Liver abscess

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:

• the portal vein
• the hepatic artery - rare
• ascending infection in the biliary tract - ascending cholangitis
• direct invasion of the liver
• penetrating injury

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.

Management:

• conservative - antibiotic treatment - either blind therapy e.g. ciprofloxacin and metronidazole, or specific treatment when the organism has been identified
• surgical - abscess can be drained if there is no resolution with conservative management