Pyogenic Liver Abscess

Pyogenic Liver Abscess Symptoms:

Symptoms of pyogenic liver abscess are similar to those of other types of liver diseases such as alcoholic hepatitis or cirrhosis. They include fever, chills, malaise, loss of appetite, nausea and vomiting. Other common symptoms include abdominal pain, weight loss and fatigue.

The most common signs of pyogenic liver abscess are acute onset of fever, chills and malaise followed by abdominal pain, weight loss and fatigue.

In addition to these symptoms there may be other complications like jaundice (yellowing of skin and eyes), increased bleeding time, decreased blood clotting times, pulmonary edema (fluid build up in lungs) and even death due to shock.

The diagnosis of pyogenic liver abscess depends upon several factors including history, physical examination findings, laboratory tests and imaging studies. The diagnostic criteria for pyogenic liver abscess are described below:

Hematological abnormalities – Blood cell count less than 200/mm3; platelets less than 100/µl; white cells less than 50/µl; red cells less than 150/µl. Hemoglobin level greater than 9 gm/dl. Liver function test abnormalities – Direct bilirubin level greater than 2.2 mg/dl; INR (International Normalized Ratio) less than 0.9, alkaline phosphatase level greater than 270 IU/L.

Erythrocyte sedimentation rate greater than 50 mm in one hour. Abdominal ultrasound shows anechoic mass with hypoechoic areas in the liver bigger than 5 cm in diameter. After contrast agent administration the mass shows multiple internal fluid-fluid levels.

The most common cause of pyogenic liver abscess is infection with a particular type of bacteria called Streptococcus viridans. It usually spreads from the mouth to liver and other organs through the bloodstream. Other causes of pyogenic liver abscess are septic thrombosis, amebiasis, and other uncommon bacterial or fungal infections.

The treatment of pyogenic liver abscess is based upon its cause, complications and response to treatment. The initial step is to stop the spread of infection by administering appropriate antibiotics. Antibiotics should also be given for possible cases of septic shock or other serious complications.

Once the cause of infection is determined appropriate treatment should be given. For example, if Streptococcus viridans is the cause of infection then penicillin or intravenous clindamycin can be used. Other antibiotics such as ertapenem, ceftriaxone, cefotaxime and ampicillin-sulbactam can also be used.

In some cases surgical drainage of pus is necessary. In rare cases liver transplant is required.

The prognosis of pyogenic liver abscess is good with appropriate treatment. In some cases, scarring of the liver may occur and can lead to cirrhosis. This is especially true in cases of recurrent pyogenic liver abscess and may result in liver failure.

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Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess by JAA Pérez, JJ González, RF Baldonedo, L Sanz… – The American journal of …, 2001 – Elsevier