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This week’s case-based question:
An 86-year old woman recently hospitalized with sepsis and myocardial infarction presents from her rehabilitation center with abdominal pain and vomiting. She required intensive care during her recent hospital admission, and she reports that the pain was actually already vaguely present upon transfer to her current center, but it has subsequently worsened. The pain is in the right upper quadrant with radiation to the right shoulder, and it is constant.
Vital signs are: temperature 38.3°C (101°F), heart rate 85 beats/minute, blood pressure 100/60 mm Hg, respiratory rate 22 breaths/minute, and oxygen saturation 94% on room air.
Examination reveals a frail-appearing woman who is wheelchair bound and does not appear jaundiced. Her abdomen is soft, but it is tender to palpation beneath the right costal margin. She has a positive Murphy sign. Laboratory results are notable for a mildly elevated alkaline phosphatase level and a white blood cell count of 19,000/µL.
Ultrasonography of the right upper quadrant is obtained (see Figure).
In addition to antibiotics, which of the following is the most appropriate treatment plan for this patient?
drainage of liver abscess
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