Pyogenic liver abscess: Pus in the liver, often due to infection

A pyogenic liver abscess is the medical term for a pus-formed space in the liver. This rare condition has several causes, such as an infection or blood poisoning. The presence of the liver abscess causes mild to severe symptoms, mainly abdominal complaints. Various imaging studies are necessary to locate the abscess. Treatment usually consists of antibiotics in combination with draining the liver abscess. Rapid diagnosis and treatment are important for this condition because otherwise the condition has a poor outlook.

  • Causes of pus in liver: Often an infection
  • Symptoms
  • Diagnosis and examinations
  • Treatment via drainage and antibiotics
  • Prognosis condition
  • Complications of pyogenic liver abscess

Causes of pus in liver: Often an infection

In the elderly, bile duct sepsis (blood poisoning) is a common cause of a pyogenic abscess. Other causes include trauma that has damaged the liver, bacteremia, a perforated intestine, pancreatic cancer (tumor in the pancreas with symptoms of jaundice and abdominal pain), colon cancer, diverticulitis (inflammation of the bulging sacs on the intestinal wall) or appendicitis. The body responds to these medical causes by forming an abscess in the liver. Usually the organism Escherichia coli is located in the abscess. Streptococcus milleri and anaerobic organisms such as Bacteroides are also commonly present. Occasionally Enterococcus faecalis, Proteus vulgaris and Staphylococcus aureus (staphylococcal bacteria) can be found. Often the infection is mixed and therefore more than one type of bacteria is present. Diabetics are a risk group for a pyogenic liver abscess because patients with diabetes are susceptible to infections.


These rare abscesses occur isolated or in multiple numbers. Some patients are not acutely ill. They present with malaise (a general ill feeling) and weakness lasting several days or even months. Others present with fever, chills, anorexia (a loss of appetite), vomiting, nausea, unintentional weight loss, pain in the right upper abdomen (common) or the entire abdomen (less common), chest pain (lower right), dark colored urine, clay-colored stools and jaundice (icterus). Less commonly, the following symptoms are possible: coughing, hiccups, or pain in the shoulder due to irritation of the diaphragm.

Diagnosis and examinations

Physical examination

During a physical examination, the doctor detects few symptoms. Occasionally a patient presents with symptoms of fever of unknown origin and jaundice. In these patients, the liver feels tender and is enlarged (hepatomegaly). These patients also have signs of a pleural effusion (fluid accumulation between the pleura and the pleura) or pleural friction in the lower right side of the chest.

Diagnostic research

The doctor performs a blood test. In addition, imaging results are needed. An abdominal ultrasound is useful for detecting abscesses. An abdominal CT scan is valuable in detecting complex and multiple lesions. The doctor also takes an X-ray of the chest (chest X-ray), which shows abnormalities in severe cases. A liver biopsy is also sometimes required, where the doctor removes some tissue and then examines it microscopically. Depending on age, an imaging examination of the colon (colonoscopy) may be necessary to find the source of the infection.

Treatment via drainage and antibiotics

During an ultrasound or sometimes during a surgical procedure, the doctor tries to drain the abscess (drain pus). For this he uses a needle or tube which he then inserts into the abscess to drain the pus. The patient also receives a course of antibiotics for four to six weeks. In addition, the doctor treats any underlying cause of a pyogenic abscess.

Prognosis condition

This condition is potentially life-threatening. Overall mortality depends on the nature of the underlying pathology and is reduced to approximately 16% by needle aspiration and the use of antibiotics. The presence of multiple abscesses poses a greater risk of death. Only one in five patients with multiple liver abscesses survives this condition.

Complications of pyogenic liver abscess

Due to a pyogenic liver abscess, the patient may develop life-threatening sepsis. Urgent antibiotic treatment is required to prevent death. When bacteria spread throughout the body, it can lead to a pulmonary embolism (blockage of an artery in the lungs), a brain abscess (collection of pus in the brain) or an inflammation of the lining of the eye (endophthalmitis).

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Pyogenic liver abscess: Pus in the liver, often due to infection
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