A 45-year-old man presents with a 1-week history of high-grade fever, abdominal pain, occasional rigors, loss of appetite, malaise, nausea, and vomiting. He was all right about a week ago when he had low-grade fever for the first 2 days. Fever was high grade during the last 3 - 4 days, with occasional rigors accompanied by abdominal pain predominantly in right upper abdomen. Pain is moderate in intensity, continuous without any radiation, and is not relieved by acetaminophen (Tylenol), which he is taking on his own.
Examination reveals tender hepatomegaly. No other organs are palpable. Abdomen is slightly distended, but bowel sounds are normal.
Vital parameters: temp 40° C, pulse 108 per minute, blood pressure 136/90mmHg, and respiration rate 20 per minute. Patient appears sick and toxic. The rest of the physical examination is as following:
Neck: Supple. No stridor.
Lymphatics: No lymph node groups were palpable.
Lungs: Decreased breath sounds at the base of the right lower lung.
Cardiac: Normal S1 and S2. No extra heart sounds. No heave.
Back: Negative
Groin: Unremarkable
Genitalia: Unremarkable
Neurological: Normal cranial nerves. Normal motor and sensory examination.
Ultrasonography reveals multiple liver abscesses in both lobes of the liver, which is confirmed by similar findings in CT scan.
What is the most common cause of the patient's pyogenic liver abscess?
A) Pylephlebitis
B) Cholangitis
C) Endocarditis
D) Sub-phrenic abscess
E) Pyelonephritis
