Liver abscess

Liver abscesses in Western countries are caused by bacteria, so-called pyogenic liver abscess. In developing countries, liver abscesses are mostly caused by parasites. Liver abscesses mostly affect the right lobe of the liver.

Etiology

In many cases, the source cannot be identified (cryptogenic abscess). In cases where the source is identified, the following sources are the most common:

• Ascending cholangitis (due to biliary obstruction)
• Bacteraemia
• Intraabdominal infection (appendicitis, diverticulitis)

Clinical features

The classical features of pyogenic liver abscess are fever, malaise, and pain in the right upper quadrant. They may also have tender hepatomegaly and may develop jaundice if biliary obstruction occurs. There may also be clinical features of the underlying source.

Diagnosis and evaluation

Elevated inflammatory markers, abnormal liver function test, and positive blood culture is often present.

Imaging shows hypoechoic/hypodense lesions, usually in the right lobe of the liver. An underlying source should also be sought on imaging.

Treatment

Treatment includes antibiotics and drainage, as well as identifying the source. Drainage is often percutaneous, but in complicated cases surgical drainage may be necessary.