Liver abscess Main Page
Synonyms and Keywords: Hepatic abscess
Liver abscess is a pus-filled cavity inside or attached to the liver. Common causes are an abdominal infection such as appendicitis or diverticulitis. With treatment the prognosis of liver abscess is poor with a mortality 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 are seen in the majority of patients, but it has a low specificity. E. coli is the most common causative 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 ultrasonography or CT-guided drainage. Therapy for liver abscess caused by bowel perforation or foreign body is open surgical drainage. Amoebic liver abscess occurs in 94% of cases of amebiasis. Liver abscess can be caused rarely as complication of percutaneous radiofrequency ablation for hepatic tumors.
The following are the list of potential sources for infection that can lead to the formation of liver abscess:
- 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
Liver abscess can be classified based on the etiology into :
|Disease||Causes||Signs and symptoms||Lab Findings||Imaging Findings||Other Findings|
(right upper quadrant pain)
|Amoebic liver abscess||Entamoeba histolytica||✔✔✔||✔✔✔||✔/✘||✔||✔✔/✘||✔
|Pyogenic liver abscess||Bacteria||✔||✔||✔✔||✔✔||✔/✘||✔✔✔||✔
|Fungal liver abscess||Candida species
|✔||✔||✔/✘||✔||✔||✔||✔||✔||✔||✔||CT and USG findings with four patterns of presentation:
|Echinococcal (hydatid) cyst||Echinococcus granulosus||✔||✔||✔||✔||✔||Histology: Hydatid cyst with three layers
a.The outer pericyst, which corresponds with compressed and fibrosed liver tissue
b.The endocyst, an inner germinal layer
c.The ectocyst, a thin, translucent interleaved membrane
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