Liver Abscess

LIVER ABSCESS 1. CHIEF COMPLAINT •Liver abscess 2. HPI 3. ROS 4. SYMPTOMS •Fever •Chills •Right upper quadrant pain •Anorexia •Malaise •Cough •Hiccoughs •Referred pain to the right shoulder 5. HISTORY •FAMILY HISTORY •SOCIAL HISTORY •PASTMEDICAL HISTORY •SURGICAL HISTORY •CHRONIC CONDITIONS 6. ALLERGIES 7. PHYSICAL EXAMINATION •Fever •Tender hepatomegaly •A palpable mass •Mid epigastric tenderness, with or without a palpable mass, is suggestive of left hepatic lobe involvement. •Decreased breath sounds in the right basilar lung zones, with signs of atelectasis and effusion on examination •A pleural or hepatic friction rub can be associated with diaphragmatic irritation or inflammation of Glisson capsule. •Jaundice 8. SPECIFIC DATA LIKE GRADING ETC

9. TESTS TO BE ORDERED •CBC count with differential •Liver function studies •Blood cultures are positive in roughly 50% of cases. •Enzyme immunoassay •Ultrasonography •CT scan •Gallium and technetium radionuclide scanning (sensitivity 50-90%) •Chest x-ray •Percutaneous needle aspiration •Percutaneous catheter drainage 10.ASSESSMENT /PLAN •Percutaneous drainage of liver abscess •Surgical drainage of liver abscess 11.EDUCATION 12.MEDICATION •Metronidazole •Clindamycin •Chloroquine •Emetine •Dehydroemetine •Meropenem •Imipenem •Cilastatin •Cefuroxime •Cefotetan •Cefoxitin •Cefaclor •Amphotericin B •Fluconazole 13.FOLLOE-UP