Liver Abscess
An abscess is a collection of pus in the body’s tissues, usually caused by bacterial infection. They can occur anywhere in the body.
People with a healthy immune system can get abscesses, but a liver abscess is uncommon.
People with CGD are prone to getting abscesses, particularly liver abscesses.
Causes of liver absceses
The bacteria staphylococcus aureus is the most common cause, although other bacteria or even fungi can be responsible.
Signs of a liver abscess
Liver abscesses can be quite hard to detect. They don’t have clear symptoms. However, some of the things to look out for are:
• Feeling generally unwell
• Feeling very tired and ‘floppy’
• Loss of appetite
• Loss of weight
• Tummy or back pain
• A fever – perhaps low to start with (37.5-37.9 Celcius) and then higher (38-40 Celcius)
Having these symptoms doesn’t necessarily mean you have a liver abscess – they can indicate many other conditions and infections too. See your doctor for a definite diagnosis.
How serious is a liver abscess?
Liver abscesses can be serious, making you feel very unwell. They need to be treated promptly and effectively. Liver abscesses can take quite a long time to get better. But with the right treatment, people normally make a full recovery.
Diagnosis of a liver abscess
If you have a suspected abscess, your doctor will examine your stomach to see if your liver is enlarged and harder than usual. It may feel tender when they press your liver.
The doctor will then send you for an ultrasound scan of your abdomen and liver. This is a very simple and quick way to look for abscesses, and to see how big they are. It is not unusual to have one larger abscess and some smaller ones. Sometimes two small abscesses join together to form a larger one.
You may need further scans, such as a CT scan, to get more detailed information about the abscess. It is also important to try and confirm which bug is causing the abscess. To do this, a doctor or nurse will take some of the pus from the abscess, using a fine needle inserted into your stomach. You will be sedated for this.
Treatment for a liver abscess
• Antibiotics
Treatment for liver abscesses is usually a combination of antibiotics and occasionally anti-fungal medication, taken intravenously (through an injection or drip), often over several months.
If you have a liver abscess, you will usually need to stay in hospital for quite a long time. However, once you feel a little better, it’s often possible to go home and get your medicines from a community nurse at home or at hospital as a day patient. Some people may be able to administer antibiotics themselves.
Doctors may insert a special tube (often called a central line) into your arm, neck or chest to make it easier to get the antibiotics into your system. This can stay in place for several months. Doctors can also use it to take blood, as people with abscesses need tests frequently. Central lines are removed as soon as they are no longer needed.
After some time, it will be possible to start taking antibiotics by mouth, but you may need to take these over several months too.
• Interferon Gamma
A medication called Interferon Gamma is another fairly common treatment for liver abscesses, combined with antibiotics/anti-fungal medicines. It’s given through an injection, just under the skin, three times a week.
Interferon Gamma can cause flu-like symptoms and ‘chills’ in the 24 hours after treatment for many people. Paracetamol can help with this. Community nurses can give Interferon Gamma at home, and some people learn to take it themselves.
• Other treatment
Draining the pus from a liver abscess can make it easier for antibiotics to work. However, it is not always possible to drain abscesses. Sometimes they don’t have any liquid pus inside and they’re difficult to get to. Occasionally, an abscess will need to be drained on more than one occasion.
Another option to make antibiotics more likely to succeed is to remove the bulk of the abscess in an operation.
• Getting better slowly
Getting better from a liver abscess takes time. It can take a while to feel fit and well and get back to your normal levels of activity. You may need to go back to school or work gradually, a few hours at a time.
Liver abscesses can take a long time to get better. The fever that comes with an abscess can take a while to cool down. Fevers should begin to happen less frequently and be less intense once treatment is underway. However, you may still have a high temperature once or twice a day for some time.
• Nutrition
Many people lose their appetite during long-term treatment and stays in hospital. Sometimes they need extra nutrition. They can get this through milkshake drinks, or perhaps a special feeding tube in their nose or stomach. Very occasionally, someone may need to be fed for a short time intravenously through a central line.
Possible long-term effects of liver abscesses
Abscesses can upset the liver. Blood tests to show how the liver is working (called liver function tests or LFTs) will show any problems up.
However, tests usually go back to normal once the abscesses are better and the liver becomes softer and smaller.
The scars left by the abscesses are likely to remain visible on X-rays and scans for some time (even years). However, abscesses rarely cause any long-term damage.
Some people will get jaundice, a yellowish colouring of the skin and/or whites of the eyes, caused by a build-up of bilirubin, a waste product of the liver.
Reference
This page has been reviewed by the Medical Advisory Panel. January 2013.