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Liver Abscess Prof. Ygber González de la Cruz, MD. MsC
Department of Medicine and Therapeutic. SMAHS-UTG
• A liver abscess is a pus-filled mass inside or attached to the liver. Common causes are an abdominal infection such as appendicitis or diverticulitis.
Liver Abscess
• Relative rare location• Described by Hippocrates (400 b.c)• First published review by Bright (1936)• Proposal for surgical drainage by
Ochsner. (1938)• Mortality went from 80 % to 5 %.
Liver Abscess
Pyogenic Abscess
Amebic Abscess
Fungal Abscess
Liver Abscess
• Liver invasion by bacteria:– Ascending infection in
the biliary tract (ascending cholangitis)
– Vascular seeding (portal or arterial)
– Direct invasion from a nearby source
– Traumatic implantation
Clinical Features
Symptoms• Pain Right Hypochondrium referred to
Right shoulder• Pyrexia (39º C)• Profuse sweating and Rigors• Loss of Weight• Earthy Complexion
Clinical Features
Signs• Palor• Tenderness and rigidity in right
hypochondrium• Palpable Liver• Intercostal Tenderness• Basal Lung Signs
Lab studies
• FBC• LFT• Blood cultures• Abscess fluid culture• Stools microscopy• Serology
Imaging studies
• Sonar scanning• CT scan w/ contrast• Gallium and technetium scanning• CxR
• Antimicrobial treatment is a common adjunct to percutaneous or surgical drainage
• Surgical drainage was the standard of care until the introduction of percutaneous drainage techniques in the mid 1970s. With the refinement of image-guided techniques, percutaneous drainage and aspiration have become the standard of care
• Antibiotic therapy as a sole treatment modality is not routinely advocated, though it has been successful in a few reported cases.– It may be the only alternative in patients too ill to
undergo invasive procedures or in those with multiple abscesses not amenable to percutaneous or surgical drainage.
• In these instances, patients are likely to require many months of antimicrobial therapy with serial imaging and close monitoring for associated complications
Medical treatment
• Pyogenic Abscess
Betalactam/betalactamase inhibitor plus
Metronidazol or Clyndamicine• Amebic Abscess
Metronidazol• Fungal Abscess
Amphotericin B or Fluconazol