Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- fevers and chills
- RUQ tenderness
- hepatomegaly
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
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
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
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
Algoritmo de tratamento
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 serves on the American Board of Internal Medicine as Vice Chair of the Traditional Exam Approval Committee for which she receives an honorarium, and on the Association of Program Directors in Internal Medicine as the Chair of Scholarship and Survey Committee. Neither role specifically relates to liver abscess.
Agradecimentos
Rachel P. Simmons would like to gratefully acknowledge Professor Lawrence S. Friedman, a previous contributor to this topic.
Declarações
LSF reported receiving royalties from Elsevier, Wiley, McGraw-Hill, Harvard Health Publications, Wolters Kluwer, and UpToDate at the time of disclosure.
Revisores
James Neuberger, BM, BCh
Consultant Physician
Liver Unit
Queen Elizabeth Hospital
Birmingham
UK
Declarações
JN declares that he has no competing interests.
Hrishikesh Samant, MD FACG
Director Hepatology
LSU Health Sciences Center
Shreveport
LA
Declarações
HS declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
Kim AY. Bacterial, parasitic, and fungal infections of the liver, including liver abscesses. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran's gastrointestinal and liver disease - 2 volume set. 12th ed. Amsterdam: Elsevier; 2026.
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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