🩺 Liver Abscess = a pus-filled cavity in the liver parenchyma. ⚡ Pathophysiology: hepatocyte injury → local inflammation → neutrophilic infiltration → liquefaction → abscess formation. Remember: Klebsiella pneumoniae abscesses may disseminate to the eye causing endophthalmitis 👁️.

📖 About

Pus-filled lesion(s) within liver tissue; usually right lobe due to portal venous drainage patterns.
⚠️ Differentials: metastases, simple cysts, hepatocellular carcinoma.

🦠 Aetiology

🧫 Pyogenic (bacterial) – polymicrobial: E. coli, Klebsiella, Streptococcus, Staphylococcus; often secondary to cholangitis, cholecystitis, diverticulitis, appendicitis, trauma.
🪱 Amoebic – Entamoeba histolytica; more common in endemic areas.
🍄 Fungal – Candida spp.; immunocompromised patients.
🐕 Echinococcus – hydatid cysts; risk of anaphylaxis on rupture.

📌 Causes, Features, Diagnosis & Treatment

Cause	Clinical Features	Diagnosis	Initial Treatment (UK, NICE-aligned)
Pyogenic	Fever, rigors, RUQ pain ± shoulder tip pain, jaundice, hepatomegaly, malaise, weight loss	USS/CT, blood cultures, aspiration & microbiology	IV broad-spectrum antibiotics (adjust per culture), image-guided drainage; surgery if refractory
Amoebic	Gradual fever, RUQ pain, ± diarrhoea, weight loss	USS (often single right lobe), serology (anti-amoebic IgG), aspiration if diagnosis unclear	Metronidazole → luminal agent (e.g., diloxanide furoate); drain only if large/persistent
Fungal	Fever, RUQ pain, weight loss; immunocompromised	CT (multiple abscesses), blood culture, biopsy	Systemic antifungals (amphotericin B, fluconazole); drainage if large
Echinococcus	Often asymptomatic; cyst rupture → anaphylaxis, urticaria, shock	USS/CT, serology (ELISA, WB), PCR if difficult	Surgical resection if feasible; otherwise PAIR (puncture, aspiration, injection ethanol, re-aspiration) + albendazole

🧑‍⚕️ Clinical Features

🌡️ Fever, chills, sweats, malaise
🤢 Anorexia, weight loss
RUQ tenderness, hepatomegaly
Right shoulder or pleuritic chest pain, hiccups
⚠️ Hydatid cyst rupture → urticaria, angioedema, anaphylaxis

🔍 Differentials

Hepatocellular carcinoma or liver metastases
Simple liver cysts, polycystic liver disease

⚠️ Complications

Sepsis ± septic shock
Empyema/peritonitis if rupture
Endophthalmitis (especially Klebsiella)

🧪 Investigations

📊 Bloods: ↑ WCC, ↑ ALP (95%), ± ↑ AST/ALT, low albumin
🧾 Coagulation: PT/INR
🩸 Blood cultures (aerobic & anaerobic)
🖼 Imaging: USS/CT (right lobe common)
🪱 Entamoeba: stool microscopy (low yield), serology (EIA/PCR)
🐕 Echinococcus: serology (ELISA/WB), PCR if needed

💊 Management (UK, NICE-aligned)

🛡️ Stabilisation: ABC, IV fluids, analgesia
🧫 IV broad-spectrum antibiotics → adjust per culture & sensitivities
🩺 Image-guided drainage (needle/catheter)
🪱 Amoebic abscess: Metronidazole → luminal agent (diloxanide)
🍄 Fungal: Amphotericin B / azole antifungals; drainage if large
🐕 Echinococcus: surgical resection if feasible; otherwise PAIR + albendazole

💡 Teaching tip: Always consider source of infection (biliary, portal, systemic), assess for immunosuppression, and monitor for sepsis. Early imaging and culture-guided therapy improve outcomes. Referral to hepatology or infectious disease recommended for complex cases.

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Liver abscess ✅