Pyogenic liver abscess

Definition

Pyogenic liver abscess is a pus-filled area in the liver.

Alternative Names

Liver abscess; Bacterial liver abscess

Causes, incidence, and risk factors

There are many potential causes of liver abscesses, including:

• Abdominal infection such as appendicitis, diverticulitis, or a perforated bowel
• Infection in the blood
• Infection of the liver secretion (biliary) tract
• Recent endoscopy of the biliary system
• Trauma that damages the liver

The most common bacteria that cause liver abscesses are:

• Bacteroides
• Enterococcus
• Escherichia coli
• Klebsiella
• Staphylococcus
• Streptococcus

In most cases, more than one bacteria is found.

Symptoms

• Chalk-colored stool
• Dark urine
• Fever, chills
• Loss of appetite
• Nausea, vomiting
• Pain in right upper abdomen (more common) or throughout the abdomen (less common)
• Unintentional weight loss
• Weakness
• Yellow skin (jaundice)

Signs and tests

Tests may include:

• Abdominal CT scan
• Abdominal ultrasound
• Blood culture for bacteria
• Liver biopsy
• Liver enzymes (liver function tests) and bilirubin
• White blood cell count

Treatment

Treatment usually consists of surgery or going through the skin with a needle or tube (percutaneous) to drain the abscess. Along with this procedure, you will receive long-term antibiotic therapy (usually 4 - 6 weeks). Sometimes antibiotics alone can cure the infection.

Expectations (prognosis)

Even with treatment this condition can be life-threatening in 10-30% of patients. The risk is higher in people who have many abscesses.

Complications

Life-threatening sepsis can develop.

Calling your health care provider

Call your health care provider if you have:

• Any symptoms of this disorder
• Severe abdominal pain
• Confusion or decreased consciousness
• Persistent high fever
• Other new symptoms during or after treatment

Prevention

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

References

Chung RT, Friedman LS. Bacterial, parasitic, and fungal infections of the liver, including liver abscess. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006: chap 79.