Incidence	- rare
Age
Sex
Geography
Aetiology	- used to be due to portal pyaemia from intra-abdominal sepsis - nowdays, cause is generally unknown - biliary sepsis, trauma, bacteraemia, direct extension from another abscess - organisms found include E. coli, S. faecalis, P. vulgaris, S. aureus; commonly mixed infection
Presentation	May present with malaise lasting weeks-months Acute - fever, rigors - anorexia, weight loss - vomiting, abdominal pain - ± Gram -ve septicaemia with shock - patient may be toxic, febrile and jaundiced with a large, tender liver and right pleural effusion or rub.
Investigations	- often investigated as PUO LFTs - raised ALP - raised bilirubin in 25% FBC - normochromic normocytic anaemia - PMN leukocytosis ESR raised Serum vitamin B12 - very high - stored in and released from liver Blood cultures - positive in only 30% USS / CT CXR - elevation of right hemidiaphragm with pleural effusion in severe cases
Macro
Micro
Staging
Serum markers
Management	- antibiotic cover for Gram +ve, Gram -ve and anaerobic organisms until organism is identified - aspiration under USS control - further drainage via large-bore needle or surgically if a localized abscess is found - treat underlying cause
Prognosis	- overall mortality is 16% with aspiration under antibiotic cover - depends on nature of underlying pathology - unilocular abscess in R lobe has best prognosis - scattered multiple abscesses have mortality of 80%
Complications

Hepatobiliary medicine

Main Page