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| __NOTOC__
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| {{Liver abscess}}
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| {{CMG}};{{AE}}{{YK}}
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| ==Overview==
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| 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%.<ref name="MedlinePlus">{{cite web | url=http://www.nlm.nih.gov/medlineplus/ency/article/000261.htm | title='MedlinePlus Medical Encyclopedia: Pyogenic liver abscess'}}</ref>. 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]] in the majority of patients, but low specificity. [[E. coli]] is 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]] [[antibiotic]]s 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.
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| ==Historical Perspective==
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| [[Abscesses]] of [[liver]] are described since the time of Hippocrates.<ref name="pmid21938200">{{cite journal| author=Kawoosa NU, Bashir A, Rashid B| title=Spontaneous cutaneous rupture of a pyogenic liver abscess. | journal=Indian J Surg | year= 2010 | volume= 72 | issue= 4 | pages= 339-42 | pmid=21938200 | doi=10.1007/s12262-010-0131-3 | pmc=3002775 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21938200 }} </ref>. In 1938, Ochsner’s classic review heralded [[surgical drainage]] as the definitive therapy.
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| ==Classification==
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| Liver abscess may be classified into 3 types based on etiology into [[pyogenic]], [[amoeba|amoebic]], and [[fungal]] liver abscess.
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| ==Natural History, Complications and Prognosis==
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| Life-threatening [[sepsis]] can develop. This condition can be life threatening some patients. The risk for death is higher in people who have many liver abscesses.
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| ==Diagnosis==
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| ===Chest X Ray===
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| Right [[pleural effusion]], elevated right hemidiaphragm, and subsegmental [[atelectasis]] on chest radiography. Findings on abdominal radiography nonspecific in 87% of cases.
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| ===Ultrasound===
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| USG and CT are critical imaging tools. USG may demonstrate a peripheral echo-free halo, distal [[acoustic]] enhancement, and progressive change over a short period of time.
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| ==Treatment==
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| ===Medical Therapy===
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| Treatment usually consists of placing a tube through the skin to drain the abscess. Less often, surgery is required. [[Antibiotic]]s are used for about 4 - 6 weeks. Sometimes, antibiotics alone can cure the infection. Commonly used antibiotics include [[penicillin]]s, [[aminoglycoside]]s, [[metronidazole]] and [[cephalosporin]]s.
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| ===Surgery===
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| Surgical options include percutaneous Drainage under USG or CT control and [[laparotomy]] in intra-abdominal disease.
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| ===Primary Prevention===
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| Prompt treatment of abdominal and other infections may reduce the risk of developing a liver abscess. Many cases are not preventable.
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| ==References==
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| {{reflist|2}}
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| {{WH}}
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| {{WS}}
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| [[Category:Gastroenterology]]
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| [[Category:Infectious disease]]
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| [[Category:Mature chapter]]
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| [[Category:Disease]]
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