Pyogenic liver abscess

Pyogenic liver abscess
A large pyogenic liver abscess presumed to be the result of appendicitis
Specialty	Gastroenterology

A pyogenic liver abscess is a type of liver abscess caused by bacteria.

Signs and symptoms[]

Acute abscess[]

• Fever
• Lethargy
• Discomfort in right upper quadrant of abdomen
• Anorexia
• Enlarged and tender liver
• Pleural effusion

Chronic abscess[]

• Fever
• Abdominal discomfort
• Enlarged liver

Cause[]

• Biliary disease (most common)

E.g.: stones, cholangiocarcinoma

• Colonic disease

E.g.: diverticulitis, appendicitis, Crohn's disease

• Cryptogenic disease
• Pancreatitis
• Infection of blood
• Intra-abdominal sepsis
• Infection of biliary system
• Traumatic introduction

E.g.: penetrating injury, iatrogenic (radiofrequency ablation)

Common bacterial causes[]

• Streptococcus milleri
• E. coli
• Streptococcus fecalis
• Klebsiella pneumoniae
• Proteus vulgaris
• Bacteroides
• Opportunistic pathogens (Staphylococcus)

Diagnosis[]

• Blood CP (no leucocytosis)
• Haemoglobin estimation (anaemia)
• Serum albumin levels (falls rapidly)
• USG and CT scanning
• Guided aspiration to confirm the diagnosis

Treatment[]

1. Antibiotics
   • Penicillins
   • Aminoglycosides
   • Metronidazole
   • Cephalosporins
2. Percutaneous drainage under USG or CT control
3. Laparotomy in intra-abdominal disease

References[]

• Pyogenic hepatic abscesses at eMedicine

External links[]