Liver Abscess - Causes, Symptoms and Treatment Definition: A liver abscess occurs when bacteria or protozoa destroy hepatictissue, producing a cavity, which fills with infectious organisms, liquelled liver cells, and leukocytes. Necrotic tissue then walls off the cavity from the rest of the liver. Liver abscess occurs equally in men and women, usually in those over age 50. Death occurs in 15% of affected patients despite treatment. Causes of Liver Abscess Underlying causes of liver abscess include benign or malignant biliary obstruction along with cholangitis, extrahepatic abdominal sepsis, and trauma or surgery to the right upper quadrant. Liver abscesses also occur from intra-arterial chemoembolizations or cryosurgery in the liver, which causes necrosis of tumor cells and potential infection. The method by which bacteria reach the liver reflects the underlying causes. Biliary tract disease is the most common cause of liver abscess. Liver abscess after intra-abdominal sepsis (such as with diverticulitis) is most likely to be caused by hematogenous spread through the portal bloodstream. Hematogenous spread by hepatic arterial flow may occur in infectious endocarditis. Abscesses arising from hematogenous transmission are usually caused by a single pathogen; those arising from biliary obstruction are usually caused by a mixed flora. Patients with metastatic cancer to the liver, diabetes mellitus, and alcoholism are more likely to develop a liver abscess. The organisms that predominate in liver abscess are gram-negative aerobic bacilli, enterococci, streptococci. and anaerobes. Amebic liver abscesses arc caused by E. histolytica. Signs and Symptoms of Liver Abscess The clinical manifestations of a liver abscess depend on the degree of involvement. Some patients are acutely ill; in others, the abscess is recognized only at autopsy, after death from another illness. in an amebic abscess. Third-generation cephalosporins can be substituted for the aminoglycosides in patients at risk for renal toxicity. an amino glycoside. and decreased serum albumin levels. diaphoresis. is usually sufficient to evacuate pus. Abnormal laboratory values include: elevated levels of serum aspartate aminotransferase. such as dyspnea and pleural pain. antibiotics should be administered for 14 days and then replaced with oral preparations to complete a 6 week course. A common combination is ampicillin. Pereutaneous drainage. a blood culture can identify the bacterial agent. and either metronidazole or clindamycin. nausea. either with ultrasound or CT guidance. along with drainage.V. Surgery may be performed to drain pus in unstable patients with continued sepsis (despite attempted non surgical treatment) and for patients with persistent fevers (lasting longer than 2 weeks) after percutaneous drainage and appropriate antibiotic therapy. alanine aminotransferase.The onset of symptoms of a pyogenic abscess is usually sudden. Treatment for Liver Abscess Antibiotic therapy. Common signs include abdominal pain. Percutaneous needle aspiration of the abscess can also be performed with diagnostic tests to identify the causative organism. fever. Surgery is reserved for bowel perforation and rupture into the pericardium. histolytica. the onset is more insidious. is the preferred treatment for most hepatic abscesses. alkaline phosphatase. In pyogenic abscess. Contrast-aided magnetic resonance imaging may become an accurate method for diagnosing hepatic abscesses. weight loss. the antibiotic regimen should be modified to match the patient's sensitivities. vomiting. When the causative organisms are identified. and anemia. Signs of right pleural effusion. a stool culture and serologic and hemagglutination tests can isolate E. Liver damage may cause jaundice. Diagnosis for Liver Abscess Ultrasonography and computed tomography (CT) scan with contrast medium can accurately define intrahepatic lesions and allow assessment of intra-abdominal pathology. I. chills. and bilirubin. in amebic abscess. Special Considerations and Prevention Tips for Liver Abscess . develop if the abscess extends through the diaphragm. an increased white blood cell count. Explain diagnostic and surgical procedures. Provide supportive care. . and watch for possible adverse effects. such as hemorrhage or sepsis. 2. Stress the importance of compliance with therapy. and maintain fluid and nutritional intake. 3. Watch carefully for complications of abdominal surgery. 5. Administer anti-infective's and antibiotics as necessary. 4. Prepare the patient for I.1. monitor vital signs (especially temperature).V antibiotic administration as an outpatient with home care support.