Summary
Definition
History and exam
Key diagnostic factors
- fevers and chills
- RUQ tenderness
- hepatomegaly
Other diagnostic factors
- 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
Risk factors
- 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
Diagnostic tests
1st tests to order
- 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
Tests to consider
- 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
Treatment algorithm
suspected pyogenic abscess
suspected amebic abscess
pyogenic abscess: following response to intravenous antibiotic therapy
amebic abscess: following response to nitroimidazole therapy
abscess recurrence
Contributors
Authors
Rachel P. Simmons, MD
Assistant Professor of Medicine
Division of General Internal Medicine
Warren Alpert Medical School of Brown University
Providence
RI
Disclosures
RPS declares that she has received honoraria from the American Board of Internal Medicine.
Lawrence S. Friedman, MD
Professor of Medicine
Harvard Medical School and Tufts University School of Medicine
Boston
MA
Disclosures
LSF has received royalties from Elsevier, Wiley, McGraw-Hill, and UpToDate.
Peer reviewers
James Neuberger, BM, BCh
Consultant Physician
Liver Unit
Queen Elizabeth Hospital
Birmingham
UK
Disclosures
JN declares that he has no competing interests.
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
Chicago
IL
Disclosures
NR declares that she has no competing interests.
Differentials
- Ascending cholangitis
- Cystadenoma or cystadenocarcinoma
- Inflammatory pseudotumors of the liver
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- Appropriateness criteria: acute nonlocalized abdominal pain
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