Pyogenic liver abscess: literature review


Agnė Kavaliauskaitė1, Roberta Buginytė1

1Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania


Pyogenic liver abscess (PLA) is one of the most common visceral abscesses. The main path of development is retrograde microorganism migration from the biliary tract. Other intra-abdominal infections, haematogenous dissemination or liver trauma can also be one of the reasons for the PLA formation. Nowadays these abscesses are more common between 60-70 years old patients. The main risk factors are diabetes mellitus, liver cirrhosis, biliary tract and pancreatic diseases. Usually abscesses are caused by polymicrobial gastrointestinal flora, which consists of aerobes and anaerobes. The main pathogens are E. Coli and K. pneumoniae. The most common symptoms of liver abscesses are fever and upper abdominal pain. Other symptoms may include chills, night sweats, malaise, nausea or vomiting, right shoulder pain, cough, dyspnoea, anorexia or recent unexplained weight loss. Laboratory tests are usually associated with an increase in liver enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP). Other significant laboratory tests may show hyperbilirubinemia or increase of international normalized ratio (INR). The main imaging test to confirm the diagnosis of liver abscess is ultrasonography (US). In order to determine a pyogenic liver abscess and causes of it, it is important to take blood culture and fine needle aspiration. Treatment of the PLA consists of antimicrobial therapy and drainage of the abscess. Cefuroxime and metronidazole or aminoglycoside cover gram-positive and gram-negative microorganisms and are the main antibiotics for PLA. Percutaneous needle aspiration (PNA) or percutaneous drainage (PCD) must be performed when abscesses are larger than 5 cm or patients did not improve clinically under antimicrobial therapy. 

Key words: liver abscess, pyogenic, upper right quadrant abdominal pain, percutaneous drainage, percutaneous needle aspiration.