Liver Abscess

Aetiology
Bacterial, parasitic, or fungal in origin.
85% to 90% bacterial or pyogenic.
Bacteria access the liver via the biliary tree or
portal vein.
Other causes include
biliary obstruction,
diverticulitis,
trauma,
inflammatory bowel disease,

Incidence
Liver gets infected by Entamoeba histolytica commonly
The most common location of a pyogenic abscess is the
right lobe.
Chronic alcoholics - prone to get this infection
Entamoeba histolytica is endemic in many parts of the
world
Pathophysiology
The amoebic cyst is ingested
Cyst develops into the trophozoite form in the colon
Reaches the liver through portal circulation
Pyogenic abscess may also occur due to the infection by
streptococcus milleri and Escherichia coli.
Many a time the pyogenic infection follows amoebic
infection
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Clinical Features
Often the diagnosis of a bacterial
abscess is suggested
clinically.
Fever
Pain right hypochondrium
Chills
Rigors
Toxicity
Right upper quadrant discomfort
Diarrhea
weight loss
Intercostal tendreness
Swelling in the right hypo
chondrium or epigastrium
tender, enlarged liver.
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Investigations
USGM of the liver
X-Ray of the chest
to see whether
there is any
pneumonitis or
effusion caused by
the irritation of the
nearby abscess
TC -Leukocytosis
LFT - Abnormal
liver function tests
(LFTs)
CT scan liver

CT :
a heterogeneous lesion
irregular margins
peripheral contrast enhancement.
Internal septations

The radiologic differential diagnosis

includes
cystic or necrotic metastases (ovarian or
leiomyosarcoma)
hydatid and echinococcal cysts.
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CT scan showing liver abscess

The abscess is
shown as a
darker area in
the liver
shadow

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Complications:
Pneumonitis
Pleural effusion
Rupture of the liver abscess into the pleural cavity - causing
empyema
Rupture into the peritoneal cavity
Treatment
percutaneous or surgical drainage (Ultrasound guided repeated
aspiration)
antibiotics.
Metronidazole
Antibiotics like cephalosporins, aminoglycosides, tetracyclines
In rare cases it may need insertion of a drain.
mortality rate is almost 100% if the abscess remains untreated
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Pleural Effusion secondary to amoebic liver

abscess

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An amoebic liver abscess causing

a bulge in the dome of the
diaphragm

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Amoebic liver
abscess burst
into the right
pleural cavity

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I. Entamoeba histolytica: Amebic dysentery;

amebic liver abscess

Epidemiology:
Found worldwide, especially in tropical areas,
There is no animal reservoir.
Mode of transmission:
Ingestion of cysts.
Anal-oral transmission due to sexual practice is also a
consideration.
C. Pathology: Two-stage life cycle.
The trophozoite (ameba stage) is motile.
The cyst stage is nonmotile.
Trophozoites are found in the intestinal and
extraintestinal lesions.
Cysts predominate in the stools, with somes trophozoites18
present.

 Amebic dysentery: Colonization of cecum &

colon by Entamoeba histolytica is common.
Localized necrosis results in "teardrop" or
flask shaped ulcerations. Invasion into the
portal submucosa is progressive after
penetration of the submucosa.
Liver abscess:
Penetration of the diaphragm can lead to lung
disease.
Most liver disease not preceded by dysentery.

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Mature Cysts

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Incidence & Causes of Liver

Abscess
Cases per 100,000 admissions

Microbiology of Liver
Abscesses
Proportion of Isolates

1950-1970

1970-1990

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