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==ACC/AHA Guideline Template==
==Actinomycosis==


{|class="wikitable" style="width:80%"
===Treatment===
{| class="wikitable"
!Type
!Treatment
|-
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|Central Nervous system
actinomycosis
|
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' RECOMMENDATION 1 HERE''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|
|-
|
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' RECOMMENDATION 2 HERE''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' RECOMMENDATION 1 HERE ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' RECOMMENDATION 2 HERE ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' RECOMMENDATION 1 HERE ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' RECOMMENDATION 2 HERE ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' RECOMMENDATION 1 HERE ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' RECOMMENDATION 2 HERE ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' RECOMMENDATION 1 HERE ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' RECOMMENDATION 2 HERE ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
==2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary(DO NOT EDIT)<ref name="pmid23256913">{{cite journal| author=American College of Emergency Physicians. Society for Cardiovascular Angiography and Interventions. O'Gara PT, Kushner FG, Ascheim DD, Casey DE et al.| title=2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 4 | pages= 485-510 | pmid=23256913 | doi=10.1016/j.jacc.2012.11.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23256913  }} </ref>==
===Reperfusion at a Non–PCI-Capable Hospital: Recommendations (DO NOT EDIT)===
 
'''Fibrinolytic Therapy When There Is an Anticipated Delay to Performing Primary PCI Within 120 Minutes of FMC (DO NOT EDIT)'''
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of FMC (Level of Evidence: A)''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Fibrinolytic therapy should not be administered to patients with ST depression except when a true posterior (inferobasal) MI is suspected or when associated with ST elevation in lead aVR  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In the absence of contraindications and when PCI is not available, fibrinolytic therapy is reasonable for patients with STEMI if there is clinical and/or electrocardiographic evidence of ongoing ischemia within 12 to 24 hours of symptom onset and a large area of myocardium at risk or hemodynamic instability ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
==2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary(DO NOT EDIT)<ref name="pmid23256913">{{cite journal| author=American College of Emergency Physicians. Society for Cardiovascular Angiography and Interventions. O'Gara PT, Kushner FG, Ascheim DD, Casey DE et al.| title=2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 4 | pages= 485-510 | pmid=23256913 | doi=10.1016/j.jacc.2012.11.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23256913  }} </ref>==
 
===Reperfusion at a PCI-Capable Hospital: Recommendations(DO NOT EDIT)===
===='''Primary PCI in STEMI (DO NOT EDIT)'''====
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours' duration ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours' duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from FMC''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Primary PCI should be performed in patients with STEMI and cardiogenic shock or acute severe HF, irrespective of time delay from myocardial infarction (MI) onset''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' PCI should not be performed in a noninfarct artery at the time of primary PCI in patients with STEMI who are hemodynamically stable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Primary PCI is reasonable in patients with STEMI if there is clinical and/or ECG evidence of ongoing ischemia between 12 and 24 hours after symptom onset  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
===='''Aspiration Thrombectomy (DO NOT EDIT)'''====
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Manual aspiration thrombectomy is reasonable for patients undergoing primary PCI ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
===='''Use of Stents in Patients With STEMI (DO NOT EDIT)'''====
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Placement of a stent (bare-metal stent or drug-eluting stent) is useful in primary PCI for patients with STEMI ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Bare-metal stents†should be used in patients with high bleeding risk, inability to comply with 1 year of dual antiplatelet therapy (DAPT), or anticipated invasive or surgical procedures in the next year''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
|
|
|}
|}


{|class="wikitable" style="width:80%"
==Amoebic liver abscess diagnosis==
|-
{{familytree/start}}
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
{{familytree | | | | | | | | | | | | A01 | | | | A01='''Diagnosis of amoebic liver abscess'''}}
|-
{{familytree | | | | | | | | | | | | |!| | | | |}}
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Drug-eluting stents should not be used in primary PCI for patients with STEMI who are unable to tolerate or comply with a prolonged course of DAPT because of the increased risk of stent thrombosis with premature discontinuation of one or both agents ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
{{familytree | | | | | | | | | | | | B01 | | | | B01='''Signs and symptoms'''(a)<br> Fever, abdominal pain, point tenderness over the liver, hepatomegaly, weight loss<br> '''History''' <br> Travel to endemic areas, immigrant from endemic areas, having had dysentery within last years, gender (male/female:9/1 }}
|-
{{familytree | | | | | | | | | | | | |!| | | | |}}
|}
{{familytree | | | | | | | | | | | | C01 | | | | C01= Laboratory diagnosis(LD) and Radiologic Methods (RM) (US, CT or MRI)}}
{{familytree | | | | | | | | | | | | |!| | | | |}}
{{familytree | | | |,|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| |}}
{{familytree | | | D01 | | | | | | | D02 | | | | | | |D03 | |D01=LD negative and RM negative:Floow|D02=LD negative and RM positive:aspiration, if possible(b)|D03=LD positive and RM positive: chemotherapy / surgical treatment}}
{{familytree | | | | | | | | | | | | |!| | | | | | | | | |}}
{{familytree | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| |}}
{{familytree | | | | | | E01 | | | | | | | | | | E02 |E01=Pyogenic abscesses <br> Neoplasia (hepatocellular carcinoma)<br>Cysticercosis<br>Cystic echinococcosis|E02=ALA}}
{{familytree/end}}


