Liver Abscess

Etiology

  • Bacterial (pyogenic): strep, staph, enterococus, e coli, klebsiella, anaerobes; can be polymicrobial
  • Parasitic: entamoeba hystiolytica (amoebic), echinococcus

Risk Factors

  • Diabetes
  • Age 50-65
  • Cirrhosis
  • Biliary tract obstruction (stone, tumor, stricture) with development of abscess secondary to cholangitis
  • Seeding during ERCP, biopsy, surgery
  • Spread via portal vein from intra-abdominal infection (appendicitis, diverticulitis, other) or direct extension (e.g. cholecystitis)
  • Trauma involving liver or abdominal structures
  • GI tract translocation secondary to malignancy (e.g. colon, gastric) or for unclear reasons
  • Seeding from systemic bacteremia, IVDU
  • Often etiology is cryptogenic
  • Amoebic: acquired via unclean water/poor sanitation, also anal intercourse
  • Echinococcus: typically traveler from Africa, Europe, Asia, the Middle East; Central and South America; very rare de novo in North America; exposure via working w/sheep/dogs, consumption of soil/water/food (containing eggs) contaminated w/feces from infected animals

Symptoms

  • F
  • C
  • Right upper quadrant pain
  • Sometimes nausea, fatigue, weight loss, diarrhea, jaundice and other less specific symptoms
  • Can be rather sub-acute, developing over weeks or longer
  • With severe illness, can have symptoms from spread of abscess (metastasis) to other sites
  • W/amebiasis, may have bloody diarrhea prior
  • Severe illness if abscess ruptures, w/intra-abdominal spread

Physical Exam Findings

  • Fever
  • Sometime severe illness/sepsis
  • Pain on palpation right upper quadrant
  • Sometimes palpable mass (varies w/size of abscess)

Tests