Pyogenic Hepatic Abscesses Clinical Presentation

Updated: Jul 22, 2016
  • Author: Todd A Nickloes, DO, FACOS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Presentation

History

The clinical presentation of liver abscess is insidious; many patients have symptoms for weeks before presentation. Fever and right-upper-quadrant (RUQ) pain are the most common complaints. Pain is reported in as many as 80% of patients and may be associated with pleuritic chest pain or right shoulder pain. Symptoms are often misdiagnosed as acute cholecystitis. Fever occurs in 87-100% of patients and is usually associated with chills and malaise. [9, 21]  Anorexia, weight loss, and mental confusion are also common symptoms.

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Physical Examination

Physical examination findings are most notable for RUQ tenderness. Hepatomegaly, liver mass, and jaundice are also common. Occasionally, patients may present with rales, pleural effusion, friction rub, or pulmonary consolidation. Rarely, patients are admitted with sepsis and peritonitis from intraperitoneal rupture of the abscess. The signs and symptoms of pyogenic liver abscess are sumarized in Table 1 below.

Table 1. Symptoms and Signs of Pyogenic Liver Abscess [9, 21] (Open Table in a new window)

Symptoms Percentage Signs Percentage
Abdominal pain 89-100 Normal findings 38
Fever 67-100 Right-upper-quadrant tenderness 41-72
Chills 33-88 Hepatomegaly 51-92
Anorexia 38-80 Mass 17-18
Weight loss 25-68 Jaundice 23-43
Cough 11-28 Chest findings 11-48
Pleuritic chest pain 9-24
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Complications

The complications of pyogenic hepatic abscess result from rupture of the abscess into adjacent organs or body cavities. They may be broadly divided into pleuropulmonary and intra-abdominal types.

Pleuropulmonary complications are the most common and have been reported in 15-20% of early series. These include pleurisy and pleural effusion, empyema, and bronchohepatic fistula. [2]  Intra-abdominal complications are also common. They include subphrenic abscess and rupture into the peritoneal cavity, stomach, colon, vena cava, or kidney. A large abscess compressing the inferior vena cava and the hepatic veins may result in Budd-Chiari syndrome. Rupture into the pericardium or brain abscess from hematogenous spread is rare.

Pyogenic liver abscess has been associated with increased risk of acute kidney injury [22]  and acute pancreatitis. [23]

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