===='''Antiplatelet Therapy to Support Primary PCI for STEMI (DO NOT EDIT)'''====
==Liver abscess==
{{familytree/start}}
{{familytree | | | | | | | | | | | | A01 | | | | A01='''Liver abscess'''}}
{{familytree | | | | | | | | | | | | |!| | | | |}}
{{familytree | | | | | | | | | | | | B01 | | | | B01='''Risk factors'''}}
{{familytree | | | |,|-|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|.|}}
{{familytree | | | C01 | | | | C02 | | | | C03 | | | | C04 |C01='''Hematogenous'''|C02='''Biliary'''|C03='''Underlying lesions or anamolies'''|C04='''Other causes'''}}
{{familytree | | | |!| | | | | |!| | | | | |!| | | | | |!|}}
{{familytree | | | D01 | | | | D02 | | | | D03 | | | | D04 | D01='''Portal vein'''<br>Intra-abdominal [[infection]]<br>Pyelophlebitis<br>[[Abdominal abscess]]<br>[[Amoebiasis]] <br> '''Arterial'''<br>[[ENT]]<br>[[Oral cavity]]|D02=[[Gall stones]]<br>Obstructed bile duct<br>Contiguous spread, [[ascending cholangitis]]<br>[[Bile duct]] [[ischemia]]|D03=Biliary cyst<br>[[Hydatid cyst]]<br>[[Cystadenoma]]<br>[[Necrosis]] of a [[primary tumor]]<br>[[Superinfection]] of a [[metastasis]]<br>[[Caroli disease]]<br>Biliary stricture<br>[[Sclerosing cholangitis]]<br>Ischemic cholangitis|D04=[[Radiofrequency ablation]] / [[Chemoembolization]] in the presence of infected [[bile]]<br>Pancreatoduodenectomy<br>[[Liver transplantation]]<br>Hepatic trauma ± arterial embolization}}
{{familytree/end}}


{|class="wikitable" style="width:80%"
==Causes liver abscess==
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Aspirin 162 to 325 mg should be given before primary PCI (''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' After PCI, aspirin should be continued indefinitely''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' A loading dose of a P2Y12receptor inhibitor should be given as early as possible or at time of primary PCI to patients with STEMI. Options include''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.''' [[Clopidogrel]] 600 mg
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.''' [[Prasugrel]] 60 mg
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''c.''' [[Ticagrelor]] 180 mg
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' P2Y12inhibitor therapy should be given for 1 year to patients with STEMI who receive a stent (bare-metal or drug-eluting) during primary PCI using the following maintenance doses:''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.''' Clopidogrel 75 mg daily
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.''' Prasugrel 10 mg
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''c.''' Ticagrelor 90 mg
|}


{|class="wikitable" style="width:80%"
{{familytree/start}}
|-
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | A01='''Pyogenic liver abscess'''}}
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | |!| |}}
|-
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | B01 | | B01='''Causes'''}}
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Prasugrel should not be administered to patients with a history of prior stroke or transient ischemic attack ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
{{familytree | | | | |,|-|-|-|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|-|.|}}
|-
{{familytree | | | | C01 | | | | | | | | | C02 | | | | | | | | C03 | | | | | | | | C04 | | | | | | | | C05 |C01='''Hepatobiliary'''|C02='''Portal'''|C03='''Arterial'''|C04='''Traumatic'''|C05='''Cryptogenic'''}}
|}
{{familytree | | | | |!| | | | | | | | | | |!| | | | | | | | | |!| | | | | | | | | | |!| | | |}}
{{familytree | |,|-|-|^|-|-|.| | | | |,|-|-|^|-|-|.| | | | | | |!| | | | | | |,|-|-|-|^|-|-|-|.|}}
{{familytree | D01 | | | | D02 | | | D03 | | | | D04 | | | | | D05 | | | | | D06 | | | | | | D07 |D01=Benign|D02=Malignant|D03=Benign|D04=Malignant|D05= • Endocarditis<br> • Vascular sepsis<br> • Dental infection<br> • ENT infection|D06=Benign|D07=Malignant}}
{{familytree | |!| | | | | |!| | | | |!| | | | | |!| | | | | | | | | | | | | |!| | | | | | | |!|}}
{{familytree | E01 | | | | E02 | | | E03 | | | | E04 | | | | | | | | | | | | E05 | | | | | | E06|E01= • Lithiasis<br> • Cholicystitis<br> • Biliary enteric anastomosis<br> • Percutaneous biliary procedures<br> • Endoscopic biliary procedures|E02= • Gall bladder<br> • Common bile duct<br> • Head of pancreas<br> • Ampulla|E03= • Appendicitis<br> • Diverticulitis<br> • Pelvic suppuration<br> • Anorectal suppuration<br> • Pancreatic abscess<br> • Postoperative sepsis<br> • Intestinal perforation<br> • Inflammatory bowel disease|E04= • Gastric cancer<br> • Colon cancer|E05= • Open or closed abdominal trauma|E06= • Percutaneous ethanol injection or radiofrequency<br> • Chemoembolization}}
{{familytree/end}}


==Treatment==
{{Family tree/start}}
{{Family tree | | | | | | A01 | | | |A01= '''Treatment'''}}
{{Family tree | | | |,|-|-|^|-|-|.|}}
{{Family tree | | | B01 | | | | B01|B01=Non-surgical treatment|B02=Open surgical drainage}}
{{family tree | |,|-|^|-|.|}}
{{family tree | C01 | | C02|C01=Conservative management with antibiotics alone|C02=Open surgical drainage}}
{{Family tree/end}}


