1) Bacterial aka pyogenic
2) Parasitic (amoebic)3) Fungal
Pathogenesis:
1) Ascension of bacteria from biliary tree (40-50% of cases)
2) Portal vein spread (from intra-abdo source i.e. diverticulitis, appendicitis)
3) Hematogenous spread
4) Direct inoculation from trauma or surgical procedure
5) Cryptogenic
Risk factors
1) Diabetes
2) Hepatobiliary/pancreatic disease
3) Malignancy
4) Liver transplant
5) Immunocompromised: HIV/AIDS
Bugs commonly involved: mostly polymicrobia aerobes + anearobes
1) Gram positives: Staph, microaerophilic Strep, Strep milleri (abscessogenic), enterococcus
2) Gram negatives: Klebsiella, enterbacteriacea coli
3) Anaerobic: fusobacterium, bacteroides (may not be grown on culture)
4) Fungus
5) Hydatiform cyst echinococcus: from dogs
6) Amoebic liver abscess: entamoeba histiolytica (fecal oral route)
Treatment of pyogenic liver abscess:
1) Abx to cover gram+/-/anaerobes (a penicillin, aminoglycoside/cephalosporin and metronidazole)
4) Source control: perc drainage
See the following article for more about liver abscesses Liver abscesses and Hydatid disease
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