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Liver Abscess

About Liver Abscess

A liver abscess is an infected, pus-filled cavity within the liver. Typically, a liver abscess is caused by a bacterial or parasitic infection. Rarely, in severely immuno-compromised patients, the infection can have a fungal source. Bacterial liver abscesses are often called pyogenic abscesses, while parasitic abscesses are called amebic abscesses. Most commonly, only a single abscess will be present. In the event of multiple abscesses, a vascular route is suspected.

Why it is Problematic

Liver abscesses in themselves are not life threatening. If a liver abscess is left untreated and it bursts, the infection can spread to the blood, causing sepsis, a potentially fatal bacterial blood infection.

Causes and Risk Factors

Because liver abscesses are caused by infection, anyone can get them. Liver abscesses can be caused by infection in other areas of the body including the gastrointestinal tract, abdomen, the blood, and also as a result of other liver trauma.

Roughly 30-60% of liver abscesses are caused by a biliary tract infection, including biliary obstructive or inflammatory conditions. Infections in the gastrointestinal tract or pelvic region, such as appendicitis or perforated bowel, account for about 24% of all liver abscesses. Hematogenously spread bacteria represent 15% of all liver abscess cases, and about 20% of all cases have no known cause.

The risk for developing a liver abscess increases if an individual has an abdominal or gastrointestinal infection.
Alcohol consumption, compromised immune function, malnutrition, and travel to regions where amebic infections are common could also increase the risk of developing a liver abscess.
Individuals with Crohn's disease or inflammatory bowel disease are predisposed to liver abscesses.
Individuals with cirrhosis, liver cancer, or those who have had a hepatic artery embolization or liver transplant are at a higher risk of developing a liver abscess.
Aging can increase the risk for developing a liver abscess when associated with biliary sepsis.
Pregnancy, malnutrition, excessive alcohol consumption, malignancy, and steroid use also predispose individuals to the formation of liver abscesses.

Symptoms

Sometimes a liver abscess is completely asymptomatic, while at other times symptoms will be nonspecific such as fatigue. When symptoms are present, they often include:

Pain in the upper right quadrant of the abdomen
Dark urine
Stool that is light in color or clay colored
Diarrhea
Nausea
Vomiting
Loss of appetite
Unexplained weight loss
Joint pain
Fever
Chills
Sweating
Jaundice(yellowing of the skin and whites of the eyes)

Seek immediate medical attention if you or someone you know has two or more of the following symptoms:

A sudden change in behavior, confusion, delusions, hallucinations
High fever (101 F +)
Jerky, uncontrolled movements
Extreme, unexplained lethargy
Rapid heartbeat
Breathing problems
Severe pain
Severe, persistent vomiting

Diagnosis

Blood tests and imaging tests such as ultrasound, CT scan, liver scan, or MRI help detect the presence of a liver abscess.

Treatment and Prevention

Treatment depends on the size and location of the abscess or the presence of multiple abscesses. The right lobe of the liver is more commonly affected. Sometimes antibiotics alone can treat the liver abscess.

Other treatments that may be used in the treatment of a liver abscess are:

Catheter drainage, a minimally-invasive procedure in which an incision is made in the abdomen. Using an imaging devise as a guide a catheter (tube) is placed into the abscess to drain the infected pus. Later, the incision is closed with stitches or staples. In some cases, the catheter may be sewn into the skin to allow for further drainage.
Needle aspiration, a procedure in which a medical professional uses an imaging device to locate the abscess and then insert a needle through the skin and into the abscess to remove the infected fluid.
Surgery, to treat the abscess if other treatments have proven ineffective. Surgery may also be the best option if the abscess is very large or if multiple abscesses are present. If other abdominal conditions are suspected, surgery may be recommended so as to better diagnose and treat those suspected problems.

Avoidance of alcohol; and maintenance of a well-balanced diet; can help prevent the formation of a liver abscess.

Proper hygiene; and avoidance of contaminated food, water, and ice can also help to prevent the formation of a liver abscess.

Incidence

In the U.S., about 3.6 individuals per 100,000 are afflicted with a liver abscess.

Amebic abscesses are significantly more common in areas with poor healthcare and a high incidence of parasitic infections including: East and South Africa, India, Mexico and parts of Central and South America. These abscesses are about 10 times more likely to occur in men than in women.

Pyogenic liver abscesses affect men and women equally.

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