Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

1258 Pyogenic Liver Abscess Pyridoxine Deficiency

management

What to Do First

■History (incl medical/surgical), physical exam, imaging

General Measures

■Admit to hospital (ICU if unstable)

specific therapy

Treatment Options

■Percutaneous drainage/aspiration w/ antibiotics

■IV antibiotics: should cover gram-negatives, microaerophilics, &

anaerobes; change to oral based on clinical response; total duration

2–3 wk

■Surgical intervention: unresponsive pts

follow-up

n/a

complications and prognosis

Complications

■Septicemia, shock, metastatic abscesses, rupture, ARDS, renal failure

Prognosis

■W/ prompt diagnosis & therapy, mortality rate 10–30%, depending

on underlying cause & comorbid conditions

PYRIDOXINE DEFICIENCY

ELISABETH RYZEN, MD

history & physical

History

■malabsorption, alcoholism, oral contraceptives, inactivation by

penicillamine, hydralazine, isoniazide

Signs & Symptoms

■glossitis, dermatitis, peripheral neuropathy, microcytic anemia

tests

Laboratory

■Basic studies: none