Overview
A liver abscess describes a collection of pus within the liver. A pyogenic liver abscess is an abscess due to bacterial infection and may occur due to local infection or dissemination from an infection elsewhere, such as appendicitis, cholecystitis, liver transplantation, or peritonitis.
The most common organisms found in pyogenic liver abscesses are Escherichia coli in adults and Staphylococcus aureus in children, however, most are polymicrobial with mixed enteric organisms.
An amoebic liver abscess is an abscess due to an amoeba, most notably Entamoeba histolytica.
Risk Factors
- Hepatobiliary disorders
- Liver transplants
- Diabetes mellitus
- Pancreatic disorders
Presentation
Overview
Pyogenic liver abscess presents subacutely (days-weeks) with:
- Fever and systemic upset (e.g. anorexia, malaise, nausea, and vomiting)
- Right upper quadrant pain and tenderness
- Jaundice may be seen
Investigations
Overview
Some investigations and their findings include:
- Full blood count (FBC) – may show leukocytosis and neutrophilia, suggesting infection
- Blood cultures – may identify causative organism
- Liver function tests (LFTs) – ALP is raised, transaminases and bilirubin may be raised
- Coagulation assay – performed to check if aspiration is contraindicated
- Chest X-ray – may show elevation of the right hemidiaphragm
- Liver ultrasound – may identify the abscess and can guide aspiration
- Abscess aspirate and culture – may identify causative organism
Management
Overview
Management involves percutaneous drainage and antibiotics – amoxicillin + ciprofloxacin + metronidazole or if penicillin allergic, ciprofloxacin + clindamycin.
In some cases, surgical drainage may be necessary, such as if percutaneous drainage and IV antibiotics fail or if abscesses are large.
