Liver Abscess

Liver Abscess

Background 

Abscess is collection of pus mixed with fluid and inflammatory debris in body or any tissue.  When this abscess occurs in liver parenchyma  they are termed as liver abscess. Liver abscess very common in Indian subcontinent especially in northern part of India. The incidence of abscess is also common in other areas of world especially with poor socio economic class population because of unsafe drinking water and food.

Types and causes of  liver abscess

The amoebic liver abscess which more commonly occur in general population, is  caused  by amoebic infection ( E. Histolytica). These are also associated with poor hygiene drinking water, consumption of excessive alcohol, smoking, diabetics and immune compromised patients.

 The second type of abscess is called as pyogenic liver abscess which is caused mainly by bacterial spread of infection in the body. These abscess usually can happen to anyone and source of the infection is intestine and blood borne infections. 

Symptoms of liver abscess 

  1. Dull aching to Severe pain in the right upper quadrant 
  2. Swelling in the right upper abdomain 
  3. Fever with chills 
  4. Nausea and vomiting 
  5. Jaundice in large abscess 
  6. Decreased appetite
  7. Systems of systemic infections 

Diagnosis and investigations of liver abscess 

These symptoms should not be ignored and consult with your clinician for examination and evaluation to rule out any other conditions. After examination, they will advice you to undergo Investigations as follow

  1. Routine blood investigations including liver profile 
  1. Ultrasonography of the abdomain- it is the initial investigation done to diagnose the disease and predict the size and location of the liver abscess 
  1. Contrast enhanced computerised tomography (CECT ) of the abdomain is done in case of large abscess, multiple abscess, when diagnosis of your abscess is not confirmed and planning for any intervention to drain the abscess. 

Treatment of the liver abscess 

Once the diagnosis of the liver abscess is confirmed, further treatment depends upon the severity of the symptoms and signs of the abscess. In case of mild symptoms, with small size of abscess less then 5 cm the clinician usually recommend antibiotics and supportive treatments. You may require admission in case of fever, pain and jaundice.

In case of large abscess, especially amoebic abscess larger then 5 cm, not responding to medications  and multiple bacterial abscess patients may require some intervention to drain the pus and promote the healing. 

Computerised tomography ( CT) or ultrasonography guided drainage of pus using needle aspiration or Pigtail placement  is the standard measure performed in many patients. This provides immediate relief to the patients as the pus starts draining which in turn decrease the pressure in the liver tissue. 

Surgery of the liver abscess is usually performed in cases of ruptured liver abscess in to the abdominal cavity where the pus spreads in to the abdomen leading to acute abdominal pain and infection. This surgery can routinely be performed by laparoscopic surgery ( Laparoscopic peritoneal lavage with drainage of pus) in stable patients. Conventional open surgery is always kept optional especially in unstable patients.

Recovery after treatment 

The patients usually respond to the treatment very well  but it takes time to liver to heal completely. The medications are also prescribed for almost 3-4 weeks to control the infection to spread. Patients usually need to maintain good protein and carbohydrates in the diet for essential recovery. 

To consult with best team of general, minimal access and liver surgeons available at  The Surgeons House (SHL) in different global locations, please click this link for more details. 

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