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In developing countries, liver abscesses are common. Most represent parasitic infections, for example amoebic and, less commonly, protozoal and helminthic organisms. In developed countries, liver abscesses are uncommon. Most are bacterial in origin, usually, Streptococcus milleri.
The organisms reach the liver via:
Liver abscesses are associated with fever, and in many instances, right upper quadrant pain, and tender hepatomegaly; uncommonly there is jaundice and referred shoulder tip pain.
Investigations may show a raised serum alkaline phosphatase and gamma GT, with a normal or only moderately increased serum bilirubin. This is due to enzyme induction in those parts of the liver where there is impaired bile excretion. Identification of an organism is via blood cultures and, if necessary, guided drainage of an abscess, with ultrasound or abdominal CT.