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4/14/2018 Liver Abscess Clinical Presentation: History, Physical Examination, Complications

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Liver Abscess Clinical

Updated: Jun 08, 2017
Author: Ruben Peralta, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF more...


The most frequent symptoms of hepatic abscess include the following (see the image below):

Fever (either continuous or spiking)

Right upper quadrant pain

Table 1: Presenting symptoms and signs in 715 patients diagnosed with liver abscess.

Cough or hiccoughs due to diaphragmatic irritation may be reported. Referred pain to the right
shoulder may be present.

Individuals with solitary lesions usually have a more insidious course with weight loss and anemia
of chronic disease. With such symptoms, malignancy often is the initial consideration.

Fever of unknown origin (FUO) frequently can be an initial diagnosis in indolent cases. Multiple
abscesses usually result in more acute presentations, with symptoms and signs of systemic 1/2
4/14/2018 Liver Abscess Clinical Presentation: History, Physical Examination, Complications


Afebrile presentations have been documented.

Physical Examination
Fever and tender hepatomegaly are the most common signs. A palpable mass need not be
present. Midepigastric 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 or radiologically, may be present. A pleural or hepatic friction rub can be associated
with diaphragmatic irritation or Glisson capsule inflammation.

Jaundice may be present in as many as 25% of cases and usually is associated with biliary tract
disease or the presence of multiple abscesses.

Complications of liver abscess may include the following:

Empyema resulting from contiguous spread or intrapleural rupture of abscess
Rupture of abscess with resulting peritonitis
Endophthalmitis when an abscess is associated with K pneumoniae bacteremia

Differential Diagnoses 2/2