Documentos de Académico
Documentos de Profesional
Documentos de Cultura
WORKUP
Laboratory Studies
Laboratory studies may include a complete blood count (CBC) with differential (to identify anemia
of chronic disease or neutrophilic leukocytosis) and liver function studies (hypoalbuminemia and
elevation of alkaline phosphatase are the most common abnormalities; elevations of transaminase
and bilirubin levels are variable.
Blood cultures are positive in roughly 50% of cases. Culture of abscess fluid should be the goal in
establishing microbiologic diagnosis.
Enzyme immunoassay should be performed to detect E histolytica in patients either from endemic
areas or who have traveled to endemic areas.
Imaging Studies
Advances in radiologic techniques has been credited with the improvement in mortality. The
various radiologic techniques have differing benefits and limitations with regard to their diagnostic
utility (see the image below).
Table 3: Comparison of the radiologic procedures used in the diagnosis of liver abscess.
Computed tomography
Computed tomography (CT) with contrast and ultrasonography remain the radiologic modalities of
choice as screening procedures and also can be used as techniques for guiding percutaneous
aspiration and drainage.
https://emedicine.medscape.com/article/188802-workup 1/3
4/14/2018 Liver Abscess Workup: Laboratory Studies, Imaging Studies, Percutaneous Aspiration and Drainage
Computed tomography (CT) scan findings of liver abscess are shown. A large, septated abscess of the right hepatic lobe
is revealed. Abscess was successfully treated with percutaneous drainage and antimicrobial therapy.
Computed tomography (CT) scan findings of liver abscess are shown. A large anterior abscess involving the left hepatic
lobe is revealed. Abscess was successfully treated with percutaneous drainage and antimicrobial therapy.
CT is superior in its ability to detect lesions less than 1 cm. This technique also enables evaluation
for an underlying concurrent pathology throughout the abdomen and pelvis. Indium-labeled white
blood cell (WBC) scans are somewhat more sensitive in this regard.
A retrospective study was undertaken using patient records from a group of 131 patients with
confirmed pyogenic liver abscesses to determine CT scan characteristics of those abscesses
caused by monomicrobial K pneumoniae infection versus other causes. A comparison was
performed between the K pneumoniae liver abscess patients and a comparison group. Notably,
only 70.2% of the cases were determined to be monomicrobial K pneumoniae liver abscesses. CT
scan characteristics more likely to be seen in these monomicrobial liver abscesses were (1) a
single abscess, (2) unilobar involvement, (3) solid appearance, (4) association with
thrombophlebitis, and (5) hematogenous appearance. [7]
https://emedicine.medscape.com/article/188802-workup 2/3
4/14/2018 Liver Abscess Workup: Laboratory Studies, Imaging Studies, Percutaneous Aspiration and Drainage
Ultrasonography
Radionuclide scanning
The initial studies are used in diagnosis. [9] Gallium and technetium radionuclide scanning use the
fact that the radiopharmaceuticals share the same uptake, transport, and excretion pathways as
bilirubin and, thus, are effective agents in evaluating liver disease. Sensitivity varies with the
radiopharmaceutical utilized, technetium (80%), gallium (50-80%), and indium (90%). Limitations
include a delay in diagnosis and the need for confirmatory procedures; thus, they offer no benefit
over other imaging modalities.
Chest radiography
Chest radiographic findings of basilar atelectasis, right hemidiaphragm elevation, and right pleural
effusion are present in approximately 50% of cases; before advancements in radiologic technique,
these served as diagnostic clues. Pneumonias or pleural diseases often are initially considered
because of the radiographic findings.
A catheter is placed under ultrasonographic or CT guidance via the Seldinger or trocar techniques.
The catheter is flushed daily until output is less than 10 mL/day or cavity collapse is documented
by serial CT.
Multiple abscesses have been drained successfully by this method. Failure to respond to catheter
drainage is the main reported complication and is also an indication for surgical intervention. Other
complications reported (rarely) are bleeding at the catheter site, perforation of hollow viscus, and
peritonitis from intraperitoneal spillage of cavity fluid.
Contraindications include coagulopathy; a difficult access path to the cavity; peritonitis; and/or a
complicated, multiloculated, thick-walled abscess with viscous pus.
https://emedicine.medscape.com/article/188802-workup 3/3