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==Differential Diagnosis==
==Differential Diagnosis==
Pyogenic liver abscess must be differentiated from:<ref name="pmid15189463">{{cite journal| author=Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA| title=Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. | journal=Trop Med Int Health | year= 2004 | volume= 9 | issue= 6 | pages= 718-23 | pmid=15189463 | doi=10.1111/j.1365-3156.2004.01246.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15189463  }} </ref><ref name="pmid5054724">{{cite journal| author=Barbour GL, Juniper K| title=A clinical comparison of amebic and pyogenic abscess of the liver in sixty-six patients. | journal=Am J Med | year= 1972 | volume= 53 | issue= 3 | pages= 323-34 | pmid=5054724 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5054724  }} </ref><ref name="pmid3316923">{{cite journal| author=Barnes PF, De Cock KM, Reynolds TN, Ralls PW| title=A comparison of amebic and pyogenic abscess of the liver. | journal=Medicine (Baltimore) | year= 1987 | volume= 66 | issue= 6 | pages= 472-83 | pmid=3316923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3316923  }} </ref><ref name="pmid3945889">{{cite journal| author=Conter RL, Pitt HA, Tompkins RK, Longmire WP| title=Differentiation of pyogenic from amebic hepatic abscesses. | journal=Surg Gynecol Obstet | year= 1986 | volume= 162 | issue= 2 | pages= 114-20 | pmid=3945889 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3945889  }} </ref><ref name="pmid9834333">{{cite journal| author=Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA| title=Fungal hepatic abscesses: Characterization and management. | journal=J Gastrointest Surg | year= 1997 | volume= 1 | issue= 1 | pages= 78-84 | pmid=9834333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9834333  }} </ref>
Pyogenic liver abscess must be differentiated from:<ref name="pmid15189463">{{cite journal| author=Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA| title=Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. | journal=Trop Med Int Health | year= 2004 | volume= 9 | issue= 6 | pages= 718-23 | pmid=15189463 | doi=10.1111/j.1365-3156.2004.01246.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15189463  }} </ref><ref name="pmid5054724">{{cite journal| author=Barbour GL, Juniper K| title=A clinical comparison of amebic and pyogenic abscess of the liver in sixty-six patients. | journal=Am J Med | year= 1972 | volume= 53 | issue= 3 | pages= 323-34 | pmid=5054724 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5054724  }} </ref><ref name="pmid3316923">{{cite journal| author=Barnes PF, De Cock KM, Reynolds TN, Ralls PW| title=A comparison of amebic and pyogenic abscess of the liver. | journal=Medicine (Baltimore) | year= 1987 | volume= 66 | issue= 6 | pages= 472-83 | pmid=3316923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3316923  }} </ref><ref name="pmid3945889">{{cite journal| author=Conter RL, Pitt HA, Tompkins RK, Longmire WP| title=Differentiation of pyogenic from amebic hepatic abscesses. | journal=Surg Gynecol Obstet | year= 1986 | volume= 162 | issue= 2 | pages= 114-20 | pmid=3945889 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3945889  }} </ref><ref name="pmid9834333">{{cite journal| author=Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA| title=Fungal hepatic abscesses: Characterization and management. | journal=J Gastrointest Surg | year= 1997 | volume= 1 | issue= 1 | pages= 78-84 | pmid=9834333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9834333  }} </ref>
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* Asterixis
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==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 20:07, 27 February 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

Pyogenic liver abscess must be differentiated from other diseases with similar presentation such as amoebic liver abscess, fungal liver abscess, echinococcal (hydatid) cyst and malignancy (hepatocelluar carcinoma or metastasis).[1][2][3][4]

Differential Diagnosis

Pyogenic liver abscess must be differentiated from:[1][2][3][4][5]

Disease Causes symptoms Lab Findings Imaging Findings Other Findings
Fever Pain cough Hepatomegaly Jaundice Weight loss Anorexia Diarrhoea

or Dysentry

Nausea and

vomiting

Stool
Abdominal pain

(right upper quadrant pain)

Pleuritic pain
Amoebic

liver abscess

Entamoeba

histolytica

✔✔✔ ✔✔✔ ✔/✘ ✔✔/✘

(late stages)

(late stages)

Hypoalbuminemia

  • Respond well to chemotherapy and rarely require drainage
  • Marked male predominance
  • More common in developing countries
  • Sero-positive
  • Right lobe is more frequently involved
Pyogenic liver abscess Bacteria
  • Gram-positive aerobes
  • Gram-negative enterics
  • Anaerobic organisms
  • Acid fast bacilli
✔✔ ✔✔ ✔/✘ ✔✔✔

(acute loss)

Pale/dark Hypoalbuminemia

✔✔✔

  • Abnormal pulmonary findings
  • Diabetes mellitus increases the risk
  • Medical-surgical approach is indicated
  • More common in developed countries
  • Culture positive and sero-negative
  • Both lobes are commonly involved
Fungal liver abscess Candida species
  • Less common
  • Pure fungal abscess or associated with pyogenic abscess
Echinococcal (hydatid) cyst Echinococcus granulosus
  • Blood or liquid from the ruptured cyst may be coughed up
Malignancy

(Hepatocellular carcinoma/Metastasis)

  • Hepatitis B and C
  • Aflatoxins
  • Alcohol
  • Heamochromatosis
  • Alpha 1 antitrypsin deficiency
  • Non alcoholic fatty liver disease

(uncommon)

Other symptoms:
  • Splenomegaly
  • Variceal bleeding
  • Ascites
  • Spider nevi
  • Asterixis


References

  1. 1.0 1.1 Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA (2004). "Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases". Trop Med Int Health. 9 (6): 718–23. doi:10.1111/j.1365-3156.2004.01246.x. PMID 15189463.
  2. 2.0 2.1 Barbour GL, Juniper K (1972). "A clinical comparison of amebic and pyogenic abscess of the liver in sixty-six patients". Am J Med. 53 (3): 323–34. PMID 5054724.
  3. 3.0 3.1 Barnes PF, De Cock KM, Reynolds TN, Ralls PW (1987). "A comparison of amebic and pyogenic abscess of the liver". Medicine (Baltimore). 66 (6): 472–83. PMID 3316923.
  4. 4.0 4.1 Conter RL, Pitt HA, Tompkins RK, Longmire WP (1986). "Differentiation of pyogenic from amebic hepatic abscesses". Surg Gynecol Obstet. 162 (2): 114–20. PMID 3945889.
  5. Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA (1997). "Fungal hepatic abscesses: Characterization and management". J Gastrointest Surg. 1 (1): 78–84. PMID 9834333.