A liver abscess or liver abscess is a pus-filled sac that forms in the liver. This condition is generally caused by bacterial and amoeba infections that enter the liver through puncture wounds in the stomach, or the spread of infection from other digestive organs.
Liver abscess patients usually experience symptoms in the form of pain in the upper right abdomen, fever, and jaundice. If left untreated, a liver abscess can cause fatal complications. On the other hand, if you get good treatment, the chance of healing a liver abscess becomes greater.
Causes of Liver Abscess
Liver abscess most often occurs due to bacterial and amoeba infections. However, in some cases, liver abscess can also occur due to fungal infection.
Based on the three causative microorganisms, liver abscesses are divided into three types, namely:
- Pyogenic liver abscess
Pyogenic liver abscess is caused by bacterial infection, generally E.coli, Klebsiella, Streptococcus, Staphylococcus, and anaerobic bacteria. - Amoeba liver abscess
Amoeba liver abscess caused by amoeba infection. The amoeba that most often causes liver abscess is Entamoeba histolytica. - Fungal liver abscess
This type of abscess is caused by a fungal infection. Fungal liver abscesses are most often caused by Candida and Aspergillus fungi. Generally, this type occurs in people with weak immunity.
Generally, the microorganisms above can spread to the liver due to infection in other organs in the digestive tract, such as:
- Appendicitis
- Inflammation of the bile ducts (cholangitis)
- Diverticulitis
- Gallbladder inflammation (cholecystitis)
In addition to infection in the digestive tract, liver abscesses can also occur in people who have suffered puncture wounds in the liver, or who have undergone abdominal surgery.
Risk factors for liver abscess
There are several factors that can increase the risk of liver abscess, namely:
- Aged over 70 years
- Male sex
- Have a weak immune system
- Suffering from certain diseases, such as cancer or diabetes
- Suffering from cirrhosis
- Using certain drugs, such as corticosteroids and chemotherapy drugs
- Suffering from malnutrition
- Consuming excessive alcoholic beverages
Liver Abscess Symptoms
The symptoms of a liver abscess are generally similar to the symptoms of bile duct inflammation. Some of the symptoms that can be experienced by liver abscess sufferers are:
- Pain in the upper right abdomen that is continuous and feels piercing
- Fever and chills
- Excessive sweating at night
- Nausea and vomiting
- It’s easy to feel overwhelmed
- Jaundice
- Loss of appetite
- Weight loss
- Pale colored stools
- Dark colored urine
- Diarrhea
- Cough
When should you go to the doctor?
Immediately see a doctor if you experience the symptoms mentioned above, especially if you experience:
- Severe pain in the stomach
- High fever that does not improve
- Bewildered
- Decreased consciousness
Immediately seek medical help if the symptoms appear during or after undergoing surgery in the abdominal area.
Diagnosis of Liver Abscess
The doctor will ask questions about the patient’s symptoms and health history. After that, the doctor will perform a comprehensive physical examination, especially on the abdomen, to detect whether there is enlargement of the liver (hepatomegaly).
To confirm the diagnosis, the doctor will perform some of the following supporting tests:
- Blood tests, to check for infection and find out the condition of the liver
- Examination of feces, to detect amoeba which is the cause of liver abscess
- Abdominal ultrasound, to see the location of the abscess formation
- Abdominal CT scan or abdominal MRI, to see the condition of the abscess more clearly
Liver Abscess Treatment
Treatment of a liver abscess depends on the cause, size, and location of the abscess. There are several treatment methods that can be done, namely:
Medicines
The doctor will prescribe medicines that are adapted to the type of microorganism that causes liver abscess. In pyogenic liver abscess, the doctor will prescribe antibiotics, such as tazobactam, amoxicillin, ceftriaxone, and metronidazole.
In amoeba liver abscess, the doctor will also prescribe metronidazole. Both in pyogenic liver abscess and amoeba liver abscess, initially the doctor will give medicines through infusion fluid. Next, the doctor will prescribe medicine in the form of drinking. Generally, medications will be given for 2–6 weeks.
While in fungal liver abscess, the doctor will give antifungal drugs, such as amphotericin, fluconazole, or itraconazole.
Surgical procedures
In addition to medication, the doctor will also perform drainage to remove the abscess through a surgical procedure. Some of the surgical procedures that can be performed are:
- Catheter tube installation
In this procedure, the doctor will give local anesthesia and install a catheter in the abdominal area with ultrasound guidance. The catheter hose will drain the pus out of the body. - Laparoscopy
In certain cases, the doctor can perform drainage through laparoscopy, that is by using a small tube and hose equipped with a camera and a light at the end. This device is inserted through several small incisions in the abdominal area. Before this operation, the patient will be given total anesthesia in order to fall asleep during the procedure. - Conventional surgery
If the liver abscess is large, numerous, or has ruptured, the doctor can perform conventional surgery. In this operation, the doctor will make an incision large enough to remove the abscess. Similar to laparoscopy, this procedure is also preceded by the administration of total anesthesia.
Complications of Liver Abscess
If left untreated, a liver abscess can cause the following complications:
- Sepsis
- Infection of the protective lining of the lung (empyema)
- The abscess ruptures and causes inflammation of the peritoneum (peritonitis).
- Spread of infection to the eye or brain
Liver Abscess Prevention
There are several ways that can be done to reduce the risk of forming a liver abscess, namely:
- Undergo treatment and take medicine as recommended by the doctor if suffering from an infectious disease
- Diligently wash your hands with soap and running water, especially before eating or after using the toilet
- Wash and clean vegetables and fruits before processing or eating them
- Do not drink dirty and uncooked water
- Cook the meat until fully cooked before consuming it
- Carry out routine checks after the operation
- Having healthy sexual intercourse and not abusing NAPZA to avoid HIV/AIDS
Reference:
Priyadarshi, R., Kumar, R., & Anand, U. (2022). Amebic Liver Abscess: Clinico-Radiological Findings and Interventional Management. World Journal of Radiology, 14(8), pp. 272–285.
Kozielewicz, D., Sikorska, K., & Stalke, P. (2021). Liver Abscesses – from Diagnosis to Treatment. Clinical and Experimental Hepatology, 7(4), pp. 329–336.
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BMJ Best Practice (2023). Liver Abscess.
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