{|class="wikitable" style="width:80%"
==Drainage==
|-
{{Family tree/start}}
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
{{Family tree | | | | | | | A01 | | | |A01= '''Drainage'''}}
|-
{{Family tree | | | |,|-|-|-|+|-|-|-|.|}}
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable to use 81 mg of aspirin per day in preference to higher maintenance doses after primary PCI ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
{{Family tree | | | B01 | | B02 | | B03|B01=Percutaneous drainage|B02=Open surgical drainage|B03=Endoscopic retrograde cholangiopancreatography (ERCP)}}
|-
{{family tree | |,|-|^|-|.|}}
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable to start treatment with an intravenous glycoprotein (GP) IIb/IIIa receptor antagonist such as abciximab (Level of Evidence: A), high-bolus-dose tirofiban (Level of Evidence: B), or double-bolus eptifibatide (Level of Evidence: B) at the time of primary PCI (with or without stenting or clopidogrel pretreatment) in selected patients with STEMI who are receiving unfractionated heparin (UFH)<nowiki>"</nowiki>
{{family tree | C01 | | C01 |C01=CT guided|C02=Ultrasound guided}}
|-
{{Family tree/end}}
|}


{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It may be reasonable to administer intravenous GP IIb/IIIa receptor antagonist in the precatheterization laboratory setting (e.g., ambulance, emergency department) to patients with STEMI for whom primary PCI is intended ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It may be reasonable to administer intracoronary abciximab to patients with STEMI undergoing primary PCI ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.'''Continuation of a P2Y12inhibitor beyond 1 year may be considered in patients undergoing drug-eluting stent placement ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}


===='''Anticoagulant Therapy to Support Primary PCI (DO NOT EDIT)'''====
The mainstay of therapy for pyogenic liver abscesses is [[percutaneous]] drainage and antimicrobial therapy.  Empiric therapy for pyogenic [[liver]] [[abscesses]] consists of either a second- or third-generation [[cephalosporin]] with [[metronidazole]] or [[piperacillin-tazobactam]]. [[Amoebiasis|Amebic liver abscesses]] are often treated medically with a short course of [[metronidazole]] or [[tinidazole]] followed by 20 days of [[iodoquinol]].


{|class="wikitable" style="width:80%"
==Medical Therapy==
|-
*It is essential to differentiate between pyogenic and amebic liver abscesses for appropriate therapy. Differentiation can be established based on [[serology]], culture results, and response to therapy.<ref name="pmid15189463">{{cite journal| author=Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA| title=Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. | journal=Trop Med Int Health | year= 2004 | volume= 9 | issue= 6 | pages= 718-23 | pmid=15189463 | doi=10.1111/j.1365-3156.2004.01246.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15189463  }} </ref>
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
*The mainstay of therapy for pyogenic hepatic abscesses is [[ultrasound]]/CT-guided percutaneous drainage with at least 2 weeks (may last up to 6 weeks) of intravenous [[antibiotics]].<ref name="pmid21435221">{{cite journal| author=Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O et al.| title=Modern management of pyogenic hepatic abscess: a case series and review of the literature. | journal=BMC Res Notes | year= 2011 | volume= 4 | issue=  | pages= 80 | pmid=21435221 | doi=10.1186/1756-0500-4-80 | pmc=PMC3073909 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21435221  }} </ref>
|-
*Empiric [[antibiotics]] should only be used initially, with [[diagnostic]] aspiration and culture performed as soon as possible.
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''For patients with STEMI undergoing primary PCI, the following supportive anticoagulant regimens are recommended ''<nowiki>"</nowiki>
*Amebic liver abscesses can be treated successfully with antimicrobial agents and do not require drainage except in special conditions, such as:<ref name="pmid12660071">{{cite journal| author=Stanley SL| title=Amoebiasis. | journal=Lancet | year= 2003 | volume= 361 | issue= 9362 | pages= 1025-34 | pmid=12660071 | doi=10.1016/S0140-6736(03)12830-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12660071  }} </ref>
|-
:*Severe clinical illness
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.'''UFH, with additional boluses administered as needed to maintain therapeutic activated clotting time levels, taking into account whether a GP IIb/IIIa receptor antagonist has been administered'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
:*Uncertain diagnosis
|-
:*No response to [[metronidazole]] therapy (after 4 days of treatment)
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.'''Bivalirudin with or without prior treatment with UFH'' ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
:*Large left-lobe abscesses (risk of rupture into [[pericardium]])
|-
:*Imminent rupture
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Fondaparinux should not be used as the sole anticoagulant to support primary PCI because of the risk of catheter thrombosis ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}


