Question

A patient presented with right hypochondriac pain. He had an episode of diarrhea 1 weekprior. CT scan of the abdomen reveals a liver abscess of around 25 ccs. What is the next stepin management?

• A. PAIR
• B. Surgery
• C. Medical therapy
• D. Percutaneous drainage

Answer 1

The Correct Option is C

In managing a liver abscess, particularly post-diarrheal episodes, it's critical to evaluate the underlying cause and appropriate treatment measures. Here, we encounter a patient with a liver abscess of around 25 ccs following recent diarrhea.

The initial step involves determining the most effective non-invasive treatment. Options include:

1. PAIR (Puncture, Aspiration, Injection, Reaspiration): Typically used for cystic echinococcosis, not first-line for a small abscess.
2. Surgery: Preferable for large abscesses or complications, not for small or uncomplicated abscesses.
3. Medical therapy: This is often antibiotics targeting the underlying cause, such as amoebic colitis or bacterial infection.
4. Percutaneous drainage: Invasive option for larger abscesses or when medical therapy fails.

Given the abscess size (25 ccs) and context (post-diarrheal), the first-line approach is:

Medical therapy

Antibiotics can effectively manage this, especially if it's an amoebic liver abscess following gastrointestinal infection. Typically, Metronidazole is used initially, targeting anaerobic bacteria like Entamoeba histolytica. Proper medical assessment ensures resolution without invasive procedures.