Liver Abscess

A liver abscess occurs when bacteria or protozoa destroy hepatic tissue, producing a cavity, which fills with infectious organisms, liquefied liver cells, and leukocytes. Necrotic tissue then walls off the cavity from the rest of the liver.

Liver abscess occurs equally in men and women, usually in those over age 50. Death occurs in 15% of affected patients despite treatment.

Causes

Underlying causes of liver abscess include benign or malignant biliary obstruction along with cholangitis, extrahepatic abdominal sepsis, and trauma or surgery to the right upper quadrant. Liver abscesses also occur from intra-arterial chemoembolizations or cryosurgery in the liver, which causes necrosis of tumor cells and potential infection

The method by which bacteria reach the liver reflects the underlying causes. Biliary tract disease is the most common cause of liver abscess. Liver abscess after intra-abdominal sepsis (such as with diverticulitis) is most likely to be caused by hematogenous spread through the portal bloodstream. Hematogenous spread by hepatic arterial flow may occur in infectious endocarditis. Abscesses arising from hematogenous transmission are usually caused by a single organism; those arising from biliary obstruction are usually caused by a mixed flora. Patients with metastatic cancer to the liver, diabetes mellitus, and alcoholism are more likely to develop a liver abscess. The organisms that predominate in liver abscess are gram-negative aerobic bacilli, enterococci, streptococci, and anaerobes. Amebic liver abscesses are caused by Entamoeba histolytica.

Signs and symptoms

Right-sided abdominal (belly) and right shoulder pain.
Nausea (upset stomach), vomiting (throwing up), and weight loss.
Fever and sweating.
Chalk-colored stool
Dark urine
Chest pain, shortness of breath, and cough caused by fluid on the lungs.

Diagnosis

Blood culture that is positive for bacteria - this occurs in about half of the patients with pyogenic liver abscess
Occasionally elevated liver enzymes ( liver function tests ) and elevated bilirubin, which causes jaundice
Elevated white blood cell count, indicating infection
Abdominal CT scan
Abdominal ultrasound
Liver biopsy

Treatment

Antibiotic therapy along with drainage is the preferred treatment for most hepatic abscesses. Percutaneous drainage either with ultrasound or CT guidance is usually sufficient to evacuate pus. Surgery may be performed to drain pus in unstable patients with continued sepsis (despite attempted nonsurgical treatment) and for patients with persistent fevers (lasting longer than 2 weeks) after percutaneous drainage and appropriate antibiotic therapy.

Before the causative organism is identified, antibiotics should be started to treat aerobic gram-negative bacilli, streptococci, and anaerobic bacilli including Bacteroides species. A common combination is ampicillin, an aminoglycoside with either metronidazole or clindamycin. Third-generation cephalosporins can be substituted for the aminoglycosides in patients at risk for renal toxicity. When the causative organisms are identified, the antibiotic regimen should be modified to match the patient's sensitivities. I.V. antibiotics should be administered for 14 days and then replaced with oral preparations to complete a 6-week course.

Prevention

Prompt treatment of abdominal and other infections may reduce the risk of developing a liver abscess. Many cases are not preventable.

Diseases & Conditions

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