0071643192.pdf

SYMPTOMS/EXAM

■ Ill-appearing with fever; jaundice (if underlying biliary obstruction);

abdominal pain

■ Tender, enlarged liver

DIFFERENTIAL

Hepatocellular carcinoma, ascending cholangitis

DIAGNOSIS

■ Abdominal CT scan or RUQ US

■ Abscess culture is definitive.

TREATMENT

■ Abscesses >5 cm may require percutaneous or surgical drainage.

■ Antibiotics: Third-generation cephalosporins + metronidazole.

■ Fungal abscesses usually respond to amphoterecin B.

■ Metronidazole alone will treat 95% of cases of Entamoeba histolytica.

COMPLICATIONS

Sepsis

Tumors

Malignant tumors are called hepatocellular carcinoma (HCC). They are usually

asymptomatic until disease is advanced. There are several benign liver tumors,

including hemangiomas, adenomas, and focal nodular hyperplasia.

HEPATOCELLULARCARCINOMA

SYMPTOMS/EXAM

■ Abdominal distention, abdominal pain, jaundice, fatigue, weight loss

■ Enlarged palpable liver and an occasional palpable mass

■ Bruit over the tumor

DIFFERENTIAL

■ Benign liver tumors

■ Metastatic cancer

■ Liver abscess or cyst

DIAGNOSIS

■ Elevation in α-fetoprotein (AFP)

■ Ultrasound is suggestive.

■ Quad phase CT or MR in the appropriate clinical setting (cirrhosis and/or

chronic HBV) can establish the diagnosis.

■ Tissue biopsy may be required for confirmation or atypical cases.

TREATMENT

■ Local regional therapy (radiofrequency ablation, chemoebolization) is not

curative but often is performed as a bridge to liver transplantation.

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES