Liver abscess – Causes, Symptoms, Diagnosis and Treatment

What is a liver abscess?

A Liver abscess is nothing but a collection of infected pus formed in the liver. The term ‘abscess’ is nothing but the accumulation of pus. This disease is primarily caused due to formation of germs like bacteria, parasites and fungus. Liver abscesses are a collection of pus in the liver parenchyma that is produced from bacterial, fungal and parasitic infections. Early treatment of liver abscess avoids complications and serious problems in the future.  

The infections attack the liver through the hepatic vein, biliary tree and portal veins. There can be multiple abscesses present in the liver. In general, liver abscesses are classified into two groups, namely, Pyogenic liver abscesses and Amebic liver abscesses.  

Liver abscess causes serious problems, and if left untreated, liver abscesses may even lead to death. People with a diagnosis of liver abscess can get biliary tract infection due to spread of infection.  

A liver abscess harms the tissue of the area where it is found. Liver abscess is not a deadly disease; however, it becomes a life-threatening disease if the pus comes out and spreads the infection.

Causes of Liver abscess 

Liver Abscess is caused due to multiple reasons. It is said that these conditions are caused due to infections occurring in the blood, abdomen and gastrointestinal systems. There is no specific reason for the cause of the Liver abscess. The other notable cause of a liver abscess is an injury caused during the surgery or pain caused in the liver. Some of the possible causes of a Liver abscess include:

Abdominal infections such as Appendicitis, Perforated bowel and diverticulitis

The main reason for the cause of a liver abscess is abdominal infections that result in diseases like Appendicitis.

Infection in the blood

A blood infection is one of the important reasons for the cause of the Liver abscess. Sometimes bacteria enter the bloodstream and spoil the blood quality. This condition is known to be Septicemia.  

Infection of the bile draining tubes

Bile drainage is nothing but the insertion of a tube into the bile duct. This happens when the bile ducts in the body are blocked. This may also cause liver-related problems leading to liver abscess.

Endoscopy of the bile draining tubes

The error that occurs while performing endoscopy on bile draining tubes may gradually result in liver abscess problems.

Symptoms of Liver abscess

If you are diagnosed with a liver abscess, you can easily figure out the disease by simply acknowledging the symptoms mentioned below:

Chest pain chest  

In case a person is diagnosed with a liver abscess condition, they may feel a little compression in the chest or mild chest pain.

Pain in the upper right abdomen

You may feel abdominal pain more often in the upper right abdomen as it is a sign or indication of a liver abscess.

Clay-coloured stools

Clay coloured stools appear only when there is a presence of obstructive jaundice. In other cases, normal coloured stools can occur.

Dark urine

Urine appears to be dark in colour. You could notice a change in the colour of the urine to be dark.

Fever, chills, night sweat

Liver abscess also shows up mild symptoms like fever, chills and night sweat.  

Nausea, vomiting

A person may experience unremitting vomiting and nausea problems during liver abscess.

Unintentional weight loss

A person may undergo sudden weight loss due to this condition; however, not every weight loss problem is due to a liver abscess condition.

Weakness

You may also feel tired and restless. This is due to weakness caused by the liver abscess condition.  

Jaundice

Jaundice is a sign of liver abscess condition. You need to immediately consult a doctor to know whether you are affected by a liver abscess.  

Right shoulder pain

You can feel pain in the exact right-hand shoulder of your body. This pain may also arise if you are diagnosed with a liver abscess condition.

Exams and tests for liver abscess

Liver abscesses can be examined and tested using various methods.  

The test for a liver abscess includes:

Abdominal CT scan

An abdominal CT scan that is often referred to as a CAT scan, is used to detect and test liver abscess conditions. This is an imaging method that uses x-rays to take images around the corner of the belly area.

Abdominal ultrasound

Abdominal ultrasound is a medical test that helps to examine and assess abdomen structures and organs. It also helps to detect kidney stones, tumours and liver abscesses.

Blood culture test for bacteria

A blood culture test precisely figures out the bacteria or germs present in the blood.

Complete blood count

CBC test is a medical test that gives complete information about the cells present in the body. This provides accurate information on the white blood cells, red blood cells and platelets.  

Liver biopsy

This test is done for the diagnosis of liver disease. This is performed by removing a small tissue of the liver for the examination.

Liver function tests

A liver function test is only for diagnosing liver problems. This test provides complete information about a person’s liver condition.

Treatment for liver abscess

The treatment for Liver abscesses can be done either by medications or surgery. However, the mode of treatment essentially depends on the severity of the infection. Surgery is recommended only in critical cases where damage is more and does not cure under easy medications.

A liver abscess can occur to anyone; therefore, if you experience any of the following symptoms and suspect it might be due to a liver Abscess, then you need to immediately consult a doctor for confirmation. If you are diagnosed with Amebic liver abscess, after the treatment, you still have the chance of getting affected by it again. Hence, your doctor may prescribe additional medications to kill the germs present in the intestine to avoid abscess recurrence.

The treatment is also performed based on the quantity and size of the pus. Treatment for liver abscess can be performed in two ways:

• Treatment via medication
• Treatment via surgery

Treatment via medication

Different types of antibodies are given as oral antibodies for the treatment of a liver abscess. Antibodies are prescribed by considering the severity, types and the seriousness of the infection. Some of the widely used prominent medications for liver abscesses are:

• Metronidazole (Flagyl)
• Combination piperacillin-tazobactam (Zosyn)
• Clindamycin (Cleocin)
• Aminoglycosides, such as amikacin (Amikin)
• Gentamicin (Garamycin)

Treatment via surgery

If a condition aggravates, then the performance of surgery becomes inevitable to cure the condition. Surgery is done when the medication expected to cure the problem does not show any results. Surgery is performed only under the necessary condition to drain the abscess with the needle, or a small tube is inserted through the abdomen. The surgical procedure performed for a liver abscess is known as Laparoscopic or Percutaneous drainage.  

There are numerous ways available to drain the abscess. If the abscess is large enough to burst or oral medications do not bring favourably, then a treatment called Aspiration is recommended, and it is repeated at times whenever necessary. Aspiration is employed to drain the abscess where a syringe needle is inserted into the abscess through the skin to drain the abscess completely.  

In some cases, surgery is performed by directly cutting the liver abscess and draining it.  

Diagnosis of Liver abscess 

Your health care provider or doctor may insist you take the following blood and imaging test to determine the presence of a liver abscess.

• MRI scan on the abdomen
• Blood test to check signs of infectious inflammation like increased serum white blood count and neutrophil level
• Abdominal ultrasound test to easily locate the abscess
• For the measurement of abscess, a CT scan with injected dye or Intravenous contrast.  

What is the differential diagnosis?

Differential diagnosis is the way of analysing a disease by examining the medical history and body condition of a person. In simple words, it is the process of differentiating one disease from the other disease and arriving at a conclusion. Liver abscess shows symptoms like fever, hepatitis and quadrant pain. However, the differential diagnosis of liver abscess includes:  

Viral hepatitis

Viral hepatitis is the swelling or injury that occurs in the liver, causing inflammation and damage.

Cholecystitis

Cholecystitis is the inflammation caused in the gall bladder. A gall bladder is a small digestive organ that is found under the liver.  

Cholangitis

Cholangitis is a bile duct inflammation. This is a type of liver disease with the potential cause of morbidity and mortality.

Right lower lobe pneumonia

This is a type of pneumonia particularly characterised by inflammatory exudate that affects a large area of the lobe of a lung.

Appendicitis 

Appendicitis is a condition where your appendix becomes abscessed and inflamed, causing unbearable pain.

Necrotic liver masses

Necrotic liver masses are another liver infection that causes swelling and pain in the liver.

Prognosis

Due to advancements in medical technology, a condition like liver abscess has a much better prognosis now. Recurrence of liver abscess happens if the patients are diagnosed with biliary tract disease.

Monitoring of liver abscess

Conditions like liver abscesses need long-term monitoring to avoid further complications in the future. This monitoring involves checking the treated liver after removing pus or abscess. Through monitoring, you can proactively check the status of your liver condition and prevent the spread of pus.

Long-term monitoring of liver abscess involves:

• Weekly monitoring of the liver through Ultrasound Examination and Computed Tomography (CT) to check the drainage of the abscess cavity in the liver.
• Monitoring fever curves.
• More aggressive drainage is needed when you face continuous fever, even after two weeks.  
• Try to maintain drains until the output is less than 10ML/day.

Prevention of liver abscess  

It’s not possible to pre-determine the condition of the Liver abscess. However, the following preventive methods may lower the risk of liver abscess.  

• Abstain from contaminated food and water.
• Stop travelling to places where Amebic infections are high.
• Following appropriate sanitary measures to safeguard yourself from deadly infections.  
• Maintaining the practice of handwashing and food hygiene.
• Always drink boiled water
• Safe sexual practices

Risk factors of liver abscess

There are a plethora of factors that increase the risk of liver abscess. However, it does mean you have a liver abscess problem if you encounter any one of the risk factors mentioned below:

• Overconsumption of alcohol
• Lower immune system due to HIV
• Bad body nutrition
• Travelling to places where the cases of Amebic liver are high

General risk factors for Pyogenic liver abscess include:

• Crohn’s disease
• Gastrointestinal infection
• History of abdominal surgery
• Recent endoscopy of bile draining tubes

Other possible risk factors for Liver abscess are:

Biliary tract Disease

This disease deteriorates the gallbladder, bile ducts and other vitals responsible for the production of bile.  

Age>50 years 

People above the age of 50 are more likely to get affected by this disease, especially when they have any problems related to the liver.

Underlying malignancy

Malignant cells growing in the body cause serious risk factors and may cause a liver abscess.

Diabetes Mellitus

Diabetic Mellitus is a severe metabolic disorder that occurs due to high blood sugar levels for a long period of time.  

Summing up 

People would easily panic after they find out they are affected by a liver abscess condition. Whoever is diagnosed with this condition must consider seeing their doctors as soon as possible for the treatment. Liver abscess leads to death only under critical conditions, and most of the times, problems can be solved via treatment and medications. It is all about monitoring and controlling your body to prevent liver abscesses.

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