Bacterial liver abscess – causes, symptoms, treatment

The cause of many abscesses, especially those resulting from systemic infection (sepsis) resulting from changes in the abdominal organs or bile ducts, is a mixed bacterial flora. The main pathogens are: colon, staphylococcus aureus, faecal streptococcus, intestinal bacteria. The number and size of abscesses may vary.

What is a bacterial liver abscess?

A bacterial liver abscess is a condition that is caused by a bacterial infection. Abscesses can attack singly or multiple times. The main causes of the disease include: faecal streptococcus, golden staphylococcus, colitis and intestinal bacteria. Patients usually develop high fever, chills and sweating. Bacterial infection occurs through the ascending route from the biliary tract, through the portal route or through the hepatic artery, from the surrounding organs, as a result of trauma, and for an unknown cause. Mortality in this disease in developed countries (according to statistics) ranges from 2 to 12 percent. The prognosis depends largely on whether other diseases are coexisting and the patient’s response to treatment.

What factors contribute to the appearance of a bacterial liver abscess?

Among the indirect factors that may increase the risk of the disease are:

1. liver problems,
2. diabetes
3. pancreatic diseases,
4. procedures performed in the abdominal area,
5. liver transplant performed,
6. biliary tract infection,
7. less commonly, a blood infection or liver surgery.

Direct causes of bacterial liver abscess

A bacterial liver abscess causes infection with the following bacteria:

1. staphylococci:S. aureus, S. pyogenes and others, less frequent Gram-positive bacteria;
2. Klebsiella pneumoniae;
3. yeasts;
4. mycobacteria of tuberculosis;
5. streptococci: Streptococcus milleri, S. anginosus;
6. if you are traveling to Southeast Asia or Australia:Burkholderia pseudomallei;
7. amoebiasis.

Bacterial liver abscess – symptoms

Symptoms of a bacterial liver abscess are initially non-specific, with nausea, weight loss, epigastric discomfort. Then there is a high fever, jaundice that is rarely seen. In addition, there are high levels of inflammation in the blood, and elevated liver tests. The patient may also develop:

1. reluctance to eat (anorexia),
2. a feeling of fullness in the belly,
3. vomiting,
4. lack of energy,
5. feeling of constant fatigue,
6. discoloration of the skin yellow.

Diagnosis of a bacterial liver abscess

A bacterial liver abscess gives non-specific symptoms, therefore, in combination with an appropriate medical history, the doctor can quickly make a diagnosis. First, a physical examination is performed, during which the doctor is able to recognize an enlarged liver. Also, on the basis of observations, it can be determined whether the patient has jaundice (eyes and skin are yellowed). In addition, physical examination reveals increased heart rate and skin moistness.

Then, to diagnose the disease, your doctor may order basic blood tests that may show high levels of white blood cells (usually associated with a bacterial infection) and increased markers of inflammation (CRP, acute phase protein). In addition, a number of other additional tests are recommended, including:

1. blood culture – thanks to this test in half of the cases it is possible to detect the bacteria that caused the liver abscess. The material for examination is collected by pricking the abscess through the abdominal wall and then removing fluid from its inside. If the patient was previously drained – it is not recommended to collect a sample from the abscess;
2. chest X-ray – on x-rays of the lungs it is possible to see a raised diaphragm, which indicates an enlargement of the liver;
3. ultrasound and computed tomography – these two tests reveal the fluid space in the liver and the swelling. During ultrasound, it is also possible to distinguish a liver abscess from other nodules or cysts;
4. other laboratory tests – liver enzymes (abscess damages liver cells), bilirubin levels.

How To Treat A Liver Abscess?

Treatment depends on the cause that caused the bacterial liver abscess. Before the bacteriological test result is obtained, the doctor prescribes antibiotics that have a broad spectrum of activity and are effective against bacteria that can cause the disease. Antibiotics are usually administered intravenously. After receiving the test results, the doctor selects antibiotic therapy individually for the patient, which is based on the received indications regarding the bacteria found in the fluid. In some patients, drainage is assumed (especially if the liver abscess is very large). A drain is a special tube that drains the fluid inside the abscess out of the body. This is a type of surgery that is performed under the guidance of ultrasound or computed tomography. There are several ways to insert drainage, for example by surgery or by needle aspiration of purulent contents. The first one involves surgical removal of the abscess, requires general anesthesia and is used when multiple abscesses are present. The second method is used in the case of single abscesses not exceeding 5 cm.

Other ways to perform drainage:

1. insertion of a drainage catheter – the procedure is performed when the patient has large changes. Drainage can be left for a few days – until less and less fluid is released;
2. endoscopic decompression of a liver abscess – the doctor uses a small endoscope to penetrate the intestine into the biliary tract. This type of drainage is used in patients who undergo biliary procedures.