Liver abscess overview

Abscess Main Page
Liver abscess Main Page
Overview
Causes
Classification Pyogenic liver abscess Amoebic liver abscess
Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

A liver abscess is a pus-filled mass inside or attached to the liver. Common causes are an abdominal infection such as appendicitis or diverticulitis. With treatment, the death rate is 10-30%.. Biliary tract disease is the most common cause but no cause identified in the majority of patients. There are nonspecific clinical findings hence a high degree of suspicion required for diagnosis. There are most often single, rather than multiple foci. Hyperbilirubinemia and elevated alkaline phosphatase in the majority of patients, but low specificity. E. coli is the most prevalent organism, followed by Klebsiella, Streptococcus, and Bacteroides species. Rare cause is bowel perforation following foreign body ingestion. Therapy for solitary liver abscess from causes other than bowel perforation is intravenous antibiotics and percutaneous US- or CT-guided drainage. Therapy for liver abscess caused by bowel perforation or foreign body is open surgical drainage. Amebic liver abscess occurs in 94% of cases of amebiasis. Liver abscess is a relatively infrequent (1.7% according to Cho, D. et. al.), although possible, complication of percutaneous radiofrequency ablation of hepatic tumors.

Historical Perspective

Abscesses of liver are described since the time of Hippocrates.. In 1938, Ochsner’s classic review heralded surgical drainage as the definitive therapy.

Classification

Liver abscess may be classified into 3 types based on etiology into pyogenic, amoebic, and fungal liver abscess.

Natural History, Complications and Prognosis

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

Diagnosis

Chest X Ray

Right pleural effusion, elevated right hemidiaphragm, and subsegmental atelectasis on chest radiography. Findings on abdominal radiography nonspecific in 87% of cases.

Ultrasound

USG and CT are critical imaging tools. USG may demonstrate a peripheral echo-free halo, distal acoustic enhancement, and progressive change over a short period of time.

Treatment

Medical Therapy

Treatment usually consists of placing a tube through the skin to drain the abscess. Less often, surgery is required. Antibiotics are used for about 4 - 6 weeks. Sometimes, antibiotics alone can cure the infection. Commonly used antibiotics include penicillins, aminoglycosides, metronidazole and cephalosporins.

Surgery

Surgical options include percutaneous Drainage under USG or CT control and laparotomy in intra-abdominal disease.

Primary Prevention

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