Liver abscess
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| Liver abscess Classification and external resources | |
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| CT image demonstrates a large abscess in the right hepatic lobe. (Image courtesy of RadsWiki) | |
| ICD-10 | K75.0 |
| ICD-9 | 572.0 |
| DiseasesDB | 22094 |
| eMedicine | med/1316 |
| MeSH | D008100 |
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WikiDoc Resources for Liver abscess | |
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Most recent articles on Liver abscess Most cited articles on Liver abscess | |
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Powerpoint slides on Liver abscess | |
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Evidence Based Medicine | |
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Clinical Trials | |
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Ongoing Trials on Liver abscess at Clinical Trials.gov Trial results on Liver abscess Clinical Trials on Liver abscess at Google
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US National Guidelines Clearinghouse on Liver abscess NICE Guidance on Liver abscess
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Patient resources on Liver abscess Discussion groups on Liver abscess Patient Handouts on Liver abscess Directions to Hospitals Treating Liver abscess Risk calculators and risk factors for Liver abscess
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Causes & Risk Factors for Liver abscess | |
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Overview
A liver abscess is a pus-filled mass inside or attached to the liver. Common causes are an abdominal infection such as appendicitis or diverticulitis. With treatment, the death rate is 10-30%.[1]
General Characteristics of Liver Abscess
- Biliary tract disease is the most common cause but no cause identified in the majority of patients.
- Nonspecific clinical findings - high degree of suspicion required for diagnosis
- Most often single, rather than multiple foci
- Hyperbilirubinemia and elevated alkaline phosphatase in the majority of patients, but low specificity.
- E. coli the most prevalent 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 US- or CT-guided drainage
- Therapy for liver abscess caused by bowel perforation or foreign body is open surgical drainage
- Amebic liver abscess occurs in 94% of cases of amebiasis
- Liver abscess is a relatively infrequent (1.7% according to Cho, D. et. al.), although possible, complication of percutaneous radiofrequency ablation of hepatic tumors.
Types
There are 3 major forms of liver abscess, classified by etiology:
- Pyogenic abscess, which is most often polymicrobial, accounts for 80% of hepatic abscess cases in the United States.
- Amebic abscess due to Entamoeba histolytica accounts for 10% of cases.
- Fungal abscess, most often due to Candida species, accounts for less than 10% of cases.
Clinical Features
- Symptoms
- Pain Right Hypochondrium referred to Right shoulder
- Pyrexia (100.4 F)
- Profused sweating and Rigors
- Loss of Weight
- Earthy Complexion
- Signs
- Pallor
- Tenderness and rigidity in right hypochondrium
- Palpable Liver
- Intercostal Tenderness
- Basal Lung Signs
Diagnosis
- Blood CP
- Haemoglobin Estimation
- Stools Examination (Trophozoites and Cysts)
- Radiography
- Aspiration Exploratory
- Medical ultrasonography and CT Scanning
- Sigmoidoscopy
- Liver function tests
- Serological Tests
Diagnostic Findings
- Right pleural effusion, elevated right hemidiaphragm, and subsegmental atelectasis on chest radiography
- Findings on abdominal radiography nonspecific in 87% of cases
- US and CT are critical imaging tools
- US may demonstrate a peripheral echo-free halo, distal acoustic enhancement, and progressive change over a short period of time.
- On CT, abscesses may be single or multipe, round or oval, have an enhancing rim, complete or incomplete rim of edema, have smooth or nodular margins, intraabscess hemorrhage, peripheral biliary ductal dilatation, and may contain internal septations. Patterns are variable.
- Pretreatment amebic liver abscess appears as a heterogeneously low-signal intensity mass with sharp borders on T1 and as a hyperintense region with hyperintensity extending to the liver surface, corresponding to edematous hepatic parenchyma.
- Progression of edema is followed with T2-weighted imaging.
- Posttreatment amebic liver abscess becomes homogeneously hypointense on T1-weighted images.
- Maturation of the abscess wall during and after treatment is characterized by the appearance of concentric rings.
- Differential for MR findings for amebic liver abscess also includes bacterial abscess, hematoma and necrotic tumor.
