Definition

Pyogenic liver abscess is a pus-filled pocket of fluid within the liver. Pyogenic means "with pus".

Alternative Names

Liver abscess; Bacterial liver abscess; Hepatic abscess

Causes

There are many possible causes of liver abscesses, including:

• Abdominal infection, such as appendicitis, diverticulitis, or a perforated bowel
• Infection in the blood
• Infection of the tubes draining bile (bile ducts)
• Recent endoscopy of the bile draining tubes
• Trauma that damages the liver

A number of common bacteria may cause liver abscesses. In most cases, more than one type of bacteria are found.

Symptoms

Symptoms of liver abscess may include:

• Pain in the right upper abdomen (more common) or throughout the abdomen (less common)
• Clay-colored stools
• Dark urine
• Fever, chills, night sweats
• Loss of appetite
• Nausea, vomiting
• Unintentional weight loss
• Weakness
• Yellow skin (jaundice)
• Right shoulder pain (referred pain)
• Chest pain (lower right)

Exams and Tests

Tests may include:

• Abdominal CT scan
• Abdominal ultrasound
• Blood culture for bacteria
• Complete blood count (CBC)
• Liver biopsy
• Liver function tests

Treatment

Treatment usually consists of placing a tube through the skin into the liver to drain the abscess. Less often, surgery is needed. You will also receive antibiotics for about 4 to 6 weeks. Sometimes, antibiotics alone can cure the infection.

Outlook (Prognosis)

This condition can be life threatening. The risk for death is higher in people who have many liver abscesses.

Possible Complications

Life-threatening sepsis can develop. Sepsis is an illness in which the body has a severe inflammatory response to bacteria or other germs.

When to Contact a Medical Professional

Contact your health care provider if you have:

• Any symptoms of this disorder
• Severe abdominal pain
• Confusion or decreased consciousness
• High fever that doesn't go away
• Other new symptoms during or after treatment

Prevention

Prompt treatment of abdominal and other infections may reduce the risk of developing a liver abscess, but most cases are not preventable.

References

Kim AY, Chung RT. Bacterial, parasitic, and fungal infections of the liver, including liver abscesses. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 84.

Sifri CD, Madoff LC. Infections of the liver and biliary system (liver abscess, cholangitis, cholecystitis). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 75.