Pyogenic liver abscess
Liver abscess; Bacterial liver abscess; Hepatic abscess
Pyogenic liver abscess is a pus-filled pocket of fluid within the liver. Pyogenic means "with pus".
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
A liver abscess can develop from several different sources, including a blood infection, an abdominal infection, or an abdominal injury which has been become infected. The most common infecting bacteria include E coli, enterococcus, staphylococcus, and streptococcus. Treatment is usually a combination of drainage and prolonged antibiotic therapy.
The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.
Causes
There are many possible causes of liver abscesses, including:
- Abdominal infection, such as appendicitis, diverticulitis, or a perforated bowel
- Infection in the blood
- Infection of the tubes draining bile (bile ducts)
- Recent endoscopy of the bile draining tubes
- Trauma that damages the liver
A number of common bacteria may cause liver abscesses. In most cases, more than one type of bacteria are found.
Symptoms
Symptoms of liver abscess may include:
- Pain in the right upper abdomen (more common) or throughout the abdomen (less common)
- Clay-colored stools
- Dark urine
- Fever, chills, night sweats
- Loss of appetite
- Nausea, vomiting
- Unintentional weight loss
- Weakness
- Yellow skin (jaundice)
- Right shoulder pain (referred pain)
- Chest pain (lower right)
Exams and Tests
Tests may include:
Treatment
Treatment usually consists of placing a tube through the skin into the liver to drain the abscess. Less often, surgery is needed. You will also receive antibiotics for about 4 to 6 weeks. Sometimes, antibiotics alone can cure the infection.
Outlook (Prognosis)
This condition can be life threatening. The risk for death is higher in people who have many liver abscesses.
Possible Complications
Life-threatening sepsis can develop. Sepsis is an illness in which the body has a severe inflammatory response to bacteria or other germs.
When to Contact a Medical Professional
Contact your health care provider if you have:
- Any symptoms of this disorder
- Severe abdominal pain
- Confusion or decreased consciousness
- High fever that doesn't go away
- Other new symptoms during or after treatment
Prevention
Prompt treatment of abdominal and other infections may reduce the risk of developing a liver abscess, but most cases are not preventable.
References
Kim AY, Chung RT. Bacterial, parasitic, and fungal infections of the liver, including liver abscesses. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 84.
Sifri CD, Madoff LC. Infections of the liver and biliary system (liver abscess, cholangitis, cholecystitis). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 75.
Version Info
Last reviewed on: 9/10/2022
Reviewed by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