{|class="wikitable" style="width:80%"
===Antibiotic Regimens===
|-
* '''Pyogenic Liver Abscess'''
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
:* '''1. Empiric antimicrobial therapy'''<ref name="pmid15578367">{{cite journal| author=Rahimian J, Wilson T, Oram V, Holzman RS| title=Pyogenic liver abscess: recent trends in etiology and mortality. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 11 | pages= 1654-9 | pmid=15578367 | doi=10.1086/425616 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15578367  }} </ref><ref name="pmid15667489">{{cite journal| author=Lederman ER, Crum NF| title=Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. | journal=Am J Gastroenterol | year= 2005 | volume= 100 | issue= 2 | pages= 322-31 | pmid=15667489 | doi=10.1111/j.1572-0241.2005.40310.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15667489  }} </ref><ref name="pmid26287275">{{cite journal| author=Lübbert C, Wiegand J, Karlas T| title=Therapy of Liver Abscesses. | journal=Viszeralmedizin | year= 2014 | volume= 30 | issue= 5 | pages= 334-41 | pmid=26287275 | doi=10.1159/000366579 | pmc=PMC4513824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26287275  }} </ref><ref name="pmid15245694">{{cite journal| author=Kurland JE, Brann OS| title=Pyogenic and amebic liver abscesses. | journal=Curr Gastroenterol Rep | year= 2004 | volume= 6 | issue= 4 | pages= 273-9 | pmid=15245694 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15245694  }} </ref><ref name="pmid21435221">{{cite journal| author=Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O et al.| title=Modern management of pyogenic hepatic abscess: a case series and review of the literature. | journal=BMC Res Notes | year= 2011 | volume= 4 | issue=  | pages= 80 | pmid=21435221 | doi=10.1186/1756-0500-4-80 | pmc=PMC3073909 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21435221  }} </ref>
|-
::* Preferred regimen (1): ([[Ceftriaxone]] 1-2 g IV/IM q24h {{or}} [[Cefotaxime]] 1-2 g IV or IM q8h) {{and}} ([[Metronidazole]] 15 mg/kg IV single dose {{then}} 7.5 mg/kg PO/IV q6h)
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients with STEMI undergoing PCI who are at high risk of bleeding, it is reasonable to use bivalirudin monotherapy in preference to the combination of UFH and a GP IIb/IIIa receptor antagonist''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
::* Preferred regimen (2): [[Ciprofloxacin]] 400 mg IV q12h {{and}} ([[Metronidazole]] 15 mg/kg IV single dose {{then}} 7.5 mg/kg PO/IV q6h)
|-
::* Preferred regimen (3): [[Piperacillin-Tazobactam]] 3.375 g IV q6h
|}
::* Note: The empiric therapy for pyogenic abscesses should be based on local resistance patterns, with particular attention to resistant Klebsiella spp.. Ampicillin is not recommended due to the high resistance found among Klebsiella spp.. There is no set duration for treatment, which may vary from 2 to 6 weeks.
:* '''2. Pathogen-directed antimicrobial therapy'''
::* '''2.1 Klebsiella spp.'''<ref name="pmid15667489">{{cite journal| author=Lederman ER, Crum NF| title=Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. | journal=Am J Gastroenterol | year= 2005 | volume= 100 | issue= 2 | pages= 322-31 | pmid=15667489 | doi=10.1111/j.1572-0241.2005.40310.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15667489  }} </ref>
:::* Preferred regimen: [[Gentamicin]] {{and}} ([[Piperacillin-Tazobactam]] 3.375 g IV q6h {{or}} [[Cefazolin]] 0.5-1 g IV q6-8h {{or}} [[Ceftriaxone]] 1-2 g IV/IM q24h {{or}} [[Cefotaxime]] 1-2 g IV or IM q8h) for 2–3 wk 
:::*Note: Acute therapy may be followed by 4 weeks of oral antibiotics (fluoroquinolone or second/third-generation cephalosporin).
* '''Amebic Liver Abscess'''
:* Preferred regimen (1): [[Metronidazole]] 2-4 g PO qd for 2 days {{then}} [[Iodoquinol]] 650 mg PO tid for 20 days
:* Preferred regimen (2): [[Tinidazole]] 2 g PO qd for 3 days {{then}} [[Iodoquinol]] 650 mg PO tid for 20 days


==2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary(DO NOT EDIT)<ref name="pmid23256913">{{cite journal| author=American College of Emergency Physicians. Society for Cardiovascular Angiography and Interventions. O'Gara PT, Kushner FG, Ascheim DD, Casey DE et al.| title=2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 4 | pages= 485-510 | pmid=23256913 | doi=10.1016/j.jacc.2012.11.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23256913  }} </ref>==
==References==
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Gastroenterology]]


==='''Renin-Angiotensin-Aldosterone System Inhibitors (DO NOT EDIT)'''===
[[Category:Mature chapter]]
 
[[Category:Disease]]
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' An angiotensin-converting enzyme inhibitor should be administered within the first 24 hours to all patients with STEMI with anterior location, HF, or ejection fraction less than or equal to 0.40, unless contraindicated''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' An angiotensin receptor blocker should be given to patients with STEMI who have indications for but are intolerant of angiotensin-converting enzyme inhibitors''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' An aldosterone antagonist should be given to patients with STEMI and no contraindications who are already receiving an angiotensin-converting enzyme inhibitor and beta blocker and who have an ejection fraction less than or equal to 0.40 and either symptomatic HF or diabetes mellitus''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Angiotensin-converting enzyme inhibitors are reasonable for all patients with STEMI and no contraindications to their use ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
|}
 
==2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary(DO NOT EDIT)<ref name="pmid23256913">{{cite journal| author=American College of Emergency Physicians. Society for Cardiovascular Angiography and Interventions. O'Gara PT, Kushner FG, Ascheim DD, Casey DE et al.| title=2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 4 | pages= 485-510 | pmid=23256913 | doi=10.1016/j.jacc.2012.11.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23256913  }} </ref>==
 
