Liver abscess

Last reviewed: 25 Aug 2023
Last updated: 20 Sep 2023



History and exam

Key diagnostic factors

  • fevers and chills
  • RUQ tenderness
  • hepatomegaly
More key diagnostic factors

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
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations 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
More 1st investigations to order

Investigations 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
More investigations to consider

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



Rachel P. Simmons, MD

Assistant Professor of Medicine

Section of Infectious Diseases

Boston University




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.

Peer reviewers

James Neuberger, BM, BCh

Consultant Physician

Liver Unit

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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