Liver abscess: Causes, Symptoms, Diagnosis & Treatments
The liver abscess can be divided into pyogenic liver abscess and amebic liver abscess.
The patient's diagnosis of pyogenic liver abscess accounts for about 85% of liver abscesses in the United States.
The path / cause of the infection is as follows.
1) Biliary tract (most common): Cholangitis / Acute cholecystitis -> Ascending infection
2) Portal vein: Diverticulitis / Appendicitis
3) Abdominal trauma: penetrating wound /
4) Immune decline due to chronic diseases
The causative organism varies according to the infection route. Usually E. coli is the main causative organism. If it is infected through the biliary tract, K. pneumoniae, enterococci, etc. may be suspected in addition to E. coli. In case of hematogenous spread, S. aureus and streptococci Can be. Candida spp. Can be suspected if liver abscess is found at the time of recovery of neutropenia in patients under chemotherapy.
The clinical manifestations of pyogenic liver abscess include Fever (m / c), RUQ abdominal pain, hepatomegaly, tenderness, nausea, vomiting, and elevated ALP / Bilirubin / AST in the lab. If a fever is present after a doctor's visit, a basic blood test / culture test will be performed, and fine needle aspiration will proceed after imaging test like US / CT. In US, hypoechoic mass and irregular margin are characteristic. On computed tomography (CT), contrast enhancement can be observed around the hypoechoic lesion with clear border. Gram stain and culture should be performed with FNA for confirmation. The patient was also diagnosed with Klebsiella liver abscess through blood test / culture test / CT / Culture.
The treatment is largely 1) Percutaneous or surgical drainage 2) There is a case where surgical drainage is performed from the beginning by using empirical broad-spectrum antibiotics.
An indication of the surgical drainage is shown below.
1) Multiple or large abscess
2) Viscous abscess contents
3) Findings of peritonitis
4) Percutaneous drainage without any improvement after 4-7 days
Antibiotic therapy is usually based on the patient's underlying disease and severity. Treatment usually takes 2-3 weeks. If the disease progresses, the patient is treated with oral antibiotics for 4-6 weeks.
The patient's diagnosis of pyogenic liver abscess accounts for about 85% of liver abscesses in the United States.
The path / cause of the infection is as follows.
1) Biliary tract (most common): Cholangitis / Acute cholecystitis -> Ascending infection
2) Portal vein: Diverticulitis / Appendicitis
3) Abdominal trauma: penetrating wound /
4) Immune decline due to chronic diseases
The causative organism varies according to the infection route. Usually E. coli is the main causative organism. If it is infected through the biliary tract, K. pneumoniae, enterococci, etc. may be suspected in addition to E. coli. In case of hematogenous spread, S. aureus and streptococci Can be. Candida spp. Can be suspected if liver abscess is found at the time of recovery of neutropenia in patients under chemotherapy.
The clinical manifestations of pyogenic liver abscess include Fever (m / c), RUQ abdominal pain, hepatomegaly, tenderness, nausea, vomiting, and elevated ALP / Bilirubin / AST in the lab. If a fever is present after a doctor's visit, a basic blood test / culture test will be performed, and fine needle aspiration will proceed after imaging test like US / CT. In US, hypoechoic mass and irregular margin are characteristic. On computed tomography (CT), contrast enhancement can be observed around the hypoechoic lesion with clear border. Gram stain and culture should be performed with FNA for confirmation. The patient was also diagnosed with Klebsiella liver abscess through blood test / culture test / CT / Culture.
The treatment is largely 1) Percutaneous or surgical drainage 2) There is a case where surgical drainage is performed from the beginning by using empirical broad-spectrum antibiotics.
An indication of the surgical drainage is shown below.
1) Multiple or large abscess
2) Viscous abscess contents
3) Findings of peritonitis
4) Percutaneous drainage without any improvement after 4-7 days
Antibiotic therapy is usually based on the patient's underlying disease and severity. Treatment usually takes 2-3 weeks. If the disease progresses, the patient is treated with oral antibiotics for 4-6 weeks.