(Images shown below are courtesy of RadsWiki)
CT image demonstrates a large abscess in the right hepatic lobe |
 CT image demonstrates a large abscess in the right hepatic lobe |
Pyogenic liver abscess
Etiology
- Streptococcus milleri
- E. coli
- Streptococcus fecalis
- Klebsiella
- Proteus vulgaris
- Opportunistic Pathogens (Staphylococcus)
Clinical features
- 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
Treatment
- Percutaneous Drainage under USG or CT Control
- Laparotomy in intraabdominal disease
References
External Links
Additional Resources
- Dongil Choi, Hyo K. Lim, Min Ju Kim, Suk Jung Kim, Seung Hoon Kim, Won Jae Lee, Jae Hoon Lim, Seung Woon Paik, Byung Chul Yoo, Moon Seok Choi, and Seonwoo Kim. Liver Abscess After Percutaneous Radiofrequency Ablation for Hepatocellular Carcinomas: Frequency and Risk Factors. Am. J. Roentgenol., Jun 2005; 184: 1860 - 1867.
- Dewbury, K.C., Joseph, A.E., Millward Sadler, G.H., and Birch, S.J. Ultrasound in the diagnosis of the early liver abscess. Brit. J. of Radiol. 1980;53, 635: 1160-1165.
- Drnovsek, V., Fontanez-Garcia, D., Wakabayashi, M.N., Plavsic, B.M. Gastrointestinal Case of the Day, Radiographics, 1999;19:820-822.
- Elizondo, G., Weissleder, R., Stark, D.D., Todd, L.E., Compton, C., Wittenberg, J., and Ferrucci, J.T. Amebic Liver Abscess: Diagnosis and Treatment Evaluation with MR Imaging. Radiology, 1987; 165:795-800.
- Radin, D.R., Ralls, P.W., Colletti, P.M., and Halls, J.N. CT of amebic liver abscess. Am. J. Roentgen. 1988; 150, 6: 1297-1301.
WikiDoc Research Resources for Liver abscess | |
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| Articles on Liver abscess | Most recent articles on Liver abscess • Most cited articles on Liver abscess • Review articles on Liver abscess • Articles on Liver abscess in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Liver abscess | Powerpoint slides on Liver abscess • Images of Liver abscess • Photos of Liver abscess • Podcasts & MP3s on Liver abscess • Videos on Liver abscess |
| Evidence Based Medicine Regarding Liver abscess | Cochrane Collaboration on Liver abscess • Bandolier on Liver abscess • TRIP on Liver abscess |
| Cost Effectiveness of Liver abscess | Cost Effectiveness of Liver abscess |
| Clinical Trials Involving Liver abscess | Ongoing Trials on Liver abscess at Clinical Trials.gov • Trial results on Liver abscess • Clinical Trials on Liver abscess at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Liver abscess | US National Guidelines Clearinghouse on Liver abscess • NICE Guidance on Liver abscess • NHS PRODIGY Guidance • FDA on Liver abscess • CDC on Liver abscess |
| Textbook Information on Liver abscess | Books and Textbook Information on Liver abscess |
| Pharmacology Resources on Liver abscess | Dosing of Liver abscess • Drug interactions with Liver abscess • Side effects of Liver abscess • Allergic reactions to Liver abscess • Overdose information on Liver abscess • Carcinogenicity information on Liver abscess • Liver abscess in pregnancy • Pharmacokinetics of Liver abscess • |
| Genetics, Pharmacogenomics, and Proteinomics of Liver abscess | Genetics of Liver abscess • Pharmacogenomics of Liver abscess • Proteomics of Liver abscess |
| Newstories on Liver abscess | Liver abscess in the news • Be alerted to news on Liver abscess • News trends on Liver abscess |
| Commentary on Liver abscess | Blogs on Liver abscess |
| Patient Resources on Liver abscess | Patient resources on Liver abscess • Discussion groups on Liver abscess • Patient Handouts on Liver abscess • Directions to Hospitals Treating Liver abscess • Risk calculators and risk factors for Liver abscess |
| Healthcare Provider Resources on Liver abscess | Symptoms of Liver abscess • Causes & Risk Factors for Liver abscess • Diagnostic studies for Liver abscess • Treatment of Liver abscess |
| Continuing Medical Education (CME) Programs on Liver abscess | CME Programs on Liver abscess |
| International Resources on Liver abscess | Liver abscess en Espanol • Liver abscess en Francais |
| Business Resources on Liver abscess | Liver abscess in the Marketplace • Patents on Liver abscess |
| Informatics Resources on Liver abscess | List of terms related to Liver abscess |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
