A pus-filled mass inside the liver caused by bacteria is known as a liver abscess. Liver abscesses are rare and with advancement in technology, drainage techniques have also improved as a curative measure. But if they are left untreated, it can prove fatal. Blood is received by the liver through systemic and portal circulations. The Kupffer cells present in the lining of the hepatic sinusoids efficiently clear the bacteria eliminating the anticipation of an infection. It is only when there is an increase in the susceptibility to bacterial infections that an abscess forms in the liver.
The types of liver abscesses are classified in accordance to their etiology:
PLA or pyogenic liver abscess: polymicrobial causes such as gram-negative enterogenic bacteria, gram-positive aerobes and anaerobic organisms
ALA or amoebic liver abscess: caused by Entamoeba histolytica
Signs and symptoms
Right upper quadrant pain
Diaphragmatic irritation leading to coughs and hiccoughs; referred pain to right shoulder
FUO or fever of unknown origin
Presence of fever
Tenderness and hepatomegaly
Midepigastric tenderness involvement of left hepatic lobe
Decreased breath sounds
Pleural or hepatic friction rub
CBC with differential shows increased white blood cell count
Liver function studies: hypoalbuminaemia, abnormal alkaline phosphatase, transaminase and bilirubin levels
Abscess fluid culture
Most of the liver abscesses can be treated with medicines. Some resistant cases would require ultrasound or CT guided drainage or repeated aspirations. Surgical therapy is indicative for all untreated hepatic abscesses which can cause complications such as empyema, sepsis or peritonitis. Open surgery with the transperitoneal approach or posterior transpleural approach is done. In most cases, the minimally invasive laparoscopic approach is chosen due to its speedy healing times and early recovery.
Dr. Deepak Varma obtains an interventional radiology to facilitate rapid drainage of cavity fluid as soon as possible. In complicated cases, he provides laparoscopic drainage or debridement of liver abscess.