Liver Abscess

A liver abscess is a sore inside your liver that contains a thick fluid (pus). Pus in the liver is usually caused by either a bacterial infection or infection with a parasite called an amoeba.

CAUSES

The liver can get infected:

  • If an infection somewhere in the abdomen spreads to the liver. This spread of infection could occur from an infected appendix, from an infection in the large intestine (diverticulitis), or from an infection in the gallbladder (cholecystitis) or bile ducts (cholangitis). Bile ducts are the tubes that drain bile out of the liver. Bile is a fluid produced by the liver that helps you digest some foods.

  • After surgery to the abdomen or after a penetrating abdominal injury. This could occur due to an accident or violence, such as a gunshot or stabbing.

  • If an infection from a different part of the body spreads to the liver. These infections usually spread to the liver through your bloodstream.

A liver abscess can contain:

  • Bacteria. This is the most common cause, and usually more than one type of bacteria is involved. The bacteria that typically cause the infection are those that normally occupy the inside of your intestines where they cause no harm or illness.

  • Entamoeba histolytica. This is a tiny parasite called an amoeba. When this parasite is the cause, the disease is called an amebic liver abscess.

  • Candida. This is a fungus, and it is a rare cause. When this is the cause, there are usually multiple liver abscesses occurring in a person who is very ill because of an underlying disease such as leukemia or other cancers, or in a person who is receiving nourishment by vein over long periods of time because of other conditions.

SYMPTOMS

Signs that you might have a liver abscess often come on slowly over many days or a few weeks. The most typical symptoms are fever and pain over or deep within the liver. The liver is in the upper right part of the abdomen, and the pain may also go up into your right shoulder. Other common symptoms may include:

  • Malaise. This means you feel uncomfortable. You may feel like you are coming down with something, but you are not yet sick.

  • Loss of appetite.

  • Weight loss.

  • Throwing up (vomiting) or feeling sick to your stomach (nauseous).

DIAGNOSIS

To determine whether you have a liver abscess, your caregiver will probably use some of the following methods.

  • Physical exam. This will include asking about symptoms. Your caregiver may also press on the liver to check for pain.

  • Blood tests. These tests can tell whether the liver is working like it should. Tests can also check for bacteria or a fungus in the blood, and determine if the infection may be an amebic abscess. They can also check if you have a high number of white blood cells. This is a sign of infection.

  • Imaging tests, such as CT scans or ultrasounds. These tests take pictures of the liver. This is often the best way to find an abscess.

  • Needle aspiration. A long needle is put through the skin and into the liver. A CT scan may be used to help find the abscess. Once inside the abscess, a sample of pus is drained out through the needle. The sample is studied under a microscope and a culture is performed. This will show what is causing the abscess.

TREATMENT

A liver abscess must be treated. Treatment of liver abscesses caused by bacteria involves draining the pus and taking antibiotics to fight infection. Treatment may take awhile. You might be in a hospital for 2 weeks or more. Some treatments will continue once you are at home.

  • Antibiotics. You will start taking these medicines as soon as possible. Often, 2 or more antibiotics are needed. Which drugs you take will depend on what bacteria are causing your abscess.

  • In the hospital, you may be given antibiotics through an intravenous line (IV). A needle will be put in your hand or arm. It is hooked to a plastic tube. The medicine will flow directly into your body through the IV.

  • At home, you will probably still need to take antibiotics either by IV or in pill form. You may need to do this for 4 to 6 weeks or longer.

  • Drainage of a liver abscess caused by bacteria is a necessary part of treatment. Methods include:

  • Drainage through the skin (percutaneous). Most of the time, a thin tube (catheter) is put in place when needle aspiration is done. This allows the abscess to keep draining. Your caregiver may also use the catheter to flush out the abscess area. When the pus is gone, the catheter will be taken out.

  • Open drainage. This involves a surgical procedure. It may be needed for very large abscesses. It may also be done if other treatments are not working.

Liver abscesses caused by either amoeba or candida do not usually need drainage. However, effective treatment of these abscesses does require many weeks of therapy with a drug or drugs to cure these infections.

HOME CARE INSTRUCTIONS

  • Only take over-the-counter or prescription medicines as directed by your caregiver.

  • Return for new blood tests and imaging tests as directed by your caregiver.

  • Keep all follow-up appointments. Your caregiver will need to check whether you are getting better.

  • Take it easy for awhile. Avoid heavy lifting. Do not do anything that takes extra effort until your caregiver says it is okay. Ask when you will be able to go back to your normal activities.

SEEK MEDICAL CARE IF:

  • You have any questions about medicines.

  • You do not feel like eating.

  • You feel nauseous.

  • You have pain in your abdomen.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Pain in your abdomen suddenly gets worse.

  • Your skin or eyes look yellow.

  • You feel like sleeping all the time.

  • You develop confusion.

  • You have a fever.