Pyogenic Liver Abscess: Causes, Symptoms, Treatment and Cost

Pyogenic liver abscess is a condition in which an accumulation of pus develops in the liver due to bacterial infection.

PLAs can be divided into four types depending on their origin:

• Amebic Liver Abscess: This type of abscess is caused by an infection from amoebas, usually found in contaminated food and water. These abscesses tend to be solitary and have a rounded shape with well defined walls and internal debris.
• Bacterial Liver Abscess: Bacterial infections are commonly associated with this type of abscess and they tend to form due to the spread of bacteria from the bile ducts or blood stream into the liver itself.
• Fungal Liver Abscess: This type of abscess is caused by a fungal infection most commonly Aspergillus species that spread through airborne spores directly into the liver parenchyma or through hematogenous spread around the body gaining access to the liver parenchyma through periodic circulation in veins that drain hepatic tissue back to heart (right sided heart).
• Parasitic Liver Abscess: These abscesses are usually found among people living in tropical areas where there is poor sanitation leading indirectly to increased incidents of parasitic infections throughout different parts of the body including the liver parenchyma.

• It is most commonly caused by a wide range of bacterial infections, including Salmonella, Streptococcus, E. Coli, and other anaerobic bacteria like Bacteroides and Fusobacterium.
• Other potential causes include viral infections (Hepatitis A, B and C), protozoan parasites (such as Entameba histolytica) and fungi (such as Candida).
• Risk factors for PLA include diabetes mellitus, alcohol abuse and biliary tract disorders.

• Abdominal Pain: Pain in the upper right part of the abdomen that may worsen after eating or when lying down.
• Fever & Chills: Uncontrolled shivering and heightened temperature associated with infection.
• Nausea & Vomiting: Uneasiness in the stomach that leads to expulsion of stomach contents through the mouth.
• Loss of Appetite: Reduced desire to eat and drink due to presence of symptoms associated with Pyogenic Liver Abscess.
• Jaundice: A liver infection that results in an excess of bilirubin being present in the circulation, which causes a yellow colouring of the skin and eye whites.
• Diarrhea & Constipation: In some cases, diarrhea and/or frequent stools interchanged with scanty hard stools can develop due to Pyogenic Liver Abscesses, especially if multiple abscesses are present in one's liver area or if perforation occurs, leading to leakage of pus or bile over a long period of time into one's digestive tract.

• Maintain good hygiene.
• Avoid contact with individuals who have hepatitis A & B.
• Utilize vaccinations against Haemophilus influenzae & Streptococcus pneumoniae.
• Consume a healthy diet and exercise regularly.
• Practice safe sex & get tested for sexually transmitted infections.
• Clean any wounds with antiseptic solutions and dressings properly.
• Refrain from using injectable drugs.

• Clinical Evaluation: Examining patient's symptoms and physical signs, such as abdominal tenderness, elevated temperature etc.
• Imaging Tests: Ultrasound and CT scan for precise diagnosis of the size and number of abscesses.
• Laboratory tests: Liver function tests and blood culture for identifying the cause and type of infection.
• Biopsy: Removal and examination of tissue sample from the affected area to further examine bacteria or parasites present in the area from within an arising abscess, if needed.

• Shock: Sepsis or infection can lead to a life-threatening drop in blood pressure, decrease in oxygen and pH, disruption of organs and failure of multiple organ systems.
• Peritonitis: Bacteria can spread to the peritoneum which lines the abdomen and cause inflammation leading to fever, nausea, vomiting and abdominal pain.
• Bacteremia: Bacteria within an abscess may enter the bloodstream, leading to bacteremia (bacteria in the blood).
• Diabetes Mellitus: This condition occurs as a result of chronic pancreatic abscess where scarring causes damage to pancreatic cells that help regulate blood glucose levels.
• Amoebiasis: In some cases bacteria from a liver abscess can spread through the intestinal wall into other organs potentially causing amoebiasis (amoeba infections).
• Disseminated Intravascular Coagulation (DIC): Invasive bacteria may stimulate an excessive clotting response within our small vessels which can lead to further complications such as bleeding or organ failure.

• Take herbal supplements such as Gotu Kola, Amalaki, and Turmeric to reduce inflammation.
• Drink warm water with lemon juice daily to help detoxify the liver.
• Consume medicinal herbs like Guduchi, Kutki and Kalmegh to help improve liver functioning.
• Consume bitter herbs such as neem and turmeric that can help reduce fever associated with the abscesses.