=== Coronary Artery Bypass Graft Surgery: Recommendations(DO NOT EDIT)===
'''CABG in Patients With STEMI'''
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Urgent CABG is indicated in patients with STEMI and coronary anatomy not amenable to PCI who have ongoing or recurrent ischemia, cardiogenic shock, severe HF, or other high-risk features''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' CABG is recommended in patients with STEMI at time of operative repair of mechanical defects ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The use of mechanical circulatory support is reasonable in patients with STEMI who are hemodynamically unstable and require urgent CABG ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Emergency CABG within 6 hours of symptom onset may be considered in patients with STEMI who do not have cardiogenic shock and are not candidates for PCI or fibrinolytic therapy ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
'''Timing of Urgent CABG in Patients With STEMI in Relation to Use of Antiplatelet Agents'''
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Aspirin should not be withheld before urgent CABG ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Clopidogrel or ticagrelor should be discontinued at least 24 hours before urgent on-pump CABG, if possible''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Short-acting intravenous GP IIb/IIIa receptor antagonists (eptifibatide, tirofiban) should be discontinued at least 2 to 4 hours before urgent CABG ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Abciximab should be discontinued at least 12 hours before urgent CABG ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Urgent off-pump CABG within 24 hours of clopidogrel or ticagrelor administration might be considered, especially if the benefits of prompt revascularization outweigh the risks of bleeding  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Urgent CABG within 5 days of clopidogrel or ticagrelor administration or within 7 days of prasugrel administration might be considered, especially if the benefits of prompt revascularization outweigh the risks of bleeding ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
==2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary<ref name="pmid23256913">{{cite journal| author=American College of Emergency Physicians. Society for Cardiovascular Angiography and Interventions. O'Gara PT, Kushner FG, Ascheim DD, Casey DE et al.| title=2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 4 | pages= 485-510 | pmid=23256913 | doi=10.1016/j.jacc.2012.11.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23256913  }} </ref>==
 
===Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals===
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' All communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of emergency medical services and hospital-based activities. Performance can be facilitated by participating in programs such as Mission: Lifeline and the Door-to-Balloon Alliance''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Performance of a 12-lead electrocardiogram (ECG) by emergency medical services personnel at the site of first medical contact (FMC) is recommended in patients with symptoms consistent with STEMI''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Reperfusion therapy should be administered to all eligible patients with STEMI with symptom onset within the prior 12 hours''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' Primary PCI is the recommended method of reperfusion when it can be performed in a timely fashion by experienced operators''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' Emergency medical services transport directly to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI, with an ideal FMC-to-device time system goal of 90 minutes or less''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' Immediate transfer to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI who initially arrive at or are transported to a non–PCI-capable hospital, with an FMC-to-device time system goal of 120 minutes or less''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI at non–PCI-capable hospitals when the anticipated FMC-to-device time at a PCI-capable hospital exceeds 120 minutes because of unavoidable delays ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''8.''' When fibrinolytic therapy is indicated or chosen as the primary reperfusion strategy, it should be administered within 30 minutes of hospital arrival''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Reperfusion therapy is reasonable for patients with STEMI and symptom onset within the prior 12 to 24 hours who have clinical and/or ECG evidence of ongoing ischemia. Primary PCI is the preferred strategy in this population ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
==2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>==
 
====Heart Failure====
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''Control of resting heart rate using either a beta blocker or nondihydropyridine calcium channel antagonist is recommended for patients with persistent or permanent AF and compensated HF with preserved ejection fraction ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In the absence of pre-excitation, intravenous beta-blocker administration (or a nondihydropyridine calcium channel antagonist in patients with HFpEF) is recommended to slow the ventricular response to AF in the acute setting, with caution needed in patients with overt congestion, hypotension, or HF with reduced left ventricular ejection fraction''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' In the absence of pre-excitation, intravenous digoxin or amiodarone is recommended to control heart rate acutely in patients with HF''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''Assessment of heart rate control during exercise and adjustment of pharmacological treatment to keep the rate in the physiological range is useful in symptomatic patients during activity.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' Digoxin is effective to control resting heart rate in patients with HF with reduced ejection fraction''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' AV node ablation should not be performed without a pharmacological trial to achieve ventricular rate control ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' For rate control, intravenous nondihydropyridine calcium channel antagonists, intravenous beta blockers, and dronedarone should not be administered to patients with decompensated HF ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' A combination of digoxin and a beta blocker (or a nondihydropyridine calcium channel antagonist for patients with HFpEF) is reasonable to control resting and exercise heart rate in patients with AF ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable to perform AV node ablation with ventricular pacing to control heart rate when pharmacological therapy is insufficient or not tolerated ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Intravenous amiodarone can be useful to control heart rate in patients with AF when other measures are unsuccessful or contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' For patients with AF and rapid ventricular response causing or suspected of causing tachycardia-induced cardiomyopathy, it is reasonable to achieve rate control by either AV nodal blockade or a rhythm-control strategy ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' For patients with chronic HF who remain symptomatic from AF despite a rate-control strategy, it is reasonable to use a rhythm-control strategy''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Oral amiodarone may be considered when resting and exercise heart rate cannot be adequately controlled using a beta blocker (or a nondihydropyridine calcium channel antagonist in patients with HFpEF) or digoxin, alone or in combination ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' AV node ablation may be considered when the rate cannot be controlled and tachycardia-mediated cardiomyopathy is suspected ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|}
 
