Liver Abscess
A liver abscess is a mass filled with pus inside the liver. Common causes are abdominal conditions such as appendicitis or diverticulitis due to haematogenous spread through the portal vein. It can also develop as a complication of a liver injury.
Causes
Major bacterial causes of liver abscess include the following:
- Streptococcus species (including Enterococcus)
- Escherichia species
- Staphylococcus species
- Klebsiella species (Higher rates in the Far East)
- Anaerobes (including Bacteroides species)
- Pseudomonas species
- Proteus species
- Entamoeba Histolytica
However, as noted above, many cases are polymicrobial.
Diagnosis
Types
There are several major forms of liver abscess, classified by cause:
- Pyogenic liver abscess, which is most often polymicrobial, accounts for 80% of hepatic abscess cases in the United States.
- Amoebic liver abscess due to Entamoeba histolytica accounts for 10% of cases. The incidence is much higher in developing countries.
- Fungal abscess, most often due to Candida species, accounts for less than 10% of cases.
- Iatrogenic abscess, caused by medical interventions
Management
Antibiotics: IV metronidazole and third generation cephalosporin/quinolones, β-lactam antibiotics, and aminoglycosides are effective.
Prognosis
The prognosis has improved for liver abscesses. The mortality rate in-hospital is about 2.5-19%. The elderly, ICU admissions, shock, cancer, fungal infections, cirrhosis, chronic kidney disease, acute respiratory failure, severe disease, or disease of biliary origin have a worse prognosis.