Liver Abscesses

Question 1

Define liver abscess

Answer 1

Purulent collections in the liver parenchyma formed by the spread of infection from one of
the following:
• Biliary tree
• Portal vein (from appendicitis)
• Hepatic vein
• Bacteraemia
• Trauma

Question 2

What are the causes/risk factors of liver abscesses?

Answer 2

Causes
• Pyogenic
- E.coli
- Klebsiella sp.
- Streptococcus milleri
- Enterococcus
- Bacteroides
• Amoebic
- Entamoeba histolytica

Risk factors
• Biliary tract abnormalities
• Age >50 years
• Malignancy
• Diabetes mellitus
• Interventional biliary or hepatic
procedures
• Travel in endemic areas

Question 3

What are the symptoms of liver abscesses?

Answer 3

• Fever
• Lethargy
• Weight loss
• Anorexia
• Night sweats
• RUQ/epigastric pain
• Nausea & vomiting

Respiratory symptoms
• Cough
• SOB
• Chest pain

Question 4

What are the signs of liver abscesses?

Answer 4

• Tender hepatomegaly
• Jaundice

Signs of right lower zone consolidation/effusion
• Dullness to percussion
• Reduced breath sounds

Question 5

What investigations are carried out for liver abscesses?

Answer 5

• FBC - anaemia, leucocytosis.
• LFTs - raised ALP, BR
• ESR/ CRP - elevated
• Blood Cultures - positive for the causative bacteria in pyogenic abscesses.
• Serology - antibodies positive for amoeba and hydatid.
• Stool Cultures - positive for E. histolytica and tapeworm eggs.
• USS - localises the abscess
• CT/ MRI - localises the abscess
• CXRAY - look for right pleural effusiom, atelectasis, raised hemidiaphragm
• Aspiration and abscess culture - most pyogenic liver abscesses are polymicrobial. Amoebic abscesses contain ‘anchovy sauce’ fluid of necrotic hepatocytes and trophozoites