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Liver abscess


A pus-filled mass inside the liver caused by bacteria is known as a liver abscess. Liver abscesses are rare and with advancement in technology, drainage techniques have also improved as a curative measure. But if they are left untreated, it can prove fatal. Blood is received by the liver through systemic and portal circulations. The Kupffer cells present in the lining of the hepatic sinusoids efficiently clear the bacteria eliminating the anticipation of an infection. It is only when there is an increase in the susceptibility to bacterial infections that an abscess forms in the liver.

Types

The types of liver abscesses are classified in accordance to their etiology:

  • PLA or pyogenic liver abscess: polymicrobial causes such as gram-negative enterogenic bacteria, gram-positive aerobes and anaerobic organisms
  • ALA or amoebic liver abscess: caused by Entamoeba histolytica

Signs and symptoms

  • Spiking fevers
  • Right upper quadrant pain
  • Chills
  • Anorexia
  • Malaise
  • Diaphragmatic irritation leading to coughs and hiccoughs; referred pain to right shoulder
  • Weight loss
  • Anaemia
  • FUO or fever of unknown origin
  • Systemic toxicity

Diagnosis

Physical examination:

  • Presence of fever
  • Tenderness and hepatomegaly
  • Midepigastric tenderness involvement of left hepatic lobe
  • Decreased breath sounds
  • Pleural or hepatic friction rub

Lab studies:

  • CBC with differential shows increased white blood cell count

Liver function studies:

  • hypoalbuminaemia, abnormal alkaline phosphatase, transaminase and bilirubin levels
  • Blood cultures
  • Abscess fluid culture
  • Enzyme immunoassay
  • CT scan
  • Ultrasonography
  • Radionuclide scanning
  • Chest radiography

Treatment

Most of the liver abscesses can be treated with medicines. Some resistant cases would require ultrasound or CT guided drainage or repeated aspirations. Surgical therapy is indicative for all untreated hepatic abscesses which can cause complications such as empyema, sepsis or peritonitis. Open surgery with the transperitoneal approach or posterior transpleural approach is done. In most cases, the minimally invasive laparoscopic approach is chosen due to its speedy healing times and early recovery. We obtain an interventional radiology to facilitate rapid drainage of cavity fluid as soon as possible. In complicated cases, we provide laparoscopic drainage or debridement of liver abscess.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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