II. Causes

  1. Amebiasis or Entamoeba histolytica (10-15%)
    1. Fecal-oral transmission in endemic regions (asia, africa, latin america)
  2. Fungal including candida (<10%)
  3. Bacterial Infection (80%)
    1. Aerobic Gram Negative Bacteria (Enterobacteriaciae, esp. Klebsiella species)
    2. Streptococcus species
    3. Enterococcus
    4. Staphylococcus aureus
    5. Anaerobic Bacteria (Clostridium difficile)
    6. Syphilis (Treponema pallidum)
    7. NeisseriaGonorrhea
    8. Bartonella (AIDS)
    9. Yersinia enterocolitica (rare, except in Hemochromatosis)

III. Pathophysiology

  1. Bacterial causes are associated with identified GI or biliary tract source in 50% of cases
  2. Sources
    1. Portal Vein infection
    2. Systemic bacteremia
    3. Ascending Cholangitis
    4. Direct extension
      1. Appendicitis
      2. Diverticulitis
      3. Ruptured Peptic Ulcer
      4. Empyema
  3. Majority of abscesses are single
  4. Subacute onset over weeks

IV. Symptoms

  1. Fever
  2. Chills
  3. Nausea
  4. Anorexia
  5. Weight loss
  6. Right Upper Quadrant Abdominal Pain (50%)
    1. Pain may radiate to right Shoulder

V. Signs

  1. Hepatomegaly
  2. Right upper quadrant tenderness
  3. Jaundice

VI. Labs

  1. Complete Blood Count (CBC)
    1. Anemia
    2. Leukocytosis
  2. Liver Function Test abnormalities
    1. Alkaline Phosphatase increased
    2. Aspartate Aminotransferase (AST) elevated
    3. Alanine Aminotransferase (ALT) elevated
  3. Blood Cultures (50% sensitive)
  4. Obtain AmebiasisSerology on all patients

VII. Imaging

  1. CT Abdomen or RUQ Ultrasound
    1. Fluid filled Liver masses

VIII. Management

  1. Initial empiric broad spectrum antibiotics
    1. Metronidazole 30-40 mg/kg/day divided every 8 hours IV (or 500 mg every 6-8 hours orally) AND
    2. Choose one second antibiotic
      1. Ceftriaxone 1-2 g IV every 24 hours OR
      2. Piperacillin-Tazobactam 3.375 g IV every 4-6 hours OR
      3. Ciprofloxacin 400 mg IV every 12 hours OR
      4. Levofloxacin 400 mg IV every 12 hours OR
      5. Ertapenem 1 g IV every 24 hours
  2. Focus antibiotic coverage with Blood Culture results
  3. After sufficient abscess drainage, antibiotic course of 4-5 days is typically adequate (up to 8-10 day course)
    1. Sawyer (2015) N Engl J Med 372:1996-2005 +PMID:25992746 [PubMed]
  4. Surgery or percutaneous drainage

IX. References

  1. (2019) Hepatic Abscess, Sanford Guide, accessed 9/26/2018
  2. Akhondi (2019) Liver Abscess, StatPearls +PMID:30855818

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Related Studies

Ontology: Liver Abscess (C0023885)

Definition (MSHCZE) Ojedinělé nebo mnohočetné hromadění hnisu v játrech jako výsledek bakteriální či protozoární infekce nebo jako výsledek infekce způsobené jiným agens.
Definition (NCI) A bacterial, parasitic, or fungal abscess that develops in the liver. It is usually the result of an abdominal infection, trauma, or surgery in the right upper quadrant. Signs and symptoms include abdominal pain, nausea, vomiting, and fever.
Definition (MSH) Solitary or multiple collections of PUS within the liver as a result of infection by bacteria, protozoa, or other agents.
Definition (CSP) solitary or multiple collections of pus within the liver; usually associated with systemic manifestations of toxemia and clinical signs of disease in the right upper quadrant of the abdomen.
Concepts Disease or Syndrome (T047)
MSH D008100
ICD9 572.0
ICD10 K75.0
SnomedCT 155818008, 197331000, 27916005
English Abscess, Hepatic, Abscesses, Hepatic, Abscesses, Liver, Hepatic Abscess, Hepatic Abscesses, Liver Abscess, Liver Abscesses, Abscess, Liver, Liver abscess NOS, liver abscess, liver abscess (diagnosis), Hepatic abscess NOS, Liver Abscess [Disease/Finding], Abscess;liver, abscess hepatic, hepatic abscess, abscess liver, of liver abscess, abscessed liver, abscess of liver, liver abscesses, abscesses hepatic, Liver abscess (disorder), Liver abscess NOS (disorder), Liver abscess, Liver--Abscess, Abscess of liver, Abscess of liver (disorder), Hepatic abscess, abscess; liver, liver; abscess, Abscess of liver, NOS, Hepatic abscess, NOS
Italian Ascesso del fegato, Ascesso epatico
Dutch abces van de lever, abces; lever, lever; abces, leverabces, Abces, hepatisch, Abces, lever-, Leverabces
French Abcès au foie, Abcès hépatique, Abcès du foie
German Abszess der Leber, Leberabszess, Abszeß, Leber-, Leberabszeß
Portuguese Abcesso do fígado, Abcesso hepático, Abscesso Hepático
Spanish Absceso en hígado, absceso hepático, SAI (trastorno), absceso hepático, SAI, absceso de hígado (trastorno), absceso de hígado, absceso hepático, Absceso hepático, Absceso Hepático
Swedish Leverabscess
Japanese カンノウヨウ, 肝臓膿瘍, 肝膿瘍, 膿瘍-肝
Czech játra - absces, Absces jater, Jaterní absces
Finnish Maksapaise
Korean 간의 고름집(농양)
Polish Ropień wątroby
Hungarian májtályog
Norwegian Leverabscess