A liver abscess occurs when bacteria or protozoa destroy hepatic tissue, producing a cavity, which fills with infectious organisms, liquefied liver cells, and leukocytes. Necrotic tissue then walls off the cavity from the rest of the liver.
Although liver abscess is relatively uncommon, it carries a mortality of 30%. Complications include rupture into the peritoneum, pleura, or pericardium, significantly increasing mortality.
In pyogenic liver abscesses, the common infecting organisms are Escherichia coli, Klebsiella, Staphylococcus, Streptococcus, Bacteroides, and enterococcus. The infecting organisms may invade the liver directly after a liver wound or they may spread from the lungs, skin, or other organs by the hepatic artery, portal vein, or biliary tract. Pyogenic abscesses are generally multiple and commonly follow cholecystitis, peritonitis, pneumonia, and bacterial endocarditis.
An amebic abscess results from infection with the protozoa Entamoeba histolytica, the organism that causes amebic dysentery. Amebic liver abscesses usually occur singly, in the right lobe.
There are 8 to 16 cases of liver abscess for every 100,000 people hospitalized, and there is a 5% to 30% mortality rate. Most cases occur in people in their 60s and 70s.
The clinical manifestations of a liver abscess depend on the degree of involvement. Some patients are acutely ill; in others, the abscess is recognized only at autopsy, after death from another illness. The onset of symptoms of a pyogenic abscess is usually sudden; in an amebic abscess, the onset is more insidious. Common signs and symptoms include right abdominal and shoulder pain, weight loss, fever, chills, diaphor-esis, nausea, vomiting, and anemia. Signs of right pleural effusion, such as dyspnea and pleural pain, develop if the abscess extends through the diaphragm. Liver damage may cause jaundice.
A liver ultrasound may indicate defects caused by the abscess, but it’s less definitive than a liver scan. Relevant laboratory values include elevated serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin levels; increased white blood cell count; and decreased serum albumin levels. In pyogenic abscess, a blood culture can identify the bacterial agent; in amebic abscess, a stool culture and serologic and hemagglutination tests can assist in diagnosis.
If the organism causing the liver abscess is unknown, long-term antibiotic therapy begins immediately. When culture results are obtained, antibiotics are prescribed specific to treat the organism. Therapy usually continues for 2 to 4 months. Surgery is usually avoided, but it may be done for a single pyogenic abscess or for an amebic abscess that fails to respond to antibiotics. In acutely toxic patients, percutaneous needle aspiration and decompression may be needed to remove the abscess.
❑ Provide supportive care, monitor the patient’s vital signs (especially temperature), and maintain fluid and nutritional intake.
❑ Administer anti-infectives and antibiotics as ordered, and watch for possible adverse effects. Stress the importance of compliance with therapy.
❑ Explain diagnostic and surgical procedures.
❑ Watch carefully for complications of abdominal surgery, such as hemorrhage or sepsis.
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Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
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