Liver Abscess: Causes, Symptoms and Treatment [Full Explanation]

A liver abscess is a condition when there is a buildup of pus in the tissues of the liver organs caused by an infection. Liver abscesses generally occur due to fungal, bacterial, or amoeba infections, but several other factors can also increase risk (diabetics, crohn’s disease, liver cirrhosis, and often consume undercooked foods).

Symptoms of liver abscesses can be fever, abdominal pain, yellow-looking body and sclera, nausea vomiting, dark urine and pale stools. The diagnosis of liver abscess is established by a doctor’s examination and is supported by ultrasound / CT scan of liver organs and laboratory examinations such as liver function, blood culture, abscess culture and a complete blood test.

Symptoms of liver abscesses can be fever, abdominal pain, yellow-looking body and sclera, nausea vomiting, dark urine and pale stools. The diagnosis of liver abscess is established by a doctor’s examination and is supported by ultrasound / CT scan of liver organs and laboratory examinations such as liver function, blood culture, abscess culture and a complete blood test.

The main treatment of liver abscesses is the administration of antibiotics as prescribed by a doctor. Under certain conditions surgery is required for the removal of pus fluid in the liver. The course of liver abscess disease can spread into complications including empirics, endocarditis, sepsis, abscess rupture, as well as heart failure.

The condition of liver abscesses can certainly be prevented by avoiding alcohol and drugs that are not as prescribed by a doctor, carrying out a healthy diet and maintaining self-hygiene 

What is a Liver Abscess?

Liver abscess is a condition when there is a buildup of pus/pus in the liver tissue caused by infection ^{[1,2,3,4,5,6]}.

In the case of liver abscess, the accumulation of pus occurs in the pouch of the liver where this pus is a fluid consisting of dead cells and white blood cells whose formation occurs due to the body’s process of fighting infection.

Liver abscess is generally characterized by inflammation and swelling in the area around the liver tissue so that the abdomen will appear larger and feel painful.

If not treated quickly, the condition of a liver abscess can be life-threatening for the sufferer.

Overview.
A liver abscess is the accumulation of pus in the liver tissue where the main cause is often an infection. Liver abscesses are often characterized by inflammation and swelling in the area of the liver and abdominal tissues.

Facts About Liver Abscess

1. There are about 2.3 cases of liver abscess per 100,000 people globally where men are much more likely to experience it than women ^[1].
2. liver abscess Klebsiella is the most common type of liver abscess in Asia and people with diabetes who are unable to control the disease are at the highest risk of developing a liver abscess. ^[2].
3. Liver abscess due to amoebic infection is known to be much more common in men with a 7-10 higher risk than women whereas amoebic liver abscess is also more common in South America, Central America, Mexico, Africa and India. ^[2,3].
4. Prevalence of liver abscess by amoeba E. histolytica is about 10% and this condition is much more common in developing countries and tropical regions with conditions of low levels of hygiene, socioeconomic status and nutritional status. ^[3].
5. As many as 15% of people with diabetes mellitus have liver abscess ^[4].

Liver Abscess Differences with Other Similar Medical Conditions

Liver abscess is a condition that is often considered similar to other medical conditions that are also related to liver disorders although they are different, such as hydatidiform cysts and liver cancer.

Liver Abscess Vs. Hydatidiform cyst

Hydatidiform cyst or also known as cystic hydatidosis is an infection Echinococcus which can not only occur in the liver ^[4].

Hydatidiform disease can cause cysts in the brain, kidneys, and lungs, to spread to other areas of the body.

Polycystic liver disease, liver cancer, and injury to the liver are known factors that commonly cause hydatidiform cysts.

Meanwhile, liver abscess is a condition when pus collects and can accumulate in the liver tissue due to a different infection from a cyst.

Liver Abscess Vs. Heart cancer

Liver cancer is a condition when cancer cells grow in the liver which then has the potential to spread to other organs of the body.

Cancer cells start from cells in the liver that undergo changes and then form tumors that develop into cancer.

