Pyogenic liver abscess
A pyogenic liver abscess is a type of liver abscess caused by bacteria.
Signs and symptoms
Acute abscess
- Fever
- Lethargy
- Discomfort in right upper quadrant of abdomen
- Anorexia
- Enlarged and tender liver
- Pleural effusion
Chronic abscess
Cause
E.g.: stones, cholangiocarcinomaE.g.: diverticulitis, appendicitis, Crohn's disease
- Cryptogenic disease
- Pancreatitis
- Infection of blood
- Intra-abdominal sepsis
- Infection of biliary system
- Traumatic introduction
Common bacterial causes
Streptococcus milleriE. coliStreptococcus fecalisKlebsiella pneumoniaeProteus vulgarisBacteroides- Opportunistic pathogens
Diagnosis
To differentiate pyogenic liver abscess from amoebic liver abscess, several features such as subjects with age more than 50 years with lungs involvement, multiple liver abscesses, with amoebic serologic titres less than 1:256 can help to pin down the diagnosis of pyogenic liver abscess.- Blood CP
- Haemoglobin estimation
- Serum albumin levels
- USG and CT scanning
- Guided aspiration to confirm the diagnosis
Treatment
- Antibiotics
- * Penicillins
- * Aminoglycosides
- * Metronidazole
- * Cephalosporins
- Percutaneous drainage under USG or CT control
- Laparotomy in intra-abdominal disease