Liver Abscess

GENERAL INFORMATION:

What is a liver abscess?

• A liver abscess (AB-ses) is a collection of pus in the liver caused by bacteria, fungi, or parasites. It may occur as a single lesion or as multiple lesions of different sizes. The abscess may contain thick, bad smelling pus or reddish-brown anchovy paste-like fluid with no odor.
  
  
• The liver is in the upper right side of the abdomen (stomach). It is located just below the right lung and behind the ribs. The liver does many things to help your body function well. It makes enzymes and bile that help digest food and removes harmful material from the blood. It stores and gives energy when you need it. The liver also cleans foreign things from the body, such as drugs, alcohol, and other chemicals. With treatment and care, your abscess may be cured and serious problems may be prevented.

What causes liver abscess?

• Bacteria: A liver abscess may be caused by different bacteria (germs). The bacteria may be from infections in another part of the body. These may include infections in the abdomen, heart, or mouth. The bacteria may reach the liver through the blood or bile ducts. The bile ducts are tubes where bile passes in and out of the liver. A liver abscess most often comes from infection of the bile ducts caused by gallstones, infections in the intestines, or appendicitis. Bacteria may also enter during a direct trauma to the liver or during procedures involving the liver.
  
  
• Parasite: An infection by a parasite (bug), most commonly by an ameba, may also cause a liver abscess. This infection, also called amebiasis, is common in overcrowded areas with poor sanitation. You can get this parasite by eating or drinking contaminated (dirty) food or water.
  
  
• Fungus: In very few cases, liver abscess may be caused by a fungus or other infectious organism. These are organisms which usually cause problems when the immune system becomes weak. The immune system is the part of your body that fights infection.

Who has a high risk of having a liver abscess? The following conditions and factors may make you more likely to develop a liver abscess:

• Activity: Traveling to places where amebiasis is common. Eating foods and drinking liquids that are sold in the street may further increase your risk.
  
  
• Age: Advanced age, particularly in people older than 70 years old.
  
  
• Health: Having a long-term disease, such as cancer, diabetes, tuberculosis, or syphilis, or had surgery to remove the spleen. Having a weak immune system, such as organ transplant or AIDS patients. Taking steroids, chemotherapy, or anti-rejection medicines.
  
  
• Lifestyle: Drinking too much alcohol, too often. Alcohol is found in beer, wine, liquor (such as vodka or whiskey), and other adult drinks.
  
  
• Nutrition: Being malnourished (having poor nutrition).

What are the signs and symptoms of liver abscess? You may have any of the following:

• Abdominal pain, mostly in the upper right part of the abdomen just below the ribs.
  
  
• Cough or trouble breathing.
  
  
• Feeling more tired and weak than usual.
  
  
• Fever and night sweats.
  
  
• Losing weight without trying.
  
  
• Loss of appetite for food, nausea (upset stomach), or vomiting (throwing up).
  
  
• Yellowing of the skin or the whites of the eyes.

How is liver abscess diagnosed? Your caregiver will take a detailed health history from you, including diseases or procedures you may have had. This also includes information about your past travels or past residences if you just moved in. You may need any of the following tests:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Computerized tomography scan: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your abdomen, including your liver. You may be given dye through an IV before the pictures are taken so that your organs show clearly. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish or have other allergies or health problems.
  
  
• Liver scan: This is a test to look at your liver. You are given a small amount of dye in your IV. Pictures are then taken by a special scanner that can see the dye in your body. The dye soaks up more in abnormal areas of the liver.
  
  
• Magnetic resonance imaging test: This test is also called an MRI. It uses magnetic waves to look at the liver. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.
  
  
• Ultrasound: This is a test that uses sound waves to look inside of your body. Pictures are shown on a TV-like screen. Caregivers may do an abdominal ultrasound to see your liver and other organs in the abdomen. A doppler ultrasound study may be done to check for blood flow in your liver. Caregivers may be able to look for clots or other problems in the veins during this test.
  
  
• X-rays: X-rays of different parts of your body may be taken. These may include your abdomen (stomach) or chest (lungs and heart).

How is liver abscess treated? Your liver abscess may be treated with any of the following:

• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antifungal medicine: This medicine helps kill fungus that can cause illness.
    
    
  • Antiparasitic medicine: This medicine may be given to kill parasites. Parasites are living things that feed or eat off of other living things.
  
  
• Procedures:
  
  
  • Catheter drainage: Caregivers make an incision (cut) into your abdomen, over your liver. With an ultrasound or CT as guide, a catheter (tube) is inserted in the cut and into the abscess. Draining the abscess may clean out any pus in your abdomen. The incision will be closed with thread or staples. The catheter may be sutured (sewn) to the skin to prevent it from moving. The catheter may need to be flushed with a saline (salt-water) solution once in a while.
    
    
  • Needle aspiration: Caregivers may do a needle aspiration to suck the fluid out of the abscess. With an ultrasound or CT as guide, a needle is put through your skin over your liver and into the abscess. The fluid is removed and sent to the lab for tests.
    
    
  • Surgery: Surgery to open your abdomen may be done if other forms of treatment have failed. It may be done if the abscess is very large or if there are multiple abscesses. Caregivers may also do surgery to look for and correct problems inside your abdomen. This may include removing bile duct stones or cleaning pus if the abscess burst.

Where can I find more information? Liver abscess may be a life-changing disease for you and your family. Accepting that you have liver abscess may be hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Contact the following for more information:

• American College of Gastroenterology
  P.O. Box 342260
  Bethesda, MD 20827-2260
  Phone: 1-301-
  Web Address: http://www.acg.gi.org/
  

• American Liver Foundation
  75 Maiden Lane Suite 603
  New York, New York 10038
  Phone: 1-212-668-1000
  Phone: 1-800-465-4837
  Web Address: http://www.liverfoundation.org
  

• National Digestive Diseases Information Clearinghouse (NDDIC)
  2 Information Way
  Bethesda, MD 20892-3570
  Phone: 1-800-8915389
  Web Address: www.digestive.niddk.nih.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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