses. Other tests of liver function may yield normal results but 50 of patients have elevated serum levels of bilirubin and 48 have elevated concentrations of aspartate aminotransferase. Other laboratory findings include leukocytosis in 77 of patients anemia usually normochromic normocytic in 50 and hypoalbuminemia in 33 . Concomitant bacteremia is found in one-third of patients. A liver abscess is sometimes suggested by chest radiography especially if a new elevation of the right hemidiaphragm is seen other suggestive findings include a right basilar infiltrate and a right pleural effusion. Imaging studies are the most reliable methods for diagnosing liver abscesses. These studies include ultrasonography CT Fig. 121-4 indium-labeled WBC or gallium scan and MRI. More than one such study may be required. Organisms recovered from liver abscesses vary with the source. In liver infection arising from the biliary tree enteric gram-negative aerobic bacilli and enterococci are common isolates. Unless previous

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