Liver%20abscess Signs and Symptoms

• Liver abscess may result from peritonitis & bowel leakage via portal circulation, direct spread from biliary disease, or from hematogenous seeding

Causative Organisms

• Most pyogenic liver abscesses are polymicrobial (eg enteric facultative & anaerobic species)
• Common etiologic agents of pyogenic liver abscess are E coli, K pneumoniae, Proteus sp & other Enterobacteriaceae, Pseudomonas sp, Streptococcus sp, S aureus, Enterococci, B fragilis, F necrophorum 
  • Usual pathogens in patients w/ underlying biliary disease: Enterococci, enteric Gram-negative bacilli
  • Usual pathogens in patients w/ underlying colonic or biliary source of infection: Anaerobes, coliforms
  • S aureus may be isolated from patients w/ liver abscess resulting from hematogenous spread of microbes from a distant source
  • Entamoeba histolytica if amoebiasis is a potential consideration

• Classical presentation: Fever, jaundice, right upper quadrant symptoms (pain, guarding, rocking & rebound tenderness)
  
  • Liver abscess diagnosis is not excluded w/ negative right upper quadrant findings

• Chills, malaise, fatigue, anorexia, weight loss, abdominal pain, vomiting
• Cough or hiccups from diaphragmatic irritation
• Pain referred to the right shoulder

Other Clinical Presentations

• Patients w/ liver abscess may occasionally be afebrile
• Elderly patients often present insidiously w/ low-grade fever, dull abdominal pain & other non-specific systemic symptoms
• Patients w/ multiple abscesses tend to present more acutely than those w/ a solitary abscess

• Biliary tract disease is the most common cause of bacterial liver abscess
  
  • Suppurative cholangitis following biliary obstruction (eg from stones, malignancy, stricture, congenital conditions), recurrent pyogenic cholangitis
  • Post-op complication in patients who have undergone endoscopic sphincterotomy for bile duct stones or surgical biliary-intestinal anastomosis

• Cholecystitis, infections in organs in the portal bed
• Penetrating & blunt trauma to the liver
• Subphrenic or perinephric abscess may result in direct spread of infection from a contiguous focus
• Systemic bacteremia eg endocarditis, pyelonephritis that may result in spread of organisms to the liver through the hepatic artery
• Systemic illnesses including diabetes mellitus, malignancy, cirrhosis, cardiopulmonary disease, severe malnutrition, inflammatory disease
• Immune system deficiencies eg chronic granulomatous disease, hematologic malignancy, liver transplant
• Severe periodontal disease especially in alcoholics
• Amoebic liver abscess should be considered in patients from endemic areas or have traveled to an endemic area
  
  • 10 times more common in men as in women
  • Inmates of residential institutions, patients w/ underlying immunosuppression & men who have sex w/ men are at increased risk

• Other possible factors include pancreatoduodenectomy, chemoembolization or radiofrequency ablation in the presence of infected bile, necrosis of a primary tumor, or superinfection of metastases