The liver is the largest organ of our human body, situated in the right upper quadrant of your abdomen. The liver is the organ that is responsible for the production of proteins and the detoxification of toxins. It also helps to maintain the chemical balance inside the body. A liver abscess is a pus-filled mass that develops in the liver.
It will happen due to some injury to the liver, and infections that occur inside the abdomen. It includes infections of parasites, fungi, and many other reasons. Although the number of patients reported with liver abscess formation is not at a considerable level, it is important to identify in early stages and manage as delay in treatment can be associated with increased mortality.
Commonly these abscesses are formed due to leakage of bowel content into the abdomen that directly travels to the liver. Patients who are diagnosed to be having diabetes mellitus, who are elderly and the ones who are having conditions that suppress the immune system are identified to be at higher risk of developing a liver abscess than the normal healthy population.
Types of Liver Abscess
The main classification of liver abscess is Pyogenic and Amoebic. Pyogenic abscesses are usually caused by a collection of several types of microorganisms. But the most common organisms involved in forming pyogenic abscesses are E.coli, Klebsiella, Streptococcus, Staphylococcus, and Anaerobes.
Liver abscesses can be further classified according to the location of them in the liver. A significant proportion of the abscesses are found in the right lobe of the liver. As it is part of the liver that gets more blood supply which makes that lobe predisposed to get more exposure to Infective organisms.
Risk Factors
- Overconsumption of alcohol
- Depletion of the functionality of the immune system due to diseases such as HIV
- Lack of nutritional intake which causes nutritional deficiencies in the body
- Traveling to places where the cases of Amebic liver are high
- Also, factors associated with increased risk to cause pyogenic liver abscess include gastrointestinal infections, history of abdominal surgery, type of inflammatory bowel disease such as Crohn’s disease, Or recent history of endoscopy of bile draining tubes
- People above the age of 50 are more likely to get affected by this disease, especially when they have any problems related to the liver.
- Underlying malignancies are a serious risk factor that may cause a liver abscess.
- Diabetic Mellitus
Causes for Liver Abscess
- Appendicitis was the most common cause back in the old days, although it is less common nowadays due to development in diagnostic and management procedures.
- The biliary tract which is closely associated with the liver can get many conditions as biliary stones, strictures, malignancy, and congenital anomalies. Those can predispose the development of pyogenic liver abscesses.
- Infection of the biliary tree which is also called cholangitis is the commonest cause for the development of abscess due to infective causes.
- Less often, the causes are hepatic artery bacteremia, portal vein bacteremia, diverticulitis, cholecystitis, or penetrating trauma.
- Although rare liver abscess formation due to parasitic infections can still be found in immigrants or travelers from other countries. An important parasitic organism is the tapeworm, Echinococcus granulosus, which causes a hydatid cyst of the liver.
Clinical Manifestations
- Fever with chills and rigors
- Right upper abdominal pain which is more common or the pain disseminated throughout the abdomen which is the rare form
- Diarrhea
- Loss of appetite
- Weight loss
- Clay-colored stools
- Dark urine
- Night sweats
- Unintentional weight loss
- Bodily weakness and feeling of fatigue
- Yellowish discoloration of the skin which is also named jaundice
- Right shoulder pain (referred pain)
- Chest pain in the lower right side
Diagnosis
- Initially, your doctor will ask specific questions regarding the history of your presentation. Next, the doctor will examine you for the above-mentioned physical findings. It will done by proper examination of the abdomen. Next, you will be sent for specific blood and imaging studies to confirm the diagnosis.
- Laboratory tests, such as white blood cell count, inflammatory markers (Ex – C-reactive protein), liver function tests, and blood culture often present with abnormal findings if you are having a liver abscess.
- Imaging techniques, such as ultrasonography and computed tomography (CT) scanning, are useful tools to demonstrate and confirm the presence or absence of a liver abscess.
- Fine needle aspiration for culture is the gold standard for the diagnosis of pyogenic liver abscess
Management of Liver Abscess
Initially after diagnosis, you will be given a broad-spectrum antibiotic.
Liver abscesses that are caused due to amoebic infections are mainly treated medically by prescribing anti-amoebic drugs. And the other pyogenic liver abscess is treated with both antibiotic therapy as well as drainage of the abscess which is done by repeated needle aspiration.
Pharmacological Management
For amoebic liver abscess, the drugs which are mainly prescribed include metronidazole or tinidazole orally for a period of 10 or 5 days respectively. Most of the patients with amoebic liver abscesses respond to medical treatment, while patients not responding to medical treatment should undergo drainage.
The pyogenic liver abscesses are treated by antibiotics and which antibiotic is used depends on the type of antibiotic that is isolated from the abscess.
Surgical Management
Surgical drainage is usually reserved for complicated cases and has now been replaced by less invasive methods such as ultrasonography or computerized tomography-directed percutaneous drainage and laparoscopic drainage.
Drainage is required for liver abscesses that are complicated by infections; which include patients who have a secondary bacterial infection and patients who are considered at high risk of abscess rupture.
Prevention of Liver Abscess
- Ensure that the water and food you consume are in proper hygienic condition and are not contaminated with pathogenic organisms that can cause liver abscesses.
- Be cautious when traveling to places where Amebic infections are high or avoid traveling into such places.
- Wash your hands before eating, after being in public places, and traveling on public transportation to ensure that you are safe from deadly infections.
- Always drink boiled water and avoid drinking tap water.
- Ensure that you are engaging in safe sexual activities with trustworthy partners.
References
- Bailey and Love’s Short Practice of Surgery- 27th Edition
- Kumar and Clerk’s Clinical Medicine -8th Edition- Parveen Kumar, Michael Clark
- Oxford Handbook of Clinical Medicine – 10th Edition
- Browse’s Introduction to the Symptoms and Signs of Surgical Disease – 4th Edition – Norman L. Browse, John Black, Kevin G. Burnand and William E.G. Thomas
