From the Guidelines
Elevated liver function tests (LFTs) in a patient with a retropharyngeal abscess should be managed by treating the underlying infection with prompt surgical drainage and appropriate antibiotic therapy, as the LFT abnormalities are likely a systemic inflammatory response to the infection rather than primary liver disease. The patient's condition can be classified based on the severity of abnormal aminotransferase levels, which can be mild, moderate, or severe, as described in the ACR Appropriateness Criteria 1.
The management of the retropharyngeal abscess should include a reasonable empiric antibiotic regimen, such as a combination of ampicillin-sulbactam and metronidazole, to cover oral anaerobes, as suggested by general medical knowledge. This regimen should be continued for 10-14 days, with transition to oral antibiotics once clinical improvement occurs.
Regarding the elevated LFTs, close monitoring is recommended, but specific liver-directed therapy is usually unnecessary, as the liver abnormalities typically resolve with successful treatment of the abscess 1. Supportive care should include adequate hydration, pain management, and possibly corticosteroids if significant airway edema is present.
Key points to consider in the management of elevated LFTs in this context include:
- The connection between the abscess and LFT elevation stems from inflammatory cytokines and potential bacteremia causing transient hepatocellular dysfunction
- If LFTs continue to worsen despite appropriate abscess treatment, additional evaluation for concomitant liver disease or medication toxicity would be warranted
- The severity of abnormal aminotransferase levels can be classified as mild, moderate, or severe, based on the upper reference limit, as described in the ACR Appropriateness Criteria 1.
In terms of specific liver enzyme levels, it is essential to note that ALT elevations are specific for liver injury, whereas AST elevations can be due to disorders involving other organs, such as the heart, skeletal muscle, kidneys, brain, and red blood cells 1.
From the Research
Elevated LFT with Retropharyngeal Abscess
- There is no direct evidence in the provided studies that links elevated Liver Function Tests (LFT) with retropharyngeal abscess 2, 3, 4, 5, 6.
- Retropharyngeal abscess is a serious condition that requires early diagnosis and treatment to prevent complications 2, 3, 4, 6.
- The most common presenting symptoms of retropharyngeal abscess are odynophagia, neck pain, and fever 2, 3.
- Surgical drainage of the abscess and intravenous antibiotics are the common treatments for retropharyngeal abscess 2, 3, 4, 6.
- Computed Tomography (CT) scan is a crucial tool for diagnosing retropharyngeal abscess and differentiating it from cellulitis 3, 4.
- The most common pathogens isolated from retropharyngeal abscesses are Streptococcus pyogenes and group A beta-hemolytic streptococci 3, 4.
- Ceftriaxone is a broad-spectrum antibiotic that has been effective in treating various infections, including those caused by multidrug-resistant Gram-negative bacteria 5.