Pyogenic liver abscess

Digestive system — The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

Also known as: Liver abscess and Bacterial liver abscess

Definition

Pyogenic liver abscess is a pus-filled area in the liver.

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
Staphylococcus
Streptococcus

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

Symptoms

Clay-colored stool
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
White blood cell count

Treatment

Treatment usually consists of surgery or going through the skin with a needle or tube to drain the abscess. 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

Neuschwander-Tetri BA. Bacterial, parasitic, fungal and granulomatous liver diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 155.

Review date:: September 15, 2010
Reviewed by:: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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