BOF 8
A 78-year-old female is admitted with a history of fever,
anorexia, malaise and weight loss. She looks thin, has a tachycardia and a soft
systolic murmur at the apex. No other abnormalities are detectable.
Investigations reveal a polymorphonuclear leucocytosis, an elevated ESR and a
high serum alkaline phosphatase. Blood cultures show growth of Streptococcus
milleri
In this patient the definitive investigation would be:
a)
Abdominal ultrasound scan
b)
Transoesophageal echocardiogram
c)
ERCP
d)
Colonoscopy
e)
CT Chest
Answer:
a)
Streptococcus milleri is a common infecting organism
in pyogenic liver abscess, which is now more common in elderly patients as a
complication of biliary tract disease or diverticulitis. It usually presents
with abdominal pain, swinging fever, anorexia, malaise weight loss and
hepatomegaly but, in elderly patients abdominal pain and hepatomegaly may not
feature. Abdominal ultrasound will usually reveal the diagnosis and may be used
to aspirate the abscess.
Last Updated: 19/02/06
