Liver abscess

• A liver abscess is a collection of pus in the liver

caused by bacteria, fungi, or parasites. You
may have more than one abscess.
 Types Of Liver Abscess
• There are three major forms of liver abscess,
classified by etiology:
– 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.
– Fungal abscess, most often due to Candida
species, accounts for less than 10% of cases.
Pyogenic Liver Abscess
 Pyogenic Liver Abscess
• A pyogenic liver abscess is a type of liver abscess
caused by bacteria, can be single or multiple.
• The right lobe is affected twice as often as the
left; 5% have bilateral involvement.
• No cause found in 15% cases. Most are secondary
to infection originating in the abdomen. Bacterial
endocarditis and dental infection are other
causes.
• More common in the immunocompromised and
in people with Liver cirrhosis.
Pyogenic Liver Abscess
 Amoebic Liver Abscess
• Amoebic liver abscess or amebiasis is a type of
liver abscess caused by Entamoeba Histolytica
(Protozoa).
• E. histolytica causes amoebic colitis and
dysentery but liver abscess is the most common
extra-intestinal manifestation of infection
• Route of entry via oro-fecal roue by ingestion of
contaminated food or water. Amoebae invade
intestinal mucosa and can gain access to the
portal venous system.
 Amoebic Liver Abscess
• Causes a large necrotic area which is liquefied
into thick reddish-brown pus (Anchovy sauce
pus) due to liquefied necrosis, thrombosis of
blood vessels, lysis of liver cells
• It affects the right lobe in 80%.
• This type is common in overcrowded areas
with poor sanitation and in alcoholics.
Amoebic Liver Abscess
 Fungal Liver Abscess
• Fungal abscesses is a less common type,
primarily due to Candida albicans and occur
in individuals with prolonged exposure to
antimicrobials, hematologic malignancies,
solid-organ transplants, and congenital and
acquired immunodeficiency.
 What increases my risk for liver
abscess?
• Traveling to places where infection is common
• Age older than 70 years
• Medical conditions, such as cancer, diabetes,
or a weak immune system
• Medicines, such as steroids or chemotherapy
• Alcohol
• Poor nutrition
 signs and symptoms
Pain in the upper right part of the abdomen, just
below the ribs
A cough, or feeling tired and weak
Fever and night sweats
Nausea or vomiting
Loss of appetite
Yellowing of the skin or the whites of the eyes
 How is liver abscess diagnosed?
Blood tests will show which germ is causing
your infection.

An x-ray, ultrasound, CT, or MRI may show the

liver abscess.
 Laboratory Studies
1. CBC
1. Increased WBC, usually Neutrophilic
Leukocytosis.
2. Raised erythrocyte sedimentation rate (ESR).
3. Mild normochromic normocytic anaemia.
2. Liver function studies
1. Hypoalbuminemia
2. Elevation of alkaline phosphatase
3. Elevations of transaminase and bilirubin levels (variable)
 Laboratory Studies
3. Blood cultures are positive in roughly 50% of cases.
4. Stool DR: Stools can contain cysts or trophozoites of E.
histolytica.
5. Serology should be carried out if E. histolytica is suspected.
6. Culture of abscess fluid should be the goal in establishing
microbiologic diagnosis. Usually done through Percutaneous
needle aspiration (under CT or Ultrasound Guidance)
 Imaging Study
1. Chest X-Ray: May show raised right hemi-diaphragm on.
2. Ultrasonography
a) Can show abscess and also allow guided percutaneous aspiration and
drainage and biliary tree examination. A Doppler ultrasound study
may be done to check for blood flow in your liver.
3. CT scanning
a) Can show the abscess, allow guided aspiration and drainage and
show other intra-abdominal abscesses or a possible cause such as
diverticular disease, appendicitis, etc. It is good for the detection of
small abscesses.
4. Liver Scan
5. MRI
 How is liver abscess treated?
• Medicine can help treat an infection caused by bacteria, a fungus,
or a parasite.

• Needle aspiration is a procedure to drain fluid with a needle.

• Catheter drainage is a procedure to drain fluid through a catheter

inserted into an incision.

• Surgery may be needed if your abscess is large or if you have more

than one. Surgery may also be needed if your abscess bursts.
How can I manage my symptoms?
Eat a variety of healthy foods. Healthy foods
include fruits, vegetables, whole-grain breads,
low-fat dairy products, beans, lean meats, and
fish.

Do not drink alcohol. Alcohol can damage your

liver and increase your risk for another abscess.
 Liver Abscess (cont.)

Medical Mgt.
 surgical drainage of abscess and antibiotics
 Metronidazole (Flagyl), Chloroquine, Emetine for amoebic abscesses
Nursing Mgt.
 provide adequate fluids and nutrition
 provide comfort measures for fever, pruritus
- coal sponge baths - prevention of dry skin
- use of soft linens - provide cool environment
 frequent oral hygiene
 pt. education
 complete dose of medications (several weeks to months) to prevent
recurrence
 monitor for signs of recurrence or worsening hepatic function 
cirrhosis
 proper hygiene, drink clean water and avoid uncooked foods