| A liver abscess is an enclosed localized infection buried within the tissues of the liver.
The two principle types of liver abscesses are amebic liver abscess from parasites in water and food of some foreign countries, and pus-filled (pyogenic) abscess usually from a bacterial infection. Amebic liver abscess is caused by the same organism in the intestinal infection called amebiasis. It is carried through the blood to the liver where the abscess is formed.
An amebic abscess is usually caused by an amebic parasite typically picked up during an individual's recent trip abroad to tropical regions or underdeveloped countries. Transmission occurs through ingestion of cysts in fecally contaminated food or water, use of human excrement as fertilizer, and individual-to-individual contact. It is contracted in areas where poor sanitation exists, water is unpurified, and when uncooked vegetables or unpeeled fruit are eaten. The abscess can develop weeks or months after the original amebic infection and, because symptoms are usually intermittent, many individuals suffer up to 30 days before seeking treatment. Because routine diagnostic tests are typically normal, these abscesses are difficult to diagnose.
Bacterial abscesses usually develop by one of five mechanisms: infection of the liver (portal) vein from an intra-abdominal infection, systemic bacterial infection where the infection spread to the liver via the circulatory system, spread of infection from the gallbladder or bile ducts up to the liver (ascending cholangitis), spread of infection from the lung to the liver, or direct trauma to the liver.
Individuals who have had some sort of systemic infection or infections of structures near the liver (lung, gallbladder, or abdomen) or those with liver trauma are at greatest risk of developing this type of abscess. Malnutrition, alcoholism, and immunosuppression predispose an individual to more severe disease.Risk: Liver abscesses are more common in men than women. They are most common in those under the age of 50. Incidence and Prevalence: In the US, pyogenic liver abscesses are more common than amebic. The incidence of pyogenic liver abscess is 6 to 10 cases per 100,000. The exact incidence rate for amebic liver abscess in the US is not known, however it is estimated to be 1 in 100,000 (Ferri).
Worldwide, amebic abscesses of the liver are more common than pyogenic forms. Approximately 40 to 50 million people are infected annually with amebic abscesses, with the most of the infections occurring in developing countries (Lingvay). For example, the infection is most common in areas with crowded living conditions and poor sanitation. Africa, Latin America, Southeast Asia, and India have significant health problems associated with this disease. |
Source: Medical Disability Advisor
| History: Individuals should be questioned about recent travel abroad. Individuals may complain of recurrent high fever, sweating (diaphoresis), chills, severe headaches, nausea, vomiting, a general feeling of illness (malaise), loss of appetite (anorexia), unintentional weight loss, diarrhea, and pain. Physical exam: Individuals may present with intense, continuous, stabbing pain in the area of the right lung and upper-right abdomen (from the enlarged, tender liver), and fever. The skin may have a yellow tinge (jaundice).
A coarse scratching sound (friction rub) may be heard over the liver and lower right lung indicating inflammation of the liver and lower lung. Tests: A multiple-panel blood test is necessary to screen for presence and identification of ameba and bacteria. A complete blood count (CBC) is done and an increase in white blood cells is a sign of infection. Liver function tests are performed and liver enzymes levels measured.
The abscess may be cultured using a needle (needle aspiration) to identify the disease-producing organism (pathogen) and the antimicrobial medication that the pathogens are sensitive to. A liver biopsy helps determine the exact nature of liver pathology. Imaging tests such as an abdominal MRI, CT, or ultrasound help the doctor pinpoint the location and number of abscesses. Radionuclide liver scans may also be used to demonstrate areas of abscess formation. |
Source: Medical Disability Advisor
| Initially, the individual is treated with drugs to kill the specific bacteria or parasite (antibiotics or antimicrobials). After the acute symptoms have cleared, the individual must continue to take oral antimicrobial drugs for 20 days to kill any bacteria or parasites in the intestines.
Treatment then consists of draining the abscess(es) either surgically (incision and drainage) or via needle (percutaneous catheter drainage) to help relieve some of the abdominal pain associated with the abscess. In addition, appropriate antibiotic therapy is necessary. If the exact infecting organism is not identified, then antibiotics covering many common pathogens (broad-spectrum) are used. Antibiotics are continued for several weeks. Occasionally, single, pyogenic abscesses may be treated solely with antibiotics. |
Source: Medical Disability Advisor
| If correctly diagnosed and treated, most individuals with liver abscesses respond well to treatment. The overall mortality for liver abscesses (either parasitic or bacterial) is 20% to 40%. Those with multiple abscesses have a higher mortality rate than those with isolated single abscesses.
Pyogenic liver abscess cure rates following percutaneous drainage and appropriate antibiotic therapy are reported to be between 88% and 100%. |
Source: Medical Disability Advisor
| With or without treatment, the abscess may rupture into the lungs, the lining of the lungs (pleural cavity), abdominal (peritoneal) cavity, or sac around the heart (pericardium), raising the individual's risk of systemic infection (sepsis) and/or death. |
Source: Medical Disability Advisor
| After full recovery, the individual may return to work with no restrictions or accommodations. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was individual's liver abscess amebic or pyogenic?
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Has individual traveled out of the country in the past year?
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Did individual complain of recurrent high fevers, sweating, chills, severe headaches, nausea, vomiting, diarrhea or pain?
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Was individual generally ill, with no appetite, or with unintentional weight loss?
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Did individual have continuous stabbing pain in the upper right abdomen and lung?
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Was individual's skin yellowish?
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When did symptoms first occur?
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Did individual have any trauma to the liver?
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Did individual recently have a systemic infection?
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Did individual recently have an infection in the lung, gallbladder, or abdomen?
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Is individual immunosuppressed?
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Does individual have malnutrition or alcoholism?
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Was the diagnosis confirmed using CT scanning or ultrasound?
Regarding treatment:
- Was the abscess drained percutaneously?
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Is individual receiving medication appropriate for the abscess pathogen (antibiotics and/or antimicrobials)?
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Were broad-spectrum antibiotics necessary?
Regarding prognosis:
- Have there been any complications such as rupture of the abscess into adjacent lung, heart, or abdominal cavities?
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Is there evidence of some prior infection and other organ system involvement? If so, has it been treated?
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Source: Medical Disability Advisor
| Ferri, Fred, ed. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. 2004 ed. St. Louis: Mosby, Inc., 2004.Lingvay, Ildiko, et al. "Amebic Hepatic Abscesses." eMedicine. Eds. Robert A. Fingerote, et al. 5 Apr. 2002. Medscape. 22 Oct. 2004 <http://emedicine.com/med/topic2662.htm#section~clinical>. |
Source: Medical Disability Advisor
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