A pyogenic liver abscess (PLA) is a pocket of pus that forms in the liver in response to an infection or trauma. Pus is a fluid composed of white blood cells, dead cells, and bacteria that forms when your body fights off infection. Instead of draining from the infection site, the pus collects in your liver. An abscess is usually accompanied by swelling and inflammation in the surrounding area, and can cause pain and swelling in the abdomen.
Pyogenic liver abscess can be fatal if not treated promptly.
The most common cause of PLA is biliary disease. This is a broad term for conditions affecting the liver, pancreas, and gallbladder. Of the biliary diseases, an inflamed gallbladder is most often responsible for PLA.
Other causes include:
- ruptured appendix (bacteria from the rupture can form an abscess)
- pancreatic cancer
- colon cancer
- inflammatory bowel disease, including diverticulitis or a perforated bowel
- blood infections (septicemia)
- trauma to the liver by accident or injury
According to research published in the New England Journal of Medicine, diabetics are at a higher risk for this condition, as diabetics are often more susceptible to infection. (Yu & Lee, 2011)
PLA symptoms resemble those of gallbladder inflammation or massive infection, and may include:
- right upper abdominal pain
- sudden dramatic weight loss (10 pounds in a few weeks)
- dark-colored urine
- whitish or clay-colored stool
To diagnose this condition, a doctor may order a combination of blood cultures and imaging tests. The following tests may be used:
- computed tomography (CT) scan—to locate the abscess
- CT with intravenous contrast—to pinpoint and measure the abscess (very useful when planning a surgery)
- blood tests—elevated white blood count and high neutrophil level indicate infection
- blood cultures for bacteria—to identify the bacteria so your doctor knows what antibiotic to prescribe
- abdominal ultrasound—to visualize an abscess in the right upper quadrant
A pyogenic liver abscess may appear as a mass on the liver when viewed with CT scans.
Some people can be successfully treated for PLA with antibiotics alone. Most, however, will require drainage of the abscess. This involves inserting a needle or tube into the abscess and removing the pus. Your doctor may perform a liver biopsy at the same time to determine the overall health of your liver. This procedure is performed with the aid of a CT scan.
Doctors try to treat PLA without surgery if possible to prevent the risk of bacteria spreading through the body. However, in more severe cases, surgery may be required to fully remove the abscess materials. After surgery you will be treated with antibiotics for several weeks to avoid recurring infection. According to the Cleveland Clinic Journal of Medicine (CCJM), both intravenous and oral medications may be used to treat and manage PLA. (CCJM, 2010) An initial course of intravenous antibiotics aids healing. Several weeks of taking a potent oral antibiotic contributes to healing after a post-surgical checkup.
The main complication of PLA is sepsis, a body-wide bacterial infection that causes inflammation and a dangerous drop in blood pressure. If not treated promptly with antibiotics, sepsis can be fatal.
PLA drainage and surgery have a risk of spreading bacteria throughout the body. This may result in widespread infection or the formation of abscesses in other organs.
Bacteria released and spread throughout the body can cause:
- septic pulmonary embolism (a bacteria stimulated clot in one or more arteries in the lungs)
- brain abscess, causing permanent neurological damage
- endophthalmitis (infection in the inner part of the eye which may lead to vision loss)
PLA is a potentially life-threatening condition. Patients with symptoms should seek medical help immediately to avoid dangerous health complications. Prompt diagnosis and surgical treatment are important for a positive outlook.