A pyogenic liver abscess is a type of liver abscess caused by bacteria. Pyogenic refers to the formation of pus that characterizes these liver abscesses.
Signs and symptoms Acute abscess Fever Lethargy Discomfort in right upper quadrant of abdomen Anorexia Enlarged and tender liver Pleural effusion
Chronic abscess Fever Abdominal discomfort Enlarged liver
Cause Biliary disease (most common) E.g.: stones, cholangiocarcinoma Colonic disease E.g.: diverticulitis, appendicitis, Crohn's disease Cryptogenic disease Pancreatitis Infection of blood Intra-abdominal sepsis Infection of biliary system Traumatic introduction E.g.: penetrating injury, iatrogenic (radiofrequency ablation)
Common bacterial causes Streptococcus milleri E. coli Streptococcus fecalis Klebsiella pneumoniae Proteus vulgaris Bacteroides Opportunistic pathogens (Staphylococcus)
Diagnosis To differentiate pyogenic liver abscess from amoebic liver abscess, several features such as subjects with age more than 50 years with lungs involvement, multiple liver abscesses, with amoebic serologic titres less than 1:256 can help to pin down the diagnosis of pyogenic liver abscess. Blood CP (no leucocytosis) Haemoglobin estimation (anaemia) Serum albumin levels (falls rapidly) USG and CT scanning Guided aspiration to confirm the diagnosis
Treatment Antibiotics Penicillins Aminoglycosides Metronidazole Cephalosporins Percutaneous drainage under USG or CT control Laparotomy in intra-abdominal disease
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