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What is a liver abscess

The liver is the organ most susceptible to the formation of abscesses, which can be solitary or multiple, and which can arise due to the spread of bacteria through the blood or the local dissemination of infection spots in the peritoneal cavity, close to the liver, as is case of appendicitis, diseases associated with the biliary tract or pileflebitis, for example.

In addition, liver abscess is a pathology that can also be caused by protozoa, known as amoebic liver abscess.

The treatment depends on the organism that is the source of the infection but usually consists of the administration of antibiotics, drainage of the abscess, or in more severe cases, it may be recommended to resort to surgery.

What are the signs and symptoms

The signs and symptoms that usually occur in people who have a liver abscess are fever and in some people, especially those with disease associated with the biliary tract, may show signs and symptoms located in the upper right quadrant, such as abdominal pain.

In addition, chills, anorexia, weight loss, nausea and vomiting may also appear.

However, only about half of people with liver abscesses have an enlarged liver, pain on palpation of the right upper quadrant, or jaundice, meaning that many people do not have symptoms that direct attention to the liver. Fever of obscure origin may be the only manifestation of liver abscess, especially in the elderly.

Possible causes

Liver abscesses can be caused by different microorganisms, such as bacteria or even fungi, which can arise due to the spread of bacteria through the blood or the local spread of infection spots in the peritoneal cavity, near the liver, as is the case of appendicitis , diseases associated with the biliary tract or pileflebitis, for example. Learn more about appendicitis and how you can identify it .

In addition, liver abscesses can also be amoebic:

Amoebic liver abscess

Amoebic liver abscess is an infection of the liver by protozoa. The disease begins when the E. histolytica protozoa  penetrate through the intestinal mucosa, cross the portal circulation and reach the liver. Most patients with this disease have no signs and symptoms or the presence of the protozoan in the stool.

The disease can appear from months to years after a trip or residence in an endemic area, so it is important to know the careful history of the trip to make the diagnosis. The most common symptoms are pain in the upper right quadrant, fever and liver tenderness.

The most common laboratory data are leukocytosis, high alkaline phosphatase, mild anemia and a high erythrocyte sedimentation rate.

What is the diagnosis

The only most reliable laboratory finding is an increase in the serum concentration of alkaline phosphatase, which is usually high in people with liver abscess. An increase in bilirubin and aspartate aminotransferase in the blood, leukocytosis, anemia and hypoalbuminemia can also occur in about half of the cases.

Imaging exams are usually the most reliable in the diagnosis of this disease, such as ultrasound, computed tomography, scintigraphy with leukocytes marked with indium or with gallium and magnetic resonance. A chest X-ray may also be taken.

The diagnosis of amebic liver abscess is based on the detection by ultrasound or computed tomography, of one or more lesions, which occupy space in the liver and a positive serological test for antibodies to E. histolytica antigens  .

How the treatment is done

Treatment can be done through percutaneous drainage, with a catheter with lateral holes kept in place. In addition, specific antibiotic remedies for the microorganism responsible for the infection can also be used after taking a sample of the abscess. In cases where the abscess is drained, more antibiotic treatment time is required.

If the infection is caused by candida, treatment usually consists of administering amphotericin, with further treatment with fluconazole. In some cases, only fluconazole treatment can be used, namely in clinically stable people, whose isolated microorganism is susceptible to this remedy.

For the treatment of amoebic liver abscess, medicines such as nitroimidazole, tinidazole, and metronidazole can be used. So far, this protozoan has shown no resistance to any of these drugs. Drainage of amoebic liver abscesses is rarely necessary.

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