==Fournier's gangrene==
 
{| class="wikitable" style="border: 2; background: none;"
! colspan="1" rowspan="2" style="border: 1; background: 1;"| Physiologic Variables
! colspan="4" rowspan="1"| High Abnormal Values
! colspan="1" rowspan="1"| Normal
! colspan="4" rowspan="1"| Low Abnormal Values
|- colspan="1" rowspan="2" style="border: 1; background: 1;"
! +4 || +3 || +2 || +1 || 0 || +1 || +2 || +3 || + 4
|-
! rowspan="1" style="border: 1; background: none;"| Temperature
| >41 || 39-40.0|| ||38.5-39 || 36-38.4 || 34-35.9 || 32-33.9 || 30-31.9 || <29.9
|-
! rowspan="1" style="border: 1; background: none;"| Heart Rate
| >180 || 140-179 || 110-139 || || 70-109 || || 55-69 || 40-54 || <39
|-
! rowspan="1" style="border: 1; background: none;"| Respiratory Rate
| >50 || 35-49 || ||25-34||12-24||10-11||6-9|| || <5
|-
! rowspan="1" style="border: 1; background: none;"| Serum Sodium (mmol/L)
|  || || || || || ||  ||  ||
|-
! rowspan="1" style="border: 1; background: none;"| Serum Potassium (mmol/L)
| || || || ||  || ||  ||  ||
|-
! rowspan="1" style="border: 1; background: none;"| Serum Creatinine<br>(mg/100/ml*2 for acute renal failure)
| || ||  || || || ||  ||  ||
|-
! rowspan="1" style="border: 1; background: none;"| Hematocrit
| || ||  || || || ||  ||  ||
|-
! rowspan="1" style="border: 1; background: none;"| WBC (Total/mm*1000)
| || ||  || || || ||  ||  ||
|-
! rowspan="1" style="border: 1; background: none;"| Serum Bicarbonate (Venous,mmol/l)
| || ||  || || || ||  ||  ||
 
|}
 
 
 
{| class="wikitable" style="text-align:center"
|-
! Region !! Gender !! Incidence/100,000 !! Prevalence/100,000
|-
! rowspan="2" | Region 1
| M || Incidence || Prevalence
|-
| F || Incidence || Prevalence
|-
! rowspan="2" | Region 2
| M || Incidence || Prevalence
|-
| F || Incidence || Prevalence
|-
! rowspan="2" | Region 3
| M || Incidence || Prevalence
|-
| F || Incidence || Prevalence
|-
! rowspan="2" | Region 4
| M || Incidence || Prevalence
|-
| F || Incidence || Prevalence
|-
! rowspan="2" | Region 5
| M || Incidence || Prevalence
|-
| F || Incidence || Prevalence
|}
 
==Zika Prevention==
 
{|
| colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''How Long to Wait Before Attempting to Have a Baby in Zika Endemic areas'''}}
|-
! style="width: 180px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Presence of Symptoms}}
! style="width: 250px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Women}}
! style="width: 250px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Men}}
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''Zika symptoms'''
| style="background: #DCDCDC; padding: 5px;" | At least 8 weeks after symptoms start
| style="background: #DCDCDC; padding: 5px;" | At least 6 months after symptoms start
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''No Zika symptoms'''
| style="background: #DCDCDC; padding: 5px;" | Talk with doctor or healthcare provider
| style="background: #DCDCDC; padding: 5px;" | Talk with doctor or healthcare provider
|}
 
==Zika sexual transmission==
{|
| colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''For People Who Have Traveled to an Area with Zika'''}}
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you are pregnant'''
| style="background: #DCDCDC; padding: 5px;" | Pregnant women should not travel to areas with Zika. If you must travel to an area with Zika, talk to your healthcare provider.
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If your partner is pregnant'''
| style="background: #DCDCDC; padding: 5px;" | Use condoms correctly, every time you have vaginal, anal, or oral sex or do not have sex for the entire pregnancy.
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you and your partner are planning a pregnancy'''
| style="background: #DCDCDC; padding: 5px;" | Discuss your plans for pregnancy with a healthcare provider to determine your risk and the options available.
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you or your partner are not pregnant and are not planning a pregnancy'''
| style="background: #DCDCDC; padding: 5px;" | Men - consider using condoms or not having sex for at least 6 months after travel (if you don’t have symptoms) or for at least 6 months from the start of symptoms (or Zika diagnosis) if you develop Zika.<br> Women- consider using condoms or not having sex for at least 8 weeks after travel (if you don’t have symptoms) or for at least 8 weeks from the start of symptoms (or Zika diagnosis) if you develop Zika.
|}
 
{|
| colspan="3" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''For People Living in an Area with Zika'''}}
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you or your partner are pregnant'''
| style="background: #DCDCDC; padding: 5px;" | Use condoms from start to finish, every time you have vaginal, anal, or oral sex or do not have sex for the entire pregnancy.<br> It is also very important to see a healthcare provider to discuss your options during pregnancy
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you and your partner are planning a pregnancy'''
| style="background: #DCDCDC; padding: 5px;" | Discuss your plans for pregnancy with a healthcare provider to determine your risk and the options available.
|-
| style="background: #F5F5F5; padding: 20px; text-align: center;" | '''If you or your partner are not pregnant and are not planning a pregnancy'''
| style="background: #DCDCDC; padding: 5px;" | Consider using condoms or not having sex as long as there is Zika in the area.  If either you or your partner develop symptoms of Zika or have concerns, talk to a healthcare provider and follow the guidelines on the left.
|}
 
