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Liver abscess

Última revisão: 20 Aug 2025
Última atualização: 31 Oct 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • fevers and chills
  • RUQ tenderness
  • hepatomegaly
Detalhes completos

Outros fatores diagnósticos

  • weight loss
  • fatigue
  • abdominal pain
  • nausea and vomiting
  • cough, shortness of breath, or chest pain
  • jaundice
  • signs of pleural effusion in the right lower zone
  • signs of shock
  • ascites
Detalhes completos

Fatores de risco

  • biliary tract disease
  • age >50 years
  • underlying malignancy
  • diabetes mellitus
  • interventional biliary or hepatic procedures
  • living in or visiting area endemic for amebiasis
  • cirrhosis
  • liver transplantation
  • alcoholism
  • male sex
  • cardiopulmonary disease
  • immunocompromised state
  • penetrating abdominal trauma
  • inflammatory bowel disease, pancreatitis, appendicitis, diverticulitis, or peritonitis
  • bacteremia, endocarditis, or other intravascular infection
  • poor dentition
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • CBC
  • serum LFTs
  • blood cultures
  • prothrombin time and activated partial thromboplastin time
  • liver ultrasound
  • contrast-enhanced abdominal CT scan
  • Gram stain and culture of aspirated abscess fluid
Detalhes completos

Investigações a serem consideradas

  • CXR
  • serum antibody test for Entamoeba histolytica
  • stool Entamoeba histolytica antigen detection test
  • antigen testing or polymerase chain reaction (PCR) of aspirated abscess fluid
  • liver MRI
  • CRP
Detalhes completos

Algoritmo de tratamento

Inicial

suspected pyogenic abscess

suspected amebic abscess

AGUDA

pyogenic abscess: following response to intravenous antibiotic therapy

amebic abscess: following response to nitroimidazole therapy

CONTÍNUA

abscess recurrence

Colaboradores

Autores

Rachel P. Simmons, MD

Assistant Professor of Medicine

Division of General Internal Medicine

Warren Alpert Medical School of Brown University

Providence

RI

Declarações

RPS declares that she has no competing interests.

Lawrence S. Friedman, MD

Professor of Medicine

Harvard Medical School and Tufts University School of Medicine

Boston

MA

Declarações

LSF has received royalties from Elsevier, Wiley, McGraw-Hill, Harvard Health Publications, Wolters Kluwer, and UpToDate.

Revisores

James Neuberger, BM, BCh

Consultant Physician

Liver Unit

Queen Elizabeth Hospital

Birmingham

UK

Declarações

JN declares that he has no competing interests.

Nancy Reau, MD

Assistant Professor of Medicine

University of Chicago

Center for Liver Disease

Chicago

IL

Declarações

NR declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Feldman M, Friedman LS, Brandt LJ. Brandt. Sleisenger and fordtran's gastrointestinal and liver disease - 2​: pathophysiology, diagnosis, management. 11th ed. Elsevier; 2022.

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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