Gastric Surgery MCQ: Liver Abscess
Q. A 34-year-old male with right sided lower quadrant abdominal pain is diagnosed with a liver abscess evidenced by CT scan which of the following is the next best step in management of this individual?
a. HIDA Scan
b. Open surgery
c. USG guided Aspiration
d. Contrast CT
Aspiration is both diagnostic and therapeutic. Percutaneous drainage should be CT or ultrasound-guided. Simple aspiration may be sufficient for some small abscesses but, where possible, placement of a drainage catheter (with a pigtail catheter) is preferred.
Important points:
1. Fever is the most common presenting sign of liver abscess.
2. The single most reliable laboratory finding is an elevated serum concentration of alkaline phosphatase (documented in about 70% of patients with liver abscesses.
3. The most common organisms are Streptococcus milleri and Escherichia coli, but other enteric organisms such as Streptococcus faecalis, Klebsiella and Proteus vulgaris also occur, and mixed growths are common.
4. Ultrasound and CT scan are the first-choice imaging studies for identification of liver abscess (CT is slightly more sensitive than ultrasound).
5. Diagnosis is confirmed by culture and sensitivity testing of aspirate.
6. First-line antibiotics to be used are a penicillin, aminoglycoside and metronidazole or a cephalosporin and metronidazole.
Topic: Liver abscess, Gastroenterology, Surgery.
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