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Chapter 10 ♦ Liver, Gallbladder, and Biliary Tree Disorders

II. Clinical presentation: Fever, chills, leukocytosis, abnormal liver function tests (LFTs), RUQ tenderness, jaundice. III. Diagnosis: Imaging—CT or MRI. IV. Treatment: A. Antibiotics and percutaneous drainage. B. Surgery for treatment failure. V. Prognosis. Good, usually do not recur with adequate treatment. AMEBIC LIVER ABSCESS I. Etiology: Entamoeba histolytica —travels to the portal vein from the intestine and causes thrombosis of venules, leading to abscess formation. II. Clinical presentation: Fever, leukocytosis, hepatomegaly, RUQ pain III. Diagnosis: A. Imaging shows an abscess. B. Indirect hemagglutination titers for Entamoeba are elevated. C. Classic description of abscess contents is “anchovy paste”. IV. Treatment: A. Metronidazole. B. Surgery if antibiotic fails. V. Prognosis. Good with treatment. TRUSTED SOURCE Jackson-Akers JY, Prakash V, Oliver TI. Amebic Liver Abscess. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from https://www.ncbi.nlm.nih.gov/books/NBK430832/

HYDATID CYSTS I. Etiology:

A. Infection with Echinococcus granulosus . B. Seen in southern Europe, Middle East, Australia, and South America. C. Dogs are the definitive host. II. Presentation:

A. Hepatomegaly, pain, eosinophilia. B. Rupture can cause anaphylaxis.

III. Diagnosis: A. History

B. Serum antigen C. Imaging: Will show a cyst wall with calcifications and daughter cysts +/− organisms. IV. Treatment: A. Medical: Albendazole or mebendazole. B. Surgical:

1. Symptomatic cysts require aspiration or surgical removal. 2. Sterilize the site with alcohol or hypertonic saline injection.

V. Prognosis. Good.