A liver abscess is a mass filled with pus inside the liver. Common causes are abdominal conditions such as appendicitis or

diverticulitis Diverticulitis, specifically colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches—diverticula—which can develop in the wall of the large intestine. Symptoms typically include lower abdominal ...

due to haematogenous spread through the

portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approxima ...

. It can also develop as a complication of a

liver injury A liver injury, also known as liver laceration, is some form of trauma sustained to the liver. This can occur through either a blunt force such as a car accident, or a penetrating foreign object such as a knife. Liver injuries constitute 5% of a ...

Causes

Risk factors for developing liver abscess can be due to infection, post-procedural infection and metastasis such as primary liver tumours, liver metastasis, biliary procedures, biliary injuries, biliary tract disease, appendicitis, and

. Major bacterial causes of liver abscess include the following: * '' Streptococcus'' species (including '' Enterococcus'') * '' Escherichia'' species * ''

Staphylococcus ''Staphylococcus'' is a genus of Gram-positive bacteria in the family Staphylococcaceae from the order Bacillales. Under the microscope, they appear spherical (cocci), and form in grape-like clusters. ''Staphylococcus'' species are facultative ...

'' species * '' Klebsiella'' species (Higher rates in the Far East) * Anaerobes (including '' Bacteroides'' species) * '' Pseudomonas'' species * '' Proteus'' species * Entamoeba Histolytica However, as noted above, many cases are polymicrobial.

Diagnosis

Types

There are several major forms of liver abscess, classified by cause: *

Pyogenic liver abscess 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 ...

, which is most often polymicrobial, accounts for 80% of hepatic abscess cases in the United States. *

Amoebic liver abscess A amoebic liver abscess is a type of liver abscess caused by amebiasis. It is the involvement of liver tissue by trophozoites of the organism ''Entamoeba histolytica'' and of its abscess due to necrosis. Presentation Approximately 90% of patient ...

due to '' Entamoeba histolytica'' accounts for 10% of cases. The incidence is much higher in developing countries. * Fungal abscess, most often due to '' Candida'' species, accounts for less than 10% of cases. * Iatrogenic abscess, caused by medical interventions

Management

Draining of the abscess and antibiotics: IV metronidazole and third generation

cephalosporin The cephalosporins (sg. ) are a class of β-lactam antibiotics originally derived from the fungus ''Acremonium'', which was previously known as ''Cephalosporium''. Together with cephamycins, they constitute a subgroup of β-lactam antibiotics ...

quinolones Quinolone may refer to: * 2-Quinolone * 4-Quinolone * Quinolone antibiotic A quinolone antibiotic is a member of a large group of broad-spectrum bacteriocidals that share a bicyclic core structure related to the substance 4-quinolone. They ar ...

, β-lactam antibiotics, and aminoglycosides are effective.

Prognosis

The prognosis has improved for liver abscesses. The mortality rate in-hospital is about 2.5-19%. The

elderly Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms for people at this age include old people, the elderly (worldwide usage), OAPs (British usage ...

, ICU admissions, shock, cancer,

fungal infections Fungal infection, also known as mycosis, is disease caused by fungi. Different types are traditionally divided according to the part of the body affected; superficial, subcutaneous, and systemic. Superficial fungal infections include common ti ...

, cirrhosis,

chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years. Initially generally no symptoms are seen, but later symptoms may include leg swelling, feeling tired, vo ...

acute respiratory failure Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise ...

, severe disease, or disease of biliary origin have a worse

prognosis Prognosis (Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain stabl ...

References

External links

Liver Abscess CT Images
CTCases Liver Abscess CT Scan. {{Gastroenterology Diseases of liver