Liver abscesses are relatively rare but mortality has decreased to 5-30% due to improved diagnostic and treatment methods. Risk factors include diabetes, liver transplants, and immunosuppression. Symptoms include fever, right upper quadrant pain, and referred shoulder pain. Diagnosis involves blood tests, imaging like CT or ultrasound, and abscess drainage or long-term antibiotic therapy. Complications can include sepsis, empyema, or peritonitis if left untreated. Prognosis is worse with multiple abscesses, underlying illnesses, or delays in diagnosis and treatment.

1. NOW

2.  Abscesses of the liver are relatively rare
 Mortality rates decreased to 5-30%
• New radiologic techniques
• Improvement in microbiologic identification
• Advancement of drainage techniques
• Improved antibiotics
• Improved supportive care

3.  No sex predilection
 Age – mostly children and elderly
 Risk more in:-
• DM
• Liver transplants
• Immunosuppressed
 Mortality ranges from 5 – 30%

4.  Pyogenic abscess
• Polymicrobial
• Most common cause
 Amoebic abscess (Entamoeba histolytica)
 Fungal abscess (Candida species)

7.  MC symptoms :-
• Fever (either continuous or spiking)
• Chills
• Right upper quadrant pain
• Anorexia
• Malaise

8.  Cough or hiccoughs (diaphragmatic
irritation)
 Referred pain to the right shoulder
 Insidious course (weight loss, anemia)
• ?? malignancy
 Fever of unknown origin
 Acute systemic toxicity (Multiple
abscesses)
 Afebrile

9.  MC :- Fever, Tender hepatomegaly
 Mass +/-
 Decreased breath sounds
• Rt basilar lung zones
• Atelectasis, effusion
 Pleuralor hepatic friction rub
 Jaundice
• Biliary tract disease
• Multiple abscesses

10.  Biliary
Disease
 Cholecystitis
 Empyema
 A/c Gastritis
 Hepatocellular Carcinoma
 Hydatid Cysts
 Pneumonia

11.  CBC:-
• Anemia
• Neutrophilic leukocytosis
 LFT
• Albumin ↓
• Alkaline phosphatase ↑
• SGOT, SGPT, bilirubin levels ↑ (variable)
 Blood cultures (+ve 50%)
 Culture of abscess fluid
 ELISA for E histolytica

13.  CTscan
 USG
 CXR

14.  Drainage - percutaneous /surgical
 Antimicrobial treatment as adjunct
 Antibiotic therapy as standalone
• Unfit for invasive procedures
• Multiple abscesses
• Many months therapy
• Serial imaging and close monitoring

15.  Indications :-
• Signs of peritonitis
• Known abdominal surgical pathology (eg -
diverticular abscess)
• Failure of previous drainage attempts
• Complicated, multiloculated, thick-walled abscess
with viscous pus

16.  EMPERIC
• Beta-lactam/beta-lactamase inhibitor
• Carbapenems
• Second generation cephalosporins
+
• Anaerobic coverage (metronidazole /clindamycin)
 Change ≈ C&S report

17.  Amoebic :-
• Metronidazole
• Chloroquine ± emetine/dehydroemetine
 Fungal :-
• Amphotericin B (plain, lipid)
• Fluconazole

18.  4-6weeks of therapy - solitary lesions
 12 weeks - multiple abscesses
 Guide to the length of therapy :-
• clinical process
• radiographic progress

19.  Sepsis
 Empyema :-
• contiguous spread
• intrapleural rupture of abscess
– rupture of abscess
 Peritonitis
 Endophthalmitis (K pneumoniae
bacteremia)

20.  Untreated= fatal
 Bad prognosis :-
• Severity of underlying medical conditions
• Presence of complications
• Delay in diagnosis
• Bilirubin > 3.5 mg/dL
• Encephalopathy
• S.Albumin level of < 2 g/dL
• Multiple abscesses
• Malignant etiology
• High APACHE II score