Liver abscesses and hydatid disease
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7285.537 (Published 03 March 2001) Cite this as: BMJ 2001;322:537
- J E J Krige,
- I J Beckingham
Liver abscesses are caused by bacterial, parasitic, or fungal infection. Pyogenic abscesses account for three quarters of hepatic abscess in developed countries. Elsewhere, amoebic abscesses are more common, and, worldwide, amoebae are the commonest cause.
Pyogenic liver abscesses
Aetiology
Most pyogenic liver abscesses are secondary to infection originating in the abdomen. Cholangitis due to stones or strictures is the commonest cause, followed by abdominal infection due to diverticulitis or appendicitis. In 15% of cases no cause can be found (cryptogenic abscesses). Compromised host defences have been implicated in the development of cryptogenic abscess and may have a role in the aetiology of most hepatic abscesses. Diabetes mellitus has been noted in 15% of adults with liver abscesses.
Typical features of pyogenic liver abscess
Right upper quadrant pain and tenderness
Nocturnal fevers and sweats
Anorexia and weight loss
Raised right hemidiaphragm in chest radiograph
Raised white cell count and erythrocyte sedimentation rate with mild anaemia
Origins and causes of pyogenic liver abscess
Biliary tract
Gall stones
Cholangiocarcinoma
Strictures
Portal vein
Appendicitis
Diverticulitis
Crohn's disease
Hepatic artery
Dental infection
Bacterial endocarditis
Direct extension of:
Gall bladder empyema
Perforated peptic ulcer
Subphrenic abscess
Trauma
Iatrogenic
Liver biopsy
Blocked biliary stent
Cryptogenic
Secondary infection of liver cyst
Microbiology
Most patients presenting with pyogenic liver abscesses have a polymicrobial infection usually with Gram negative aerobic and anaerobic organisms. Most organisms are of bowel origin, with Escherichia coli, Klebsiella pneumoniae, bacteroides, enterococci, anaerobic streptococci, and microaerophilic streptococci being most common. Staphylococci, haemolytic streptococci, and Streptococcus milleri are usually present if the primary infection is bacterial endocarditis or dental sepsis. Immunosuppression as a result of AIDS, intensive chemotherapy, and transplantation has increased the number of abscesses due to fungal or opportunistic organisms.
Clinical features
The classic presentation is with abdominal pain, swinging fever, and nocturnal sweating, vomiting, anorexia, malaise, and weight loss. The onset may be insidious or occult in elderly people, and patients may present …
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