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Definition:
The method by which bacteria reach the liver reflects the underlying causes.
Biliary tract disease is the most common cause of liver abscess. Liver
abscess after intra-abdominal sepsis (such as with diverticulitis) is most
likely to be caused by hematogenous spread through the portal bloodstream.
Hematogenous spread by hepatic arterial flow may occur in infectious
endocarditis.
Antibiotic therapy, along with drainage, is the preferred treatment for most
hepatic abscesses. Pereutaneous drainage, either with ultrasound or CT
guidance, is usually sufficient to evacuate pus. Surgery may be performed to
drain pus in unstable patients with continued sepsis (despite attempted non
surgical treatment) and for patients with persistent fevers (lasting longer than
2 weeks) after percutaneous drainage and appropriate antibiotic therapy. A
common combination is ampicillin, an amino glycoside, and either
metronidazole or clindamycin. Third-generation cephalosporins can be
substituted for the aminoglycosides in patients at risk for renal toxicity.
When the causative organisms are identified, the antibiotic regimen should
be modified to match the patient's sensitivities. I.V. antibiotics should be
administered for 14 days and then replaced with oral preparations to
complete a 6 week course. Surgery is reserved for bowel perforation and
rupture into the pericardium.