Meanwhile, a liver abscess is when pus accumulates in the liver tissue (especially in the liver sac) which is usually caused by an amoebic, fungal, or bacterial infection.

Liver Abscess Causes

Anyone regardless of age and gender can develop a liver abscess because liver abscesses are generally caused by infection.

Infections can affect men and women, children to the elderly.

Liver abscess is a condition that occurs due to infection in the digestive system, stomach, and blood.

However, injuries from surgical procedures can also cause liver abscesses, as well as injuries involving the liver.

Infection as the main cause of liver abscess can be classified into three conditions according to the cause, namely: ^[1,2,3,5,6]:

• Fungus, especially the Candida sp.
• Amoeba, especially the Entamoeba histolytica. Liver abscess due to amoebic infection is the most common.
• Bacteria, especially the Klebsiella pneumoniae and Escherichia coli. Pyogenic liver abscess is the term used to describe liver abscess conditions caused by bacteria.

For the case of pyogenic liver abscesses, generally inflammatory diseases such as cholecystitis, diverculitis, and appendicitis are the main causes.

If the accumulation of pus is caused by insect parasites (amoeba), this condition is usually triggered by a very low level of cleanliness in certain areas.

Liver Abscess Risk Factors

It is also important to know a number of factors that can increase a person’s potential to experience a liver abscess, including: ^[1,2,5,6] :

• Use of certain medications, such as medications for the stomach.
• The immune system is low so it is easy to get infections.
• Suffer from liver cirrhosis.
• Suffering from diabetes mellitus.
• gender factor; the average patient with liver abscess is male, but it is possible for women to suffer from this disease as well.
• Age factor; although liver abscess can occur in anyone and regardless of age, the elderly aged 60 years and over have a greater risk.
• Consuming food or drink with unsafe hygiene.
• Consuming undercooked processed foods or eating raw foods that are prone to bacteria, amoeba or fungi.
• Babies with umbilical cord infection (usually caused by improper care).
• Has Crohn’s disease.
• Alco**hol addiction.
• Have a poor nutritional condition.
• Visiting a place or area where an amoeba infection outbreak is occurring.

Overview 
Liver abscess generally occurs due to fungal, bacterial, or amoeba infections, but several other factors can also be a risk increase (gender, age, poor nutritional conditions, certain diseases, consumption of raw/undercooked foods, to weak immune system).

Symptoms of Liver Abscess

Liver abscess causes symptoms that are uncertain and vary in each sufferer.

However, in general, these are the symptoms that occur and need to be watched out for: ^[1,2,5,6] :

• Fever
• Diarrhea
• Body shivering
• Stool or stools that are clay-colored
• Pain in the upper abdomen
• Dark urine when urinating
• Cough
• Jaundice (condition when the whites of the eyes and skin turn yellowish)
• Weight loss for no apparent reason
• The body sweats more than normal
• Nausea which can sometimes be accompanied by vomiting
• Body tired
• Appetite has dropped drastically
• Pain in the joints
• When you breathe, your chest hurts

When should you see a doctor?

Liver abscess can endanger the condition of the sufferer, so when some of the following complaints occur, it is better to immediately consult a doctor.

• Tachycardia or a faster heart rate.
• Throws up
• The pain is more intense and persistent.
• Breathing problems, such as shortness of breath, choking or wheezing.
• The body experiences extreme fatigue.
• High fever.
• Experiencing hallucinations and delusions.
• Experiencing confusion.

Overview 
The main symptoms commonly experienced by people with liver abscesses include fever, diarrhea, cough, joint pain, lost appetite, weight loss, jaundice, dark urine, nausea, and excessive sweating.

Liver Abscess Examination

To detect whether the symptoms experienced by the patient lead to a liver abscess, the following examination methods are applied by doctors in general: ^[1,2,3].

• Physical Examination and Medical History

The doctor will first perform a physical examination which is also followed by an interview procedure with the patient asking the patient’s medical history and the patient’s family.

A physical examination is generally carried out with the aim that the doctor is able to rule out other diseases whose symptoms resemble those of a liver abscess.