==Hand foot and mouth disease==
{| style="font-size: 85%;"
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Viruses}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Serotypes}}
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Coxsackieviruses '''
| style="background: #DCDCDC; padding: 5px;" | A2, A4 to A10, '''A16''', B2, B3, B5
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Echoviruses'''
| style="background: #DCDCDC; padding: 5px;" | 1, 4, 7, 19
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Enteroviruses'''
| style="background: #DCDCDC; padding: 5px;" | '''A71'''
|}
 
==HFMD==
 
{| style="font-size: 85%;"
! style="width: 200px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Infection}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Presentation}}
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Herpes simplex virus stomatitis]]'''
| style="background: #DCDCDC; padding: 5px;" | • Associated with high grade [[fever]], acute [[gingivitis]] and oral ulcerations <br>• The vesicles are small, grouped together and on an erythematous base<br>• Absence of [[rash]] on palms and soles<br>• A [[Tzanck test]] shows multinucleated giant cells and direct fluorescent antigens test can also help to differentiate hand-foot-and-mouth disease from [[herpes simplex virus]] infection
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Herpangina]]'''
| style="background: #DCDCDC; padding: 5px;" | Raised white cell count but <15,000 cells/mL and serum creatine <nowiki><1.5 times baseline</nowiki>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Bacteremia]] and [[sepsis]]'''
| style="background: #DCDCDC; padding: 5px;" | [[Leucocytosis]] <nowiki>>15,000 cells/mL OR serum creatinene level >1.5</nowiki> times baseline or  abdominal tenderness and serum albumin < 3 g/dL
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Chickenpox]]'''
| style="background: #DCDCDC; padding: 5px;" | [[Hypotension]] or [[shock]], [[ileus]], [[megacolon]], [[leucocytosis]] >20,000 cells/mL OR [[leucopenia]] <nowiki><2,000, lactate ></nowiki>2.2 mmol/L, [[delirium]], [[fever]] ≥ 38.5 °C, organ failure
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Measles]]'''
| style="background: #DCDCDC; padding: 5px;" | Raised white cell count but <15,000 cells/mL and serum creatine <nowiki><1.5 times baseline</nowiki>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Pharyngitis]]'''
| style="background: #DCDCDC; padding: 5px;" | Raised white cell count but <15,000 cells/mL and serum creatine <nowiki><1.5 times baseline</nowiki>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Stevens-Johnson syndrome]]'''<br> or [[Erythema multiforme]]
| style="background: #DCDCDC; padding: 5px;" | Raised white cell count but <15,000 cells/mL and serum creatine <nowiki><1.5 times baseline</nowiki>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Henoch-Schönlein purpura]]'''
| style="background: #DCDCDC; padding: 5px;" | Raised white cell count but <15,000 cells/mL and serum creatine <nowiki><1.5 times baseline</nowiki>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Kawasaki disease]]'''
| style="background: #DCDCDC; padding: 5px;" | Raised white cell count but <15,000 cells/mL and serum creatine <nowiki><1.5 times baseline</nowiki>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Behcet's disease]]'''
| style="background: #DCDCDC; padding: 5px;" | Raised white cell count but <15,000 cells/mL and serum creatine <nowiki><1.5 times baseline</nowiki>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''[[Pemphigus vulgaris]]'''
| style="background: #DCDCDC; padding: 5px;" | Raised white cell count but <15,000 cells/mL and serum creatine <nowiki><1.5 times baseline</nowiki>
|}

Latest revision as of 18:43, 18 September 2017

Actinomycosis

Treatment

Type Treatment
Central Nervous system

actinomycosis

Amoebic liver abscess diagnosis

 
 
 
 
 
 
 
 
 
 
 
Diagnosis of amoebic liver abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Signs and symptoms(a)
Fever, abdominal pain, point tenderness over the liver, hepatomegaly, weight loss
History
Travel to endemic areas, immigrant from endemic areas, having had dysentery within last years, gender (male/female:9/1
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Laboratory diagnosis(LD) and Radiologic Methods (RM) (US, CT or MRI)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LD negative and RM negative:Floow
 
 
 
 
 
 
LD negative and RM positive:aspiration, if possible(b)
 
 
 
 
 
 
LD positive and RM positive: chemotherapy / surgical treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pyogenic abscesses
Neoplasia (hepatocellular carcinoma)
Cysticercosis
Cystic echinococcosis
 
 
 
 
 
 
 
 
 
ALA

Liver abscess

 
 
 
 
 
 
 
 
 
 
 
Liver abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Risk factors
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hematogenous
 
 
 
Biliary
 
 
 
Underlying lesions or anamolies
 
 
 
Other causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Portal vein
Intra-abdominal infection
Pyelophlebitis
Abdominal abscess
Amoebiasis
Arterial
ENT
Oral cavity
 
 
 
Gall stones
Obstructed bile duct
Contiguous spread, ascending cholangitis
Bile duct ischemia
 
 
 
Biliary cyst
Hydatid cyst
Cystadenoma
Necrosis of a primary tumor
Superinfection of a metastasis
Caroli disease
Biliary stricture
Sclerosing cholangitis
Ischemic cholangitis
 
 
 
Radiofrequency ablation / Chemoembolization in the presence of infected bile
Pancreatoduodenectomy
Liver transplantation
Hepatic trauma ± arterial embolization

Causes liver abscess

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pyogenic liver abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hepatobiliary
 
 
 
 
 
 
 
 
Portal
 
 
 
 
 
 
 
Arterial
 
 
 
 
 
 
 
Traumatic
 
 
 
 
 
 
 
Cryptogenic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Benign
 
 
 
Malignant
 
 
Benign
 
 
 
Malignant
 
 
 
 
• Endocarditis
• Vascular sepsis
• Dental infection
• ENT infection
 
 
 
 
Benign
 
 
 
 
 
Malignant
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Lithiasis
• Cholicystitis
• Biliary enteric anastomosis
• Percutaneous biliary procedures
• Endoscopic biliary procedures
 
 
 
• Gall bladder
• Common bile duct
• Head of pancreas
• Ampulla
 
 
• Appendicitis
• Diverticulitis
• Pelvic suppuration
• Anorectal suppuration
• Pancreatic abscess
• Postoperative sepsis
• Intestinal perforation
• Inflammatory bowel disease
 
 
 
• Gastric cancer
• Colon cancer
 
 
 
 
 
 
 
 
 
 
 
• Open or closed abdominal trauma
 
 
 
 
 
• Percutaneous ethanol injection or radiofrequency
• Chemoembolization

Treatment

 
 
 
 
 
Treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-surgical treatment
 
 
 
Non-surgical treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Conservative management with antibiotics alone
 
Open surgical drainage

Drainage

 
 
 
 
 
 
Drainage
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Percutaneous drainage
 
Open surgical drainage
 
Endoscopic retrograde cholangiopancreatography (ERCP)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CT guided
 
CT guided


The mainstay of therapy for pyogenic liver abscesses is percutaneous drainage and antimicrobial therapy. Empiric therapy for pyogenic liver abscesses consists of either a second- or third-generation cephalosporin with metronidazole or piperacillin-tazobactam. Amebic liver abscesses are often treated medically with a short course of metronidazole or tinidazole followed by 20 days of iodoquinol.

Medical Therapy

  • It is essential to differentiate between pyogenic and amebic liver abscesses for appropriate therapy. Differentiation can be established based on serology, culture results, and response to therapy.[1]
  • The mainstay of therapy for pyogenic hepatic abscesses is ultrasound/CT-guided percutaneous drainage with at least 2 weeks (may last up to 6 weeks) of intravenous antibiotics.[2]
  • Empiric antibiotics should only be used initially, with diagnostic aspiration and culture performed as soon as possible.
  • Amebic liver abscesses can be treated successfully with antimicrobial agents and do not require drainage except in special conditions, such as:[3]
  • Severe clinical illness
  • Uncertain diagnosis
  • No response to metronidazole therapy (after 4 days of treatment)
  • Large left-lobe abscesses (risk of rupture into pericardium)
  • Imminent rupture

Antibiotic Regimens

  • Pyogenic Liver Abscess
  • Preferred regimen (1): (Ceftriaxone 1-2 g IV/IM q24h OR Cefotaxime 1-2 g IV or IM q8h) AND (Metronidazole 15 mg/kg IV single dose THEN 7.5 mg/kg PO/IV q6h)
  • Preferred regimen (2): Ciprofloxacin 400 mg IV q12h AND (Metronidazole 15 mg/kg IV single dose THEN 7.5 mg/kg PO/IV q6h)
  • Preferred regimen (3): Piperacillin-Tazobactam 3.375 g IV q6h
  • Note: The empiric therapy for pyogenic abscesses should be based on local resistance patterns, with particular attention to resistant Klebsiella spp.. Ampicillin is not recommended due to the high resistance found among Klebsiella spp.. There is no set duration for treatment, which may vary from 2 to 6 weeks.
  • 2. Pathogen-directed antimicrobial therapy
  • 2.1 Klebsiella spp.[5]
  • Amebic Liver Abscess

References

  1. ↑ Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA (2004). "Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases". Trop Med Int Health. 9 (6): 718–23. doi:10.1111/j.1365-3156.2004.01246.x. PMID 15189463.
  2. ↑ 2.0 2.1 Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O; et al. (2011). "Modern management of pyogenic hepatic abscess: a case series and review of the literature". BMC Res Notes. 4: 80. doi:10.1186/1756-0500-4-80. PMC 3073909. PMID 21435221.
  3. ↑ Stanley SL (2003). "Amoebiasis". Lancet. 361 (9362): 1025–34. doi:10.1016/S0140-6736(03)12830-9. PMID 12660071.
  4. ↑ Rahimian J, Wilson T, Oram V, Holzman RS (2004). "Pyogenic liver abscess: recent trends in etiology and mortality". Clin Infect Dis. 39 (11): 1654–9. doi:10.1086/425616. PMID 15578367.
  5. ↑ 5.0 5.1 Lederman ER, Crum NF (2005). "Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics". Am J Gastroenterol. 100 (2): 322–31. doi:10.1111/j.1572-0241.2005.40310.x. PMID 15667489.
  6. ↑ Lübbert C, Wiegand J, Karlas T (2014). "Therapy of Liver Abscesses". Viszeralmedizin. 30 (5): 334–41. doi:10.1159/000366579. PMC 4513824. PMID 26287275.
  7. ↑ Kurland JE, Brann OS (2004). "Pyogenic and amebic liver abscesses". Curr Gastroenterol Rep. 6 (4): 273–9. PMID 15245694.

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