A localised infection in the liver parenchyma that may be bacterial, fungal, or parasitic in origin.
Patients typically present with non-specific constitutional symptoms, right upper quadrant abdominal pain, and tenderness.
The most common underlying condition in people with pyogenic liver abscess is biliary tract disease.
Treatment of pyogenic abscess focuses on both timely administration of broad-spectrum antibiotics and drainage of the abscess. People with fungal abscess require anticandidal therapy. Amoebic abscess is treated with a nitroimidazole, followed by a luminal agent.
Liver abscesses are purulent collections in the liver parenchyma that result from bacterial, fungal, or parasitic infection. Infection can spread to the liver through the biliary tree, hepatic vein, or portal vein, by extension of an adjacent infection, or as a result of trauma. One or multiple abscesses can be present. Fungal liver abscess can occur in immunocompromised hosts. Amoebic liver abscess is a complication of amoebiasis.
History and exam
Key diagnostic factors
- presence of risk factors
- fevers and chills
- RUQ tenderness
Other diagnostic factors
- weight loss
- abdominal pain
- nausea and vomiting
- cough, shortness of breath, or chest pain
- signs of pleural effusion in the right lower zone
- signs of shock
- biliary tract disease
- age >50 years
- underlying malignancy
- diabetes mellitus
- interventional biliary or hepatic procedures
- living in or visiting area endemic for amoebiasis
- liver transplantation
- male sex
- cardiopulmonary disease
- immunocompromised state
- penetrating abdominal trauma
- inflammatory bowel disease, pancreatitis, appendicitis, diverticulitis, or peritonitis
- bacteraemia, endocarditis, or other intravascular infection
1st investigations to order
- serum LFTs
- blood cultures
- prothrombin time and activated partial thromboplastin time
- liver ultrasound
- contrast-enhanced abdominal CT scan
- Gram stain and culture of aspirated abscess fluid
Investigations to consider
- serum antibody test for Entamoeba histolytica
- stool Entamoeba histolytica antigen detection test
- antigen testing or polymerase chain reaction (PCR) of aspirated abscess fluid
- liver MRI
suspected pyogenic abscess
suspected amoebic abscess
pyogenic abscess: following response to intravenous antibiotic therapy
amoebic abscess: following response to nitroimidazole therapy
Rachel P. Simmons, MD
Assistant Professor of Medicine
Section of Infectious Diseases
RPS declares that she has no competing interests.
Lawrence S. Friedman, MD
Professor of Medicine
Harvard Medical School and Tufts University School of Medicine
LSF has received royalties from Elsevier, Wiley, McGraw-Hill, and UpToDate, and has received honoraria from the American Board of Internal Medicine.
James Neuberger, BM, BCh
Queen Elizabeth Hospital
JN declares that he has no competing interests.
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
NR declares that she has no competing interests.
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