This is because some of the symptoms of liver abscesses are quite similar to other conditions such as inflammation of gallstones, pleural effusion, cysts, and acute gastritis.

Scan or imaging examination is a form of follow-up examination carried out by a doctor to obtain an accurate diagnosis.

The imaging tests that doctors recommend for patients can be in the form of CT scans, ultrasounds, X-rays, drainage of percutaneous catheters, or aspiration of percutaneous needles.

In addition, doctors may also ask patients to take laboratory tests for clear and detailed diagnostic results.

Laboratory tests here usually include abscess fluid cultures, blood cultures, complete blood tests, and liver function test.

Overview
The examination method that is commonly used by doctors to detect liver abscesses is a physical examination as well as a medical history, followed by laboratory tests (liver function tests, blood culture tests, abscess fluid cultures and/or complete blood tests), as well as scanning tests.

Treatment For Liver Abscess

Liver abscess is generally treated through two methods, namely prescribing drugs by doctors and surgical procedures.

Because most liver abscesses are caused by a bacterial infection, a doctor’s prescription of antibiotics can usually help treat it ^[1,2,4,5,6].

Likewise, the condition of liver abscess due to amoebic infection, antibiotics can handle it.

However, for amoebic liver abscess, when the infection has disappeared thanks to antibiotics, other types of drugs will be given so that the remaining amoeba in the digestive tract can be completely eradicated.

Various types of antibiotics are known to be effective in treating liver abscesses, such as metronidazole, aminoglycosides, clindamycin, and also the tazobactam-piperacillin combination.

However, these antibiotics are only recommended for patients to use according to a doctor’s prescription because doctors prescribe them based on the cause of the abscess and its severity.

The surgical procedure intended to treat a liver abscess is the suction of pus from the affected liver ^{[1,2,3,4,5,6]}.

This pus removal surgery on average needs to be taken by the patient which is also referred to as drainage.

Even when the abscess fluid needs to be removed surgically, after that the doctor usually feels the need to continue to give the patient antibiotics.

However, in patients who cannot or do not allow surgical procedures, doctors will usually only prescribe antibiotics.

Overview 
Treatment of liver abscess is carried out generally by the administration of antibiotic drugs (as a solution to infection) and surgical procedures (drainage) or removal of abscess fluid from the patient's body.

Complications of Liver Abscess

Liver abscess that does not get treatment or has been treated but with inappropriate treatment, the condition can get more serious.

Some of the following complications can occur and some even lead to death. Here are the types of complicated conditions to watch out for: ^[1,5,6] :

• Ruptured abscess or a condition when a pocket of pus bursts.
• Empyemia is a condition in which pus accumulates more in the space between the chest wall and the lungs.
• Endophthalmitis or a severe inflammatory condition that occurs on the inside of the eyeball where this can occur as a result of infection.
• Endocarditis is an infection in the inner lining of the heart called the endocardium. This is the result of a bacterial infection in which bacteria enter the bloodstream and infect the heart that has already been damaged.
• Pleural effusion or fluid that builds up in the lining of the pleura (the membrane that separates the inner chest wall and the lungs).
• Heart failure
• Sepsis or the impact of the spread of infection throughout the body so that inflammation occurs and has the potential to result in death in the sufferer.

Liver Abscess Prevention

Liver abscess can be prevented by preventing the body from getting infected. Some important efforts that can be done include: ^[5] :

• Avoiding illegal drugs and certain drugs without a prescription.
• Avoid medicines for diet or herbal medicines that do not have a distribution permit from FDA.
• Regulate a healthy and regular diet, including having good living habits so that the immune system remains strong and is not susceptible to infection.
• Keep the environment and yourself clean.
• Patients with certain conditions need to immediately check themselves and treat these conditions in order to minimize the risk of liver abscess.

Overview
Prevention of liver abscesses can be done by keeping the body from being easily exposed to infections, namely maintaining personal and environmental hygiene, regulating a healthy lifestyle properly, avoiding illegal drugs, as well as drugs that are not guaranteed safety. - If you have a certain medical condition, immediately check yourself and handle it so that it does not have the potential to cause a liver abscess.