Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- fevers and chills
- RUQ tenderness
- hepatomegaly
Otros factores de diagnóstico
- 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
Factores de riesgo
- 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
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- 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
Pruebas diagnósticas que deben considerarse
- 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
Algoritmo de tratamiento
suspected pyogenic abscess
suspected amebic abscess
pyogenic abscess: following response to intravenous antibiotic therapy
amebic abscess: following response to nitroimidazole therapy
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.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
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.
Diagnósticos diferenciais
- Ascending cholangitis
- Cystadenoma or cystadenocarcinoma
- Inflammatory pseudotumors of the liver
Mais Diagnósticos diferenciaisDiretrizes
- Appropriateness criteria: right upper quadrant pain
- Appropriateness criteria: acute nonlocalized abdominal pain
Mais DiretrizesFolhetos informativos para os pacientes
Appendicitis
Diabetes: what can I do to keep healthy?
Mais Folhetos informativos para os pacientesVideos
Venepuncture and phlebotomy: animated demonstration
Peripheral intravascular catheter: animated demonstration
Mais vídeos
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal