Pyogenic liver abscess physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

Common physical examination findings associated with pyogenic liver abscess include high grade fever, yellowish discoloration of skin (jaundice), icteric sclera, reduced breath sounds or crepitations at the base of lung, hepatomegaly with point tenderness, and abdominal guarding or rebound tenderness on palpation, dullness on percussion, and absent bowel sounds.

Physical Examination

Common physical examination findings associated with pyogenic liver abscess may include:

Appearance of Patient

Patients with pyogenic liver abscess appear ill and sweating . Appears thin due to weight loss and confused in later stages of disease.

Vital signs

• High grade fever (>38°C) chills
• Tachycardia

Skin

Yellowish discoloration of skin (jaundice)

HEENT

Icteric sclera

Lungs

Reduced breath sounds or crepitations at right lung base may be heard

Heart

• Chest tenderness on palpation
• Audible pericardial friction rub (sign associated with high mortality)
• S1 and S2 are normal

Abdomen

• Hepatomegaly with point tenderness over the liver, in the intercostal spaces, or below the ribs is a typical finding.
• Epigastric mass if left lobe is involved
• Abdominal guarding or rebound tenderness
• Due to dullness on percussion, the movement on right side of the chest and abdomen is restricted (ascites)
• Abdominal distension in advanced cases
• Absent bowel sounds

Extremities

Bilateral pedal edema in advanced liver disease