Liver abscesses

Liver abscesses may be: 

• Pyogenic (80% of liver abscesses in the developed world) 
• Amoebic 
• Fungal 

Presentation: 

• Fever
• Abdominal pain/tenderness 
• Nausea/vomiting 
• Chest pain 
• Weight loss 
• Rarely: cough/hiccups from diaphragmatic irritation

Diagnosis:

• US 
• CT 
• Bloods – raised ALP commonest finding on LFTs 

Management 

• 2-3 weeks broad-spectrum IV antibiotics followed by 2-4 weeks oral antibiotics 
• Percutaneous drainage if >3cm in size 
• Surgical drainage if multiple/loculated abscess

Small print gem: most abscesses (around 70%) are in the right lobe of the liver

References 

Albenmousa, A. et al. Liver abscess presentation and management in Saudi Arabia and the United Kingdom. Ann Saudi Med. 2011;  31(5): 528-532. 

Heneghan, H. et al. Modern management of pyogenic hepatic abscess: a case series and review of the literature. BMC Res Notes. 2011;  4:80. 

Pang, T. et al. Pyogenic liver abscess: an audit of 10 years’ experience. World J Gastroenterol. 2011; 17(12): 1622-1630.