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
Divulgaciones
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
Divulgaciones
LSF has received royalties from Elsevier, Wiley, McGraw-Hill, Harvard Health Publications, Wolters Kluwer, and UpToDate.
Revisores por pares
James Neuberger, BM, BCh
Consultant Physician
Liver Unit
Queen Elizabeth Hospital
Birmingham
UK
Divulgaciones
JN declares that he has no competing interests.
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
Chicago
IL
Divulgaciones
NR declares that she has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Feldman M, Friedman LS, Brandt LJ. Brandt. Sleisenger and fordtran's gastrointestinal and liver disease - 2: pathophysiology, diagnosis, management. 11th ed. Elsevier; 2022.
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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