A 48-year-old man from North India, diabetic, presents with 10 days of fever, right upper quadrant pain, and tender hepatomegaly. Ultrasound shows a 6 cm solitary abscess in the right lobe. Aspirated pus is thick, grey-white, odourless, and culture grows Klebsiella pneumoniae. Which statement best characterises his condition?
- A Metronidazole alone is curative in over 90 percent of cases
- B Surgical drainage is the first-line treatment for all abscesses above 5 cm
- C Serological tests are the diagnostic test of choice
- D It is more likely than an amoebic abscess to be multiple and to have a frankly purulent aspirate ✓
Explanation
Pyogenic liver abscesses, commonly caused by Klebsiella and Escherichia coli via the portal vein or biliary tree, tend to be multiple, contain foul or thick purulent pus, and need percutaneous aspiration or catheter drainage alongside broad-spectrum antibiotics. Metronidazole monotherapy cures the great majority of amoebic abscesses, whose aspirate classically resembles anchovy paste. Amoebic serology is positive in amoebic disease, not pyogenic infection. Radiologically guided percutaneous drainage, not open surgery, is first-line for larger pyogenic collections in stable patients.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.