Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a several-day history of right upper quadrant (RUQ) abdominal pain, high-grade intermittent fevers, and rigors. Associated symptoms include malaise, anorexia, and unintentional weight loss. Denies recent travel, but reports history of [biliary disease/diabetes/recent abdominal procedure]. Pain is described as constant, dull, and exacerbated by movement or deep inspiration.
Clinical Examination Findings
Vitals: Febrile (T > 38.5°C), tachycardic. Abdominal exam: Significant tenderness to palpation in the RUQ with positive Murphy’s sign. Hepatomegaly noted on percussion. Bowel sounds are present but may be hypoactive. No signs of peritonitis or rebound tenderness unless rupture is suspected. Scleral icterus may be present if biliary obstruction is concurrent.
Treatment Protocol
Immediate admission for intravenous broad-spectrum antibiotic therapy (e.g., Ceftriaxone + Metronidazole or Piperacillin/Tazobactam) adjusted based on culture results. Imaging-guided percutaneous needle aspiration or pigtail catheter drainage is indicated for abscesses > 5cm or those failing medical therapy. Monitor inflammatory markers (CRP, ESR) and liver function tests. Surgical consultation for potential rupture or multi-loculated abscesses.