• Eat a diet rich in fiber and proteins to help maintain good nutrition.
• Foods like fruits, vegetables, healthy grains, low-fat milk products, and lean meats should be included.
• Increase intake of vitamin A & D containing fruits & vegetables (carrots, mangoes etc).
• Drink plenty of fluids to stay hydrated and follow the doctor's advice for any other dietary changes if necessary.

• Avoid fried or fatty foods: Eating deep-fried or greasy foods can increase the risk of infection, worsen symptoms, and aggravate an existing pyogenic liver abscess.
• Limit Dairy Products: Consuming large amounts of dairy products can increase inflammation, potentially worsening symptoms.
• Avoid Alcohol: If you have an active pyogenic liver abscess, avoid alcohol as it can further complicate your recovery and lead to increased symptoms.
• Abstain from processed meats: Processed meats such as salami, bacon sandwiches and ham contain high levels of saturated fats that can inflame the already damaged liver if consumed in high quantities.
• Stay away from processed sugars: Foods containing refined sugars like white breads, candy bars, sodas and pastries should be avoided as they contain simple carbohydrates that the body digests quickly resulting in a spike in blood sugar levels that may worsen pyogenic liver abscess symptoms.

• Percutaneous Abscess Drainage (PAD): This procedure involves draining the infected fluid from the abscess using imaging guidance and a needle.
• Surgical drainage: This surgical method involves making a small incision in the patient's skin near the abscess, draining it, and then placing a tube or catheter to ensure proper drainage and healing of the area.
• Liver resection: In very rare cases, an operation involving removal of part of the affected liver may be necessary for treatment of pyogenic liver abscesses that don’t respond to other treatments or those that are causing complications.
• Antibiotic Therapy: For treating pyogenic liver abscesses, doctors usually prescribe antibiotics that can reach high concentrations in blood and directly penetrate into the infected site in order to treat bacterial infections as well as secondary fungal infections resulting from bacterial growth in surrounding tissues.

A Pyogenic Liver Abscess typically requires an interdisciplinary team of professionals for treatment, including a Gastroenterologist, Hepatologist and Infectious Disease specialist.

• Antibiotics: These are used in the management of the bacterial infection that results in the abscess. Commonly used antibiotics include cephalosporins, carbapenems, quinolones, and aminoglycosides.
• Pain relievers: These are used to manage pain associated with the infection and abscess. Commonly used medications include acetaminophen, ibuprofen, and opioids such as morphine or oxycodone.
• Antifungal agents: These may be used to treat fungal infections that can occur along with a pyogenic liver abscess. Commonly used anti-fungal drugs include nystatin, amphotericin B, and fluconazole.
• NSAIDs: The pain brought on by the illness is often treated with non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen.

Generally, mild cases can be cured within a few weeks with medication and rest, while more severe cases may require hospitalization and intravenous antibiotics for up to two months.

No, the effects of the pyogenic liver abscess treatment are not long-lasting.

Even with effective therapy, pyogenic liver abscess might come back.

It is important to follow up with your doctor to ensure that any underlying conditions that may have caused the infection are managed properly.

• Continue antibiotics for at least 7 days post-treatment, or until all symptoms have resolved.
• Monitor for potential complications such as bile duct obstruction and recurrence of infection.
• Avoid high-fat and high-fiber diets for the first month after treatment.
• Increase fluid intake to promote healing and flush toxins from the body.
• Follow up with a doctor regularly to monitor recovery and make sure all symptoms have resolved before discontinuing antibiotics.
• To prevent infecting yourself again or infecting others, maintain appropriate hygiene habits such as regular handwashing.

On average, hospitalization costs alone can range from ₹ 25000 to ₹ 80000 for milder cases and upwards of ₹ 200000 for more severe cases.

Additionally, medicative expenses such as antibiotics and pain killers can add up to approximately another ₹ 10000 - ₹ 20000.

• Surgery may lead to bleeding, infection and inflammation at the incision site.
• Prolonged use of antibiotics can result in resistant infection and disruption of beneficial gut flora.
• Pain relief medications can cause dizziness, nausea and constipation.
• Interventional radiology procedures may lead to complications such as bleeding, infection or damage to surrounding organs due to instrument introduction or radiation exposure.

You should see a doctor nearby if you have Pyogenic Liver Abscess-related problems since they may lead to consequences including 'bacteremia, peritonitis, and diabetes mellitus' for which treatment regimens can last anywhere from a few months to years, depending on how severe the condition is.