Pyogenic liver abscess

There are many possible causes of liver abscesses, including:

• Abdominal infection, such as appendicitis, diverticulitis, or a perforated bowel
• Infection in the blood
• Infection of the tubes draining bile (bile ducts)
• Recent endoscopy of the bile draining tubes
• Trauma that damages the liver

A number of common bacteria may cause liver abscesses. In most cases, more than one type of bacteria are found.

Symptoms of liver abscess may include:

• Pain in the right upper abdomen (more common) or throughout the abdomen (less common)
• Clay-colored stools
• Dark urine
• Fever, chills, night sweats
• Loss of appetite
• Nausea, vomiting
• Unintentional weight loss
• Weakness
• Yellow skin (jaundice)
• Right shoulder pain (referred pain)
• Chest pain (lower right)

Tests may include:

• Abdominal CT scan
• Abdominal ultrasound
• Blood culture for bacteria
• Complete blood count (CBC)
• Liver biopsy
• Liver function tests

Treatment usually consists of placing a tube through the skin into the liver to drain the abscess. Less often, surgery is needed. You will also receive antibiotics for about 4 to 6 weeks. Sometimes, antibiotics alone can cure the infection.

This condition can be life threatening. The risk for death is higher in people who have many liver abscesses.

Life-threatening sepsis can develop. Sepsis is an illness in which the body has a severe inflammatory response to bacteria or other germs.

Contact your health care provider if you have:

• Any symptoms of this disorder
• Severe abdominal pain
• Confusion or decreased consciousness
• High fever that doesn't go away
• Other new symptoms during or after treatment

Prompt treatment of abdominal and other infections may reduce the risk of developing a liver abscess, but most cases are not preventable.

Liver abscess; Bacterial liver abscess; Hepatic abscess

Kim AY, Chung RT. Bacterial, parasitic, and fungal infections of the liver, including liver abscesses. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 84.

Sifri CD, Madoff LC. Infections of the liver and biliary system (liver abscess, cholangitis, cholecystitis). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 75.

Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.