Liver function tests will typically be normal or unchanged from baseline as the infection does not involve the liver parenchyma. If a D-dimer is ordered, which it often is when there is pleuritic torso pain, it will usually be markedly elevated but other testing for pulmonary embolism will be normal. CT of the abdomen with IV contrast may show subtle enhancement of the liver capsule, but this may be missed by radiologists if they are not advised to look for it. Testing for gonorrhea and chlamydia should be performed to make the diagnosis. An endocervical or low vaginal swab should be taken to test for these organisms. Antibody testing is rarely required but may be considered if other tests are non-diagnostic and suspicion is high.Laparoscopy is also rarely required, but may be performed when the diagnosis is uncertain and may reveal "guitar string" adhesions of parietal peritoneum to liver. Treatment
Treatment involves a course of antibiotics to cover the appropriate organisms, typically ceftriaxone plus azithromycin. Laparoscopy for lysis of adhesions may be performed for refractory pain. References
Further reading
Pregerson, Brady (2010). Quick Essentials: Emergency Medicine (4th ed.). ISBN 978-0-9761552-3-2. Pregerson, D. Brady (2012). Tarascon Emergency Department Quick Reference Guide. Jones & Bartlett. ISBN 978-0-7637-8789-9. == External links ==
Endemic goiter is a type of goitre that is associated with dietary iodine deficiency. Cause
Some inland areas where soil and water lacks in iodine compounds and consumption of marine foods is low are known for higher incidence of goitre. In such areas goitre is said to be "endemic". Prevention
This type of goiter is easily preventable. In most developed countries regulations have been put into force by health policy institutions requiring salt, flour or water to be fortified with iodine. Treatment
Treatment of endemic goiter is medical with iodine and thyroxine preparations. Surgery is only necessary in cases where complicated by significant compression of nearby structures. References


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