Liver abscess is collection of pus in liver caused by infectious organisms such as bacteria, parasites and fungi. Although a rare space occupying lesion, most liver abscesses are either pyogenic or ameobic. This condition is mainly seen among people living in developing countries. Increased age, compromised immune system, alcoholism, poor nutrition, diabetes etc are some of the risk factors for its occurrence.
Liver abscess can develop as a solitary abscess or in multiples. The size may vary from a small abscess to a very large lesion. Liver has two lobes; the right lobe is the likely site of infection, however, in some cases even the left lobe can be affected.
Pain in right upper quadrant of abdomen, high grade fever, presence of jaundice, and enlarged liver are few important clinical symptoms of the disease. Treatment consists of drainage of the abscess. Antibiotics and anti amoebic treatment is necessary to eliminate the organisms. Untreated cases have high mortality.
What Causes Liver Abscess In Human?
Liver abscess can be of different types depending on the organism involved.
- Pyogenic abscess: Bacteria such as E.coli, staph aureus, streptococci, K. pneumonia are the organisms mostly involved in this disease.
- Amebic liver abscess: As the name suggests it is caused by entameba histolytica a single celled parasite.
- Fungus liver abscess: The fungus species of Candida when infiltrates into the liver can cause liver abscess. Prolonged use of antibiotics, blood cancer, kidney or liver transplant, and immune deficiency are some of the causative factors.
An abscess in liver can develop through various routes. Germs can enter into the liver through the bloodstream while circulating in the blood. Another common source of entry is through infection in the adjacent organs. Conditions such as appendicitis, diverticulitis, or infection in colon can cause abscess in liver.
Ascending infection in the bile duct due to gallstone obstruction or collangitis can be the cause of abscess. A penetrating wound through the abdominal wall can damage the liver and can cause abscess in liver.
Risk factors for liver abscess:
- People who travel to places prone to amoebic infection, especially tropical countries.
- Increasing age.
- Person suffering from conditions such as diabetes, cancer or compromised immune system.
- Long term use of corticosteroids.
- Homosexual activities (amoebic liver abscess).
Signs And Symptoms Of Liver Abscess
Today most cases of liver abscess occur as a result of ascending infection in the bile duct. In the past infections such as appendicitis and colitis were the triggers. At least 20 to 30 percent of patients have past history of dysentery and diarrhea. Below are given signs and symptoms of liver abscess:
- Pain in right upper quadrant which is constant and intense. Pain may radiate to the upper back and the right shoulder. Pain increases with deep breathing, coughing, sneezing, or lying on the right side.
- High fever with rigors.
- Enlarged palpable liver.
- The area of liver is tender to touch.
- Nausea and loss of appetite.
- Weight loss.
- Mild jaundice may be present.
- Restricted movement of right side of chest due to pain.
- Pain in muscles and joints.
Diagnostic Evaluation Of Liver Abscess
Diagnosis of liver abscess is made from the medical history and clinical examination. However, other investigations are also taken into consideration while diagnosing liver abscess. Liver abscess is confirmed by CT scan and sonogram. CT scan is more accurate than sonogram to differentiate liver abscess from other lesions of liver.
Blood examination such as complete blood count, liver function test, blood culture, and culture of the aspirated pus helps to determine the causative organism. Recently polymerase chain reaction test is useful to pin point the diagnosis of amoebic infection that is responsible for liver abscess.
Treatment Guidelines For Liver Abscess
Treatment of liver abscess may depend on many factors such as the size of abscess, the severity of infection and its symptoms etc. For a small abscess usually conservative treatment is sufficient. It consists of administration of antibiotics and antiamoebic medicines. Initially the medicines are administered through intravenous route. Oral medicines are started once the patient becomes stable and the symptoms subside.
In some cases the pus needs to be drained with the help of a needle. The procedure is called percutaneous drainage. It is performed with the assistance of sonogram or CT scan. The doctor completely drains the pus from the abscess. He may also insert a drainage catheter depending on the situation. Cather is used when the pus is too thick for the aspiration with needle. A large abscess or multiple abscesses needs surgical intervention.
The treatment of liver abscess should be prompt. Delay in treatment can increase fatality.