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Pyogenic Liver Abscess

Bacterial Liver Abscess


Presentation

  • Here we present a case of pyogenic liver abscess caused by S anginosus in an adolescent presenting with fever, nausea, emesis, and right upper quadrant abdominal discomfort.[ncbi.nlm.nih.gov]
Fever
  • Patients with pyogenic liver abscesses often present to the emergency department with fever of unknown origin.[ncbi.nlm.nih.gov]
  • Fever Lethargy Discomfort in right upper quadrant of abdomen Anorexia Enlarged and tender liver Pleural effusion Fever Abdominal discomfort Enlarged liver Biliary disease (most common)E.g.: stones, cholangiocarcinoma Colonic diseaseE.g.: diverticulitis[en.wikipedia.org]
Pseudotumor
  • Two patients were subjected to biopsies showing features of inflammatory pseudotumor before a diagnosis of hepatocellular carcinoma. One patient underwent hepatic resection with good results.[ncbi.nlm.nih.gov]
Productive Cough
  • We report a rare case of a patient (with a chronic, recurrent hepatic abscess) who suffered a persistent, productive cough resulting from a hepatobronchial fistula.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Their most common symptoms were fever and abdominal pain. Eight (53.0%) had leukocytosis ( 15000/μL) and elevated C-reactive protein (CRP) level ( 10 mg/dL).[ncbi.nlm.nih.gov]
Bilious Vomiting
  • During hospital stay he developed intermittent large quantity bilious vomiting. Gastroduodenoscopy and contrast-enhanced CT of the abdomen showed rupture of left lobe liver abscess into the stomach.[ncbi.nlm.nih.gov]
Jaundice
  • Compared with the survivor group, patients in the mortality group were characterized by male gender (p 0.001), malignancy (p 0.001), respiratory distress (p 0.007), low blood pressure (p 0.024), jaundice (p 0.001), rupture of liver abscess (p 0.001),[ncbi.nlm.nih.gov]
  • Chest pain (lower right) Pain in the right upper abdomen (more common) or throughout the abdomen (less common) Clay-colored stools Dark urine Fever, chills, nightsweats Loss of appetite Nausea, vomiting Unintentional weight loss Weakness Yellow skin ( jaundice[nlm.nih.gov]
  • Main clinical manifestations included fever, chills, right-upper-quadrant pain, malaise, anorexia, jaundice, and hepatomegaly.[hepatitiscentral.com]
Hepatomegaly
  • Patients presenting with abdominal pain, hepatomegaly, and ascites should be carefully evaluated from this point of view.[ncbi.nlm.nih.gov]
  • Main clinical manifestations included fever, chills, right-upper-quadrant pain, malaise, anorexia, jaundice, and hepatomegaly.[hepatitiscentral.com]
  • On examination patient had tachycardia and tender hepatomegaly. Laboratory data showed increased leukocyte count (26,800/μL) with normal liver and kidney function tests.[austinpublishinggroup.com]
Hepatic Mass
  • It also contains a denser network of biliary canaliculi and, overall, accounts for more hepatic mass[4,12,13].[ghrnet.org]
Back Pain
  • A 14-year-old otherwise healthy boy presented with right-sided back pain following high fever. Abdominal computed tomography scan showed a large liver abscess.[ncbi.nlm.nih.gov]
Lethargy
  • Fever Lethargy Discomfort in right upper quadrant of abdomen Anorexia Enlarged and tender liver Pleural effusion Fever Abdominal discomfort Enlarged liver Biliary disease (most common)E.g.: stones, cholangiocarcinoma Colonic diseaseE.g.: diverticulitis[en.wikipedia.org]

Workup

Pericardial Effusion
  • Computed tomography of the chest and abdomen showed huge liver abscess without full liquefaction in the left lobe, large amount of left pleural effusion, and mild pericardial effusion, and the patient was treated with parenteral antibiotics and pigtail[ncbi.nlm.nih.gov]
Left Pleural Effusion
  • Computed tomography of the chest and abdomen showed huge liver abscess without full liquefaction in the left lobe, large amount of left pleural effusion, and mild pericardial effusion, and the patient was treated with parenteral antibiotics and pigtail[ncbi.nlm.nih.gov]
Streptococcus Bovis
  • Streptococcus bovis bacteremia has been linked to the presence of occult colon cancer since 1977.[ncbi.nlm.nih.gov]

Treatment

  • We report an unusual case of a ruptured GFPLA without surgical management, treated successfully with only medical treatment.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSIONS: The prognosis of PLA appears to be dependent on underlying pathologies and severity of condition. More aggressive treatment should be considered if a poor prognosis is expected.[ncbi.nlm.nih.gov]
  • The prognosis was dismal, with a mean survival of 3.5 months (range, 8 days to 6 months). PMID: 9597257, UI: 98259545[hepatitiscentral.com]

Etiology

  • We report two cases of pyogenic liver abscess without hepatobiliary disease or other obvious etiologies except that one had a history of diabetes mellitus (DM). The pathogen in the patient with DM was Klebsiella pneumonia (KP).[ncbi.nlm.nih.gov]

Epidemiology

  • BACKGROUND: The epidemiology of pyogenic liver abscess continues to change and the issue of antimicrobial therapy is controversial. This study investigated the epidemiology and clinical outcomes of antimicrobial therapy.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Singh V, Bhalla A, Sharma N, et al ; Pathophysiology of jaundice in amoebic liver abscess. Am J Trop Med Hyg. 2008 Apr78(4):556-9.[patient.info]
  • In 1938, Ochsner and Debakey published the largest series of pyogenic and amebic liver abscesses in the literature. [2] Since the late 20th century, percutaneous drainage has become a useful therapeutic option. [3, 4, 5, 6, 7] Pathophysiology Pyogenic[emedicine.medscape.com]

Prevention

  • Early surgical treatment may have prevented progression of the pericarditis to the more dismal purulent pericarditis. We also review pertinent English literature on pericarditis as a complication of PLA.[ncbi.nlm.nih.gov]

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