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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.
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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.
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Cholangitis is an infection of ...