Pyogenic liver abscess

Pyogenic liver abscess
Other names: Pyogenic hepatic abscess[1]
Top:A large pyogenic liver abscess presumed to be the result of appendicitis Bottom:Section of surgical piece of hepatectomy by PHA[2]
Specialty	General surgery, Infectious disease

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

• Fever
• Abdominal discomfort
• Enlarged liver

Cause

• Biliary disease (most common)

E.g.: stones, cholangiocarcinoma

• Colonic disease

E.g.: diverticulitis, appendicitis, Crohn's disease

• Cryptogenic disease
• Pancreatitis
• Infection of blood
• Intra-abdominal sepsis
• Infection of biliary system
• Traumatic introduction

E.g.: penetrating injury, iatrogenic (radiofrequency ablation)

Common bacterial causes

• Streptococcus milleri
• E. coli
• Streptococcus fecalis
• Klebsiella pneumoniae
• Proteus vulgaris
• Bacteroides
• Opportunistic pathogens (Staphylococcus)

Diagnosis

• Blood CP (no leucocytosis)
• Haemoglobin estimation (anaemia)
• Serum albumin levels (falls rapidly)
• USG and CT scanning
• Guided aspiration to confirm the diagnosis

Treatment

In terms of the management for Pyogenic liver abscess, the following is done:

1. Antibiotics
   • Penicillins
   • Aminoglycosides
   • Metronidazole
   • Cephalosporins
2. Percutaneous drainage under USG or CT control
3. Laparotomy in intra-abdominal disease

Epidemiology

In terms of the epidemiology of Pyogenic liver abscess we find 2.3 to 3.6 cases per 100,000 population in North America.Higher rates exist in Asia, particularly in countries like Taiwan, where the incidence has reached 15.45 per 100,000^[3]

References

• Pyogenic hepatic abscesses at eMedicine

External links