Summary
Definition
History and exam
Key diagnostic 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 amebiasis
- cirrhosis
- liver transplantation
- alcoholism
- male sex
- cardiopulmonary disease
- immunocompromised state
- penetrating abdominal trauma
- inflammatory bowel disease, pancreatitis, appendicitis, diverticulitis, or peritonitis
- bacteremia, endocarditis, or other intravascular infection
- poor dentition
Diagnostic tests
1st tests to order
- CBC
- 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
Tests to consider
- CXR
- 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
- CRP
Treatment algorithm
suspected pyogenic abscess
suspected amebic abscess
pyogenic abscess: following response to intravenous antibiotic therapy
amebic abscess: following response to nitroimidazole therapy
abscess recurrence
Contributors
Authors
Rachel P. Simmons, MD
Assistant Professor of Medicine
Division of General Internal Medicine
Warren Alpert Medical School of Brown University
Providence
RI
Disclosures
RPS declares that she serves on the American Board of Internal Medicine as Vice Chair of the Traditional Exam Approval Committee for which she receives an honorarium, and on the Association of Program Directors in Internal Medicine as the Chair of Scholarship and Survey Committee. Neither role specifically relates to liver abscess.
Acknowledgements
Rachel P. Simmons would like to gratefully acknowledge Professor Lawrence S. Friedman, a previous contributor to this topic.
Disclosures
LSF reported receiving royalties from Elsevier, Wiley, McGraw-Hill, Harvard Health Publications, Wolters Kluwer, and UpToDate at the time of disclosure.
Peer reviewers
James Neuberger, BM, BCh
Consultant Physician
Liver Unit
Queen Elizabeth Hospital
Birmingham
UK
Disclosures
JN declares that he has no competing interests.
Hrishikesh Samant, MD FACG
Director Hepatology
LSU Health Sciences Center
Shreveport
LA
Disclosures
HS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Kim AY. Bacterial, parasitic, and fungal infections of the liver, including liver abscesses. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran's gastrointestinal and liver disease - 2 volume set. 12th ed. Amsterdam: Elsevier; 2026.
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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