TOC | Gastroenterology
REF: Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 6th ed., 1998
Infections of the biliary tract (e.g., cholangitis, cholecystitis) are
the most common source of liver abscess.
In some cases, direct infection of the liver may occur along a penetrating vessel or from an adjacent septic focus.
Less commonly, liver abscess is a complication of bacteremia arising from underlying abdominal disease, such as diverticulitis, perforated or penetrating peptic ulcer, gastrointestinal malignancy, inflammatory bowel disease, or peritonitis.
In approximately 50% of cases of liver abscess, no obvious source can be identified. Oral flora have been proposed to be a potential source in such cases, particularly in patients with severe periodontal disease.
Lab: anemia, leukocytosis, an elevated erythrocyte sedimentation rate, and abnormal liver function tests, especially an elevated serum alkaline phosphatase level. Blood cultures may identify the causative organism in 50% of cases.
Ultrasound of Abdomen
Ultrasound-Guided Aspirate for Culture and Special Stains - Cultures of aspirated material are positive in 90% of cases.
CT Scan of Abdomen - accurate, with a sensitivity approaching 100%
Entamoeba histolytica Serology
MRI, Cholangiography, and arteriography may each be of value in selected clinical situations.
Differential Diagnosis: Hepatocellular carcinoma; echinococcal cyst
Prevention and Treatment
Pyogenic liver abscesses are best prevented by prompt treatment of acute biliary and abdominal infections and by adequate drainage of infected intra-abdominal collections under appropriate antibiotic coverage.
Treatment of a hepatic abscess requires
The mortality rate for patients with hepatic abscesses treated with antibiotics and percutaneous drainage is 16%. A worse prognosis may be expected when there is a delay in diagnosis; multiple organisms cultured from blood; jaundice; hypoalbuminemia; a pleural effusion; or other associated medical diseases. Complications of pyogenic liver abscess include empyema, pleuropericardial effusion, portal or splenic vein thrombosis, rupture into the pericardium, thoracic and abdominal fistula formation, and sepsis.
See also Amebic (Entamoeba histolytica
) Liver Abscess (under construction)
Amebiasis occurs worldwide but is most common in tropical and subtropical regions. In the United States, it is a disease of young, often Hispanic, adults. Endemic areas include Africa, Southeast Asia, Mexico, Venezuela, and Colombia.
Dull JS, Topa L, Balgha V, et al, "Non-surgical Treatment of Biliary Liver Abscesses: Efficacy of Endoscopic Drainage and Local Antibiotic Lavage With Nasobiliary Catheter," Gastrointest Endosc, 2000, 51(1):55-9.
Lam YH, Wong SK, Lee DW, et al, "ERCP and Pyogenic Liver Abscess,"Gastrointest Endosc, 1999, 50(3):340-4.
Rustgi AK and Richter JM, "Pyogenic and Amebic Liver Abscess," Med Clin North Am, 1989, 73(4):847-58.
Seeto RK and Rockey DC, "Amebic Liver Abscess: Epidemiology, Clinical Features, and Outcome," West J Med, 1999, 170(2):104-9.