Pyogenic liver abscess

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 bile draining tubes
• Recent endoscopy of the bile draining tubes
• Trauma that damages the liver

The most common bacteria that cause liver abscesses are:

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

In most cases, more than one type of bacteria is found.

Symptoms

• Chest pain (lower right)
• Clay-colored stools
• 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
• Bilirubin blood test
• Blood culture for bacteria
• Complete blood count (CBC)
• Liver biopsy
• Liver function tests

Treatment

Treatment usually consists of placing a tube through the skin to drain the abscess. Less often, surgery is required. You will also receive antibiotics for about 4 - 6 weeks. Sometimes, antibiotics alone can cure the infection.

Expectations (prognosis)

This condition can be life threatening some patients. The risk for death is higher in people who have many liver 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

Reddy KR. Bacterial, parasitic, fungal and granulomatous liver diseases. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 360.

Sifri CD, Madoff LC. Infections of the liver and biliary system. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone;2009:chap 72.