Pyogenic liver abscess
The development of liver abscesses is thought to follow bacterial infection elsewhere in the body.
Enteric Gram negative and anaerobic organisms, e.g. Strep. milleri. Infection may reach the liver by the portal vein from a focus of infection drained by the portal vein, e.g. diverticulitis, appendicitis, infected haemorrhoids. Infection may also result from a generalised septicaemia or direct spread from the biliary tree.
Symptoms and signs range from mild to severe, often the symptoms are less marked in elderly patients, with a mild fever with or without pain and hepatomegaly. In severe cases patients present with upper abdominal pain, swinging fever, anorexia, malaise and weight loss.
May be single or multiple lesions ranging from a few millimetres to several centimetres in size.
Ultrasound scan is useful for screening, and pus may be aspirated for culture under its guidance. Further imaging may include CT or MRI of the abdomen. Blood cultures, liver function tests and inflammatory markers should be sent. A raised alkaline phosphatase may be the only marker.
Repeated ultrasound guided aspirations may be required. Extensive, difficult to approach abscesses are drained by open surgery, with soft pliable drains.
Intravenous broad-spectrum antibiotics until bacterial culture and sensitivities are available.
Poor prognostic factors are co-existent biliary tract disease, old age and multiple abscesses.