When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Liver abscess

Last reviewed: 30 Sep 2024
Last updated: 18 Jan 2024

Summary

Definition

History and exam

Key diagnostic factors

  • fevers and chills
  • RUQ tenderness
  • hepatomegaly
Full details

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
Full details

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
Full details

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
Full details

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
Full details

Treatment algorithm

INITIAL

suspected pyogenic abscess

suspected amebic abscess

ACUTE

pyogenic abscess: following response to intravenous antibiotic therapy

amebic abscess: following response to nitroimidazole therapy

ONGOING

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 has received honoraria from the American Board of Internal Medicine.

Lawrence S. Friedman, MD

Professor of Medicine

Harvard Medical School and Tufts University School of Medicine

Boston

MA

Disclosures

LSF has received royalties from Elsevier, Wiley, McGraw-Hill, and UpToDate.

Peer reviewers

James Neuberger, BM, BCh

Consultant Physician

Liver Unit

Queen Elizabeth Hospital

Birmingham

UK

Disclosures

JN declares that he has no competing interests.

Nancy Reau, MD

Assistant Professor of Medicine

University of Chicago

Center for Liver Disease

Chicago

IL

Disclosures

NR declares that she has no competing interests.

  • Liver abscess images
  • Differentials

    • Ascending cholangitis
    • Cystadenoma or cystadenocarcinoma
    • Inflammatory pseudotumors of the liver
    More Differentials
  • Guidelines

    • Appropriateness criteria: right upper quadrant pain
    • Appropriateness criteria: acute nonlocalized abdominal pain
    More Guidelines
  • Patient information

    Appendicitis

    Diabetes: what can I do to keep healthy?

    More Patient information
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    Peripheral intravascular catheter: animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer