Liver Abscesses

Dr Tan Yu-Meng
Director, Consultant General Surgeon

What Is Liver Abscesses?

Liver abscesses are pus-filled masses in the liver, resulting from infections. These infections can be bacterial, fungal, or parasitic, often stemming from the abdomen, bloodstream, or bile-draining tubes. While once nearly always fatal, advances in medicine have significantly improved treatment outcomes.

Causes of Liver Abscesses

A variety of factors can cause liver abscesses:

  • Bacterial Infection: Bacterial infections are the most common cause of liver abscesses. These infections can reach the liver through the bloodstream, from the bile-draining tubes, or direct extension from nearby organs.
  • Parasitic Infection: Parasites, particularly Entamoeba histolytica and Echinococcus species, can also lead to liver abscess formation. These infections are more common in areas with poor sanitation and are often associated with travel to endemic regions.
  • Fungal Infection: Fungal liver abscesses are less common and usually occur in individuals with weakened immune systems, such as those with HIV/AIDS or cancer, or people taking immunosuppressive drugs.
  • Biliary Tract Diseases: Conditions that affect the bile ducts, such as cholangitis or bile duct obstruction, can lead to the development of liver abscesses. These conditions disrupt the normal flow of bile, creating an environment conducive to bacterial growth.
  • Trauma or Intervention: Direct injury to the liver, surgical procedures, or medical interventions such as liver biopsy can introduce infections leading to abscess formation.

Symptoms

The symptoms of liver abscesses can vary widely, ranging from mild to severe, and may develop quickly or over a longer period. Key symptoms include:

Abdominal Pain

Sharp and intense pain in the upper right quadrant of the abdomen, which may radiate to the shoulder and back.

Fever and Chills

A high fever, often accompanied by chills.

Jaundice

Yellowing of the skin and the whites of the eyes.

Gastrointestinal Symptoms

Nausea, vomiting, and loss of appetite.

Malaise and Weakness

General feelings of illness, malaise, and weakness.

Diagnosis

Diagnosing liver abscesses involves a combination of clinical assessment, laboratory tests, and imaging studies to confirm the presence of an abscess and identify its underlying cause. The diagnostic process usually includes:

A thorough medical history and physical examination to look for symptoms such as fever, abdominal pain, jaundice, and a tender liver.

Blood tests are used to detect signs of infection, including elevated white blood cell count, and to assess liver function.

Ultrasounds, Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) may be used for the diagnosis, to guide treatment.

Non-Surgical Treatment Options

Treatment of liver abscesses is aimed at eradicating the infection, draining the abscess, and addressing any underlying causes.

Antibiotic Therapy

The administration of broad-spectrum antibiotics helps combat the infection. This approach may be adjusted based on the results of blood cultures or analysis of abscess fluid, targeting the specific infectious agent.

Percutaneous Drainage

For abscesses that do not resolve with antibiotics alone, or when the abscess is large, percutaneous drainage may be performed. This procedure involves the insertion of a needle or catheter into the abscess under ultrasound or CT guidance to drain the pus.

Surgical Treatment Options

Surgical Drainage

Surgical drainage may be required in cases where the abscess is not accessible by percutaneous drainage, or when there are multiple abscesses. This involves opening the abscess cavity, draining the pus, and removing any necrotic tissue.

Addressing Underlying Conditions

An essential part of managing liver abscesses is treating any underlying conditions that may have contributed to their development. This could involve surgical intervention to remove bile duct obstructions, repair damaged areas, or address other contributing factors.

The choice between non-surgical and surgical treatment options is influenced by the size and location of the abscess, the causative organism and the patient’s response to initial treatments.

Complications

Sepsis

One of the most severe complications is sepsis, a life-threatening response to infection that can lead to tissue damage, organ failure, and death. Sepsis occurs when the infection spreads beyond the liver into the bloodstream.

Rupture of the Abscess

The abscess can rupture, leading to the spread of infection within the abdominal cavity or into the chest cavity, causing pleural effusion or empyema.

Liver Failure

In severe cases, the infection and inflammation associated with liver abscesses can impair liver function, leading to liver failure.

Spread to Other Organs

The infection can spread to other organs, such as the lungs, brain, or kidneys, leading to additional health complications.

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Dr Tan Yu-Meng

Director, Consultant General Surgeon

Dr Tan continues to be one of few surgeons in Asia who perform specialized surgery for peritoneal malignancies in Asia.

  • MBBS (Bachelor of Medicine & Surgery, First Class Honors & Distinction at the University of London) 1994
  • RCSEd (Fellow of the Royal College of Surgeons Edinburgh) 1999
  • Further training in advanced HPB surgery and liver transplantation at the world renowned Liver Unit of Queen Elizabeth Hospital in Birmingham, United Kingdom.
  • Further training in living donor liver transplantation in Japan.

With his interest in gastrointestinal and hepatobiliary-pancreatic (GI-HPB) surgery and the treatment of cancer, Dr Tan joined the department of surgical oncology at the National Cancer Centre in 2003 as a consultant.

Dr Tan’s interest in the management of peritoneal surface malignancies was part of his effort in leading a multidisciplinary team from NCC to Washington Cancer Institute to adopt the techniques and protocols of peritonectomy and HIPEC (Sugarbaker procedure) from Dr Paul Sugarbaker in 2009.

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    Liver Abscesses Treatment In Singapore

    Frequently Asked
    Questions

    What are the early signs of a liver abscess?

    Early signs of a liver abscess can include fever, chills, upper right abdominal pain, jaundice, nausea, and general malaise. Recognising these symptoms early is important for timely diagnosis and treatment.

    How long does it take to recover from a liver abscess?

    The recovery time can vary widely depending on the size and cause of the abscess, the treatment method, and the patient’s overall health. With appropriate treatment, patients can start to feel better within a few days, but complete recovery and the course of antibiotic treatment may take several weeks.

    Can liver abscesses recur?

    While most people recover fully from liver abscesses, they can recur, especially if underlying conditions such as biliary tract diseases or immunocompromised states are not adequately managed.

    Are liver abscesses contagious?

    Liver abscesses themselves are not contagious, but the infections that cause them, such as bacterial or parasitic infections, can be spread from person to person in certain conditions.