Liver Abscesses

Overview

Liver abscesses are collection of purulent material(pus) in the liver parenchyma that caused by bacterial, fungal, or parasitic infection. The mode of spread of these infections to the liver is via the biliary tree, hepatic vein, or portal vein, by extension of an adjacent infection, or as a result of trauma. There can be one or more abscesses present in the liver parenchyma.

Signs and Symptoms

Fevers and chills, Right upper quadrant tenderness sometimes radiation to the right shoulder, Sometimes palpable mass is postive, Hepatomegaly, Mild jaundice, Weight loss, Fatigue, Abdominal pain, Nausea and vomiting

Common Causes

Pyogenic liver abscess: Causative agent:Escherichia coli(most common), Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus, Bacteroides, Amoebic liver abscess: Causative agent: Entamoeba histolytica

Risk Factors

Biliary tract disease, Age >50 years, Underlying malignancy, Diabetes mellitus

Investigation Techniques

Full blood count, Liver function test, Blood cultures, PT and activated partial thromboplastin time, Serum antibody test for Entamoeba histolytica, Stool Entamoeba histolytica antigen detection test, Antigen testing or PCR of aspirated abscess fluid, Abdominal ultrasound, Chest X-ray, CT scan

Treatment and Prevention

Pyogenic liver abscess: Drainage of abscess surgically either via percutaneous(guided with ultrasound or CT) or laparotomy and antibiotic treatment(choice of antibiotic depends on the culture result), Amoebic liver abscess: Drainage of abscess surgically either via percutaneous(guided with ultrasound or CT) and amoebicidal drugs like metronidazole(first line therapy)