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Question 7#

The most appropriate treatment of a 4-cm hepatic abscess is:

A. Antibiotic therapy alone
B. Aspiration for culture and antibiotic therapy
C. Percutaneous drainage and antibiotic therapy
D. Operative exploration, open drainage of the abscess, and antibiotic therapy

Correct Answer is C

Comment:

Hepatic abscesses are rare, currently accounting for approximately 15 per 100,000 hospital admissions in the United States. Pyogenic abscesses account for approximately 80% of cases, the remaining 20% being equally divided among parasitic and fungal forms. Formerly, pyogenic liver abscesses were caused by pylephlebitis due to neglected appendicitis or diverticulitis. Today, manipulation of the biliary tract to treat a variety of diseases has become a more common cause, although in nearly 50% of patients no cause is identified. The most common aerobic bacteria identified in recent series include E. coli, Klebsiella pneumoniae, and other enteric bacilli, enterococci, and Pseudomonas spp., while the most common anaerobic bacteria are Bacteroides spp., anaerobic streptococci, and Fusobacterium spp. Candida albicans and other similar yeasts cause the majority of fungal hepatic abscesses. Small ( <1 em), multiple abscesses should be sampled and treated with a 4- to 6-week course of antibiotics. Larger abscesses invariably are amenable to percutaneous drainage, with parameters for antibiotic therapy and drain removal similar to those mentioned above. Splenic abscesses are extremely rare and are treated in a similar fashion. Recurrent hepatic or splenic abscesses may require operative intervention-unroofing and marsupialization or splenectomy, respectively.