There are many potential causes of liver abscesses, including: y y y y y Abdominal infection such as appendicitis, diverticulitis, or a perforated bowel

Infection in the blood Infection of the liver secretion (biliary) tract Recent endoscopy of the biliary system Trauma that damages the liver

The most common bacteria that cause liver abscesses are: y y y y y y Bacteroides Enterococcus Escherichia coli Klebsiella Staphylococcus Streptococcus

In most cases, more than one bacteria is found. Symptoms y y y y y y y y y Chalk-colored stool Dark urine Fever, chills Loss of appetite Nausea, vomiting Pain in right upper abdomen (more common) or throughout the abdomen (less common) Unintentional weight loss Weakness Yellow skin (jaundice)

Exams and Tests Tests may include: y y y y y y Abdominal CT scan Abdominal ultrasound Blood culture for bacteria Liver biopsy Liver enzymes (liver function tests) and bilirubin White blood cell count

Treatment Treatment usually consists of surgery or going through the skin with a needle or tube (percutaneous) to drain the abscess. Along with this procedure, you will receive long-term antibiotic therapy (usually 4 - 6 weeks). Sometimes antibiotics alone can cure the infection.

most series have reported . Possible Complications Life-threatening sepsis can develop. however. When to Contact a Medical Professional Call your health care provider if you have: y y y y y Any symptoms of this disorder Severe abdominal pain Confusion or decreased consciousness Persistent high fever Other new symptoms during or after treatment Prevention Prompt treatment of abdominal and other infections may reduce the risk of developing a liver abscess. which will be curative in 90% of cases. Short courses (2 wk) of therapy after percutaneous drainage have been successful in a small series of patients. Amebic abscess should be treated with metronidazole.Outlook (Prognosis) Even with treatment this condition can be life-threatening in 10 . Initial therapy for fungal abscess is currently amphotericin B. its use as an initial agent is still being studied. Systemic antifungal agents should be initiated if fungal abscess is suspected and after the abscess has been drained percutaneously or surgically. Many cases are not preventable. Patients who do not respond to metronidazole should receive chloroquine alone or in combination with emetine or dehydroemetine. Bacterial liver abscess Medication Until cultures are available. Further investigation is required for definitive proof. the organisms isolated and antibiotic sensitivities should guide the final choice of antimicrobials. Alternative Names Liver abscess. Ultimately. Duration of treatment has always been debated. Cases of successful fluconazole treatment after amphotericin failure have been reported. or second-generation cephalosporins with anaerobic coverage are excellent empiric choices for the coverage of enteric bacilli and anaerobes. Metronidazole or clindamycin should be added for the coverage of Bacteroides fragilis if other employed antibiotics offer no anaerobic coverage. Regimens using beta-lactam/beta-lactamase inhibitor combinations. carbapenems. the choice of antimicrobial agents should be directed toward the most commonly involved pathogens. Metronidazole should be initiated before serologic test results are available. The risk is higher in people who have many abscesses. however.30% of patients. Lipid formulations may offer some benefit in that the complexing of drug to lipid moieties allows for concentration in hepatocytes.

A liver abscess occurs when bacteria or protozoa destroy hepatic tissue. Some patients are acutely ill. Common signs include abdominal pain. Liver abscess after intra-abdominal sepsis (such as with diverticulitis) is most likely to be caused by hematogenous spread through the portal bloodstream. such as dyspnea and pleural pain. Amebic liver abscesses arc caused by E. the abscess is recognized only at autopsy. fever. the onset is more insidious. Signs of right pleural effusion. Both the clinical and radiographic progress of the patient should guide the length of therapy. Death occurs in 15% of affected patients despite treatment. those arising from biliary obstruction are usually caused by a mixed flora. streptococci. and anaerobes. diabetes mellitus. Liver damage may cause jaundice. which causes necrosis of tumor cells and potential infection. Abscesses arising from hematogenous transmission are usually caused by a single pathogen. in others. chills. Patients with metastatic cancer to the liver. producing a cavity. after death from another illness. which fills with infectious organisms. enterococci. The onset of symptoms of a pyogenic abscess is usually sudden. Currently 4-6 weeks of therapy is recommended for solitary lesions that have been adequately drained. and alcoholism are more likely to develop a liver abscess. vomiting. Biliary tract disease is the most common cause of liver abscess. and anemia. and leukocytes. Necrotic tissue then walls off the cavity from the rest of the liver. diaphoresis.recurrence of abscess even after more prolonged courses. Multiple abscesses are more problematic and can require up to 12 weeks of therapy. Liver abscesses also occur from intra-arterial chemoembolizations or cryosurgery in the liver. nausea. weight loss. histolytica. Hematogenous spread by hepatic arterial flow may occur in infectious endocarditis. Signs and Symptoms of Liver Abscess The clinical manifestations of a liver abscess depend on the degree of involvement. The organisms that predominate in liver abscess are gram-negative aerobic bacilli. in an amebic abscess. Liver abscess occurs equally in men and women. Causes of Liver Abscess Underlying causes of liver abscess include benign or malignant biliary obstruction along with cholangitis. . extrahepatic abdominal sepsis. liquelled liver cells. and trauma or surgery to the right upper quadrant. develop if the abscess extends through the diaphragm. usually in those over age 50. The method by which bacteria reach the liver reflects the underlying causes. Antibiotics Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

4. Watch carefully for complications of abdominal surgery. antibiotics should be administered for 14 days and then replaced with oral preparations to complete a 6 week course. alanine aminotransferase. Surgery may be performed to drain pus in unstable patients with continued sepsis (despite attempted non surgical treatment) and for patients with persistent fevers (lasting longer than 2 weeks) after percutaneous drainage and appropriate antibiotic therapy. I. Abnormal laboratory values include: elevated levels of serum aspartate aminotransferase. In pyogenic abscess. and maintain fluid and nutritional intake.Diagnosis for Liver Abscess Ultrasonography and computed tomography (CT) scan with contrast medium can accurately define intrahepatic lesions and allow assessment of intra-abdominal pathology. a blood culture can identify the bacterial agent. and bilirubin. Contrast-aided magnetic resonance imaging may become an accurate method for diagnosing hepatic abscesses. When the causative organisms are identified. alkaline phosphatase. Treatment for Liver Abscess Antibiotic therapy. and either metronidazole or clindamycin. an amino glycoside. Surgery is reserved for bowel perforation and rupture into the pericardium. in amebic abscess.V antibiotic administration as an outpatient with home care support. Prepare the patient for I.V. monitor vital signs (especially temperature). Percutaneous needle aspiration of the abscess can also be performed with diagnostic tests to identify the causative organism. is usually sufficient to evacuate pus. and decreased serum albumin levels. either with ultrasound or CT guidance. 3. A common combination is ampicillin. Pereutaneous drainage. along with drainage. and watch for possible adverse effects. an increased white blood cell count. Third-generation cephalosporins can be substituted for the aminoglycosides in patients at risk for renal toxicity. Provide supportive care. 5. is the preferred treatment for most hepatic abscesses. 2. Stress the importance of compliance with therapy. Special Considerations and Prevention Tips for Liver Abscess 1. histolytica. Administer anti-infective's and antibiotics as necessary. . Explain diagnostic and surgical procedures. such as hemorrhage or sepsis. the antibiotic regimen should be modified to match the patient's sensitivities. a stool culture and serologic and hemagglutination tests can isolate E.

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