Last reviewed: March 2020
Last updated: March  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • fevers and chills
  • RUQ tenderness
  • hepatomegaly

Other diagnostic factors

  • weight loss
  • fatigue
  • abdominal pain
  • nausea and vomiting
  • cough, shortness of breath, or chest pain
  • jaundice
  • signs of pleural effusion in the right lower zone
  • signs of shock
  • ascites

Risk factors

  • biliary tract disease
  • age >50 years
  • underlying malignancy
  • diabetes mellitus
  • interventional biliary or hepatic procedures
  • living in or visiting area endemic for amoebiasis
  • cirrhosis
  • liver transplantation
  • alcoholism
  • male sex
  • cardiopulmonary disease
  • immunocompromised state
  • penetrating abdominal trauma
  • inflammatory bowel disease, pancreatitis, appendicitis, diverticulitis, or peritonitis
  • bacteraemia, endocarditis, or other intravascular infection

Diagnostic investigations

1st investigations to order

  • FBC
  • serum LFTs
  • blood cultures
  • PT and activated partial thromboplastin time
  • liver ultrasound
  • contrast-enhanced abdominal CT scan
  • Gram stain and culture of aspirated abscess fluid
More 1st investigations to order

Investigations to consider

  • CXR
  • serum antibody test for Entamoeba histolytica
  • stool Entamoeba histolytica antigen detection test
  • antigen testing or PCR of aspirated abscess fluid
  • liver MRI
  • C-reactive protein (CRP)
More investigations to consider

Treatment algorithm


Assistant Professor of Medicine

Section of Infectious Diseases

Boston University




RPS has been reimbursed by DynaMed for reviewing topics on cellulitis, skin abscess, and mammalian bites. There is no overlap in content to this topic. RPS also receives an honorarium for writing and editing American Board of Internal Medicine board examination questions.

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 Society for Gastrointestinal Endoscopy and the American Board of Internal Medicine.

Peer reviewersVIEW ALL

Consultant Physician

Liver Unit

Queen Elizabeth Hospital




JN declares that he has no competing interests.

Assistant Professor of Medicine

University of Chicago

Center for Liver Disease




NR declares that she has no competing interests.

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