Pyogenic liver abscess (bacterial liver abscess)

Pyogenic liver abscess (bacterial liver abscess).

Aetiology.

Bacteria reach the liver and cause abscess by one of the following five mechanisms:

1.Portal vein bacteraemia from appendicitis, diverticulitis and perforated bowel.

2.Systemic bacteraemia reaching liver via hepatic artery.

3.Ascending cholangitis.

4.Direct extension from a contiguous focus of infection like subphrenic abscess.

5.Penetrating trauma introducing the bacteria into liver, or blunt trauma resulting in a hepatic haematoma which gets secondarily infected.

Single abscesses are more common in the right lobe of the liver.

Multiple abscesses are seen in elderly patients, usually due to ascending cholangitis.

Common organisms are E. coli, anaerobic streptococci and bacteroides. o Clinical features.

Most have a subacute onset.

Fever with chills and rigors.

Weight loss, anorexia, nausea and vomiting.

Right upper quadrant pain radiating to right shoulder.

Pleuritic chest pain.

Tender hepatomegaly.

Mild jaundice.

Respiratory findings at the base of right lung.

Investigations.

Leucocytosis and raised ESR.

Mildly elevated serum bilirubin.

Markedly elevated serum alkaline phosphatase.

Low serum albumin.

Blood culture may be positive.

Chest radiograph shows raised right dome of diaphragm, right basilar atelectasis and pneumonia or effusion.

Ultrasonography confirms the diagnosis.

Needle aspiration of pus for culture sensitivity.

Management.

Commence treatment with a combination of ampicillin, gentamicin and metronidazole. Later, change the antibiotic according to the sensitivity reports.

Ultrasound-guided aspiration of the abscess.

Surgical drainage for those who fail to respond.