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Patients with infections of the liver generally present with nonspecific symptoms such as fever, abdominal pain, fatigue, or weight loss. The abdominal pain may be diffuse, be confined to the right upper quadrant, or radiate to the shoulder or back. Other symptoms may include adenopathy, arthralgias, and headache. The initial history should focus on travel, unprotected sex or drug use, anatomical anomalies or surgery that may affect the biliary tracts, a need for hemodialysis or blood products, and family history of hepatitis. Physical exam is often normal; some patients will have right upper quadrant or diffuse abdominal tenderness and hepatomegaly. Jaundice or stigmata of chronic liver disease is infrequent.1 For additional details regarding viral hepatitis, please refer to Table 237-1 and Chapter 308. Details regarding diagnosis and treatment of other organisms that infect the liver are provided in the relevant chapter in Section 17.

Table 237-1. Common Viral Infections of the Liver and Presentation

Laboratory findings of liver infections often consist of leukocytosis, elevated erythrocyte sedimentation rate (ESR) with variable elevation of bilirubin, aminotransferases (ALT/AST), alkaline phosphatase, and gamma-glutamyl transferase. Diagnosis of liver infections requires a high degree of clinical suspicion and should be considered in the context of patient age, chronicity of symptoms, disease epidemiology including geographic location or travel history, and associated conditions such as immune status. Liver ultrasound is useful in initial evaluation of the patient with suspected liver infection because it can screen for liver abscess or bile duct anomalies.

Cholangitis is an infection of the biliary ...

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