Pyogenic liver abscess

Alternative names
Liver abscess; Bacterial liver abscess

Definition
Pyogenic liver abscess is a pus-filled cavity within the liver.

Causes, incidence, and risk factors

There are many potential causes of liver abscesses. They can be caused by an abdominal infection such as appendicitis, diverticulitis, or a perforated bowel. Other causes may be an infection in the blood, an infection of the biliary (liver secretion) tract, or trauma that damages the liver.

The most common bacteria that cause liver abscesses are Escherichia coli, klebsiella, enterococcus, staph and strep, and bacteroides.

Symptoms

     
  • Fever, chills  
  • Nausea, vomiting  
  • Pain in right upper abdomen  
  • Loss of appetite  
  • Unintentional weight loss  
  • Weakness  
  • Yellow skin (jaundice)  
  • Chalk-colored stool  
  • Dark urine

Signs and tests

     
  • Blood culture that is positive for bacteria - this occurs in about half of the patients with pyogenic liver abscess  
  • Occasionally elevated liver enzymes (liver function tests) and elevated bilirubin, which causes jaundice  
  • Elevated white blood cell count, indicating infection  
  • Abdominal CT scan  
  • Abdominal ultrasound  
  • Liver biopsy

Treatment
The treatment usually consists of surgical or percutaneous (through the skin, with a needle) drainage of the abscess. This is accompanied by prolonged antibiotic therapy. Sometimes antibiotics alone can cure the infection.

Expectations (prognosis)

The death rate is 10-30% in treated patients, and it is higher in those with multiple abscesses.

Complications
Life-threatening sepsis can develop.

Calling your health care provider

Call your health care provider if any symptoms of this disorder develop.

Also call if severe abdominal pain, confusion or decreased consciousness, persistent high fever, or other new symptoms develop 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.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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