Liver Abscess

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What is a liver abscess?

Liver abscess is a pus-filled cyst in the liver. The liver is an organ in the digestive system that assists the digestive process and carries out many other essential functions. These functions include producing bile to help break down food into energy; creating essential substances, such as hormones; cleaning toxins from the blood, including those from medication, alcohol and drugs; and controlling fat storage and cholesterol production and release.

Anyone can get a liver abscess. The condition can be caused by infections spread directly from nearby structures, such as the bile-draining tubes, from the appendix or intestines, or carried in the bloodstream from more distant parts of the body. A liver abscess can also develop as a result of surgery or other trauma to the liver.

The most common type of liver abscess is caused by bacterial or parasitic infection. Bacterial liver abscess is often called pyogenic liver abscess. Microscopic organisms called amebas, which cause the intestinal disorder amebic dysentery, can also cause amebic liver abscess.

When detected in time, liver abscess is usually treatable and often can be cured with a course of antibiotics or a combination of antibiotics and a surgical procedure to drain the abscess. Left untreated, however, a liver abscess can burst and spread the infection, leading to sepsis, a life-threatening bacterial blood infection.

An untreated liver abscess can cause sepsis, a life-threatening blood infection. Seek immediate medical care (call 911) for serious symptoms, such as choking or severe difficulty breathing, which may be combined with high fever (higher than 101 degrees Fahrenheit); change in level of consciousness or alertness, such as passing out or unresponsiveness; or a change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions.

Seek prompt medical care if you experience any of the following symptoms, including yellowing of the skin or whites of the eyes (jaundice); abdominal pain (especially in the right upper abdomen); nausea with or without vomiting; clay-colored stools; dark urine; fever or chills; loss of appetite; unexplained weight loss; or weakness.


What are the symptoms of a liver abscess?

Symptoms of liver abscess vary among individuals but most commonly include a combination of the symptoms listed below. In itself, a liver abscess is not life threatening, but it can become dangerous if it opens and spreads the infection. This can happen suddenly, so you should consult your health care provider if you have any of the following symptoms.

Common symptoms of a liver abscess

You may experience any combination of liver abscess symptoms. At times, any of these symptoms can be severe:

  • Abdominal pain (especially in the upper right portion of the abdomen)

  • Clay-colored stools

  • Cough

  • Dark urine

  • Diarrhea

  • Fever or chills

  • Joint pain

  • Loss of appetite

  • Malaise or lethargy

  • Nausea with or without vomiting

  • Pleuritis chest pain (hurts to breathe)

  • Sweating

  • Unexplained weight loss

  • Yellowing of the skin and whites of the eyes (jaundice)

Serious symptoms that might indicate a life-threatening condition

In some cases, liver abscess can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • High fever (higher than 101 degrees Fahrenheit)

  • Jerky movements

  • Malaise or lethargy

  • Rapid heart rate (tachycardia)

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing or inability to breathe, labored breathing, wheezing, or choking

  • Severe pain

  • Vomiting


What causes a liver abscess?

Anyone can get a liver abscess. The condition can be caused by infections in the blood, gastrointestinal system, or abdomen. It can also be caused by injury from a surgical procedure or other trauma to the liver.

Infectious causes of a liver abscess

Liver abscess may result from the following infectious causes:

  • Bacterial infection in the bile-draining tubes

  • Bacterial infections in the abdomen associated with appendicitis, diverticulitis, or perforated bowel

  • Bloodstream infections

  • Entamoeba histolytica infection (organism that also causes amebic dysentery; may be spread through water or through person-to-person contact)

Traumatic causes of a liver abscess
Liver abscess may result from surgical and diagnostic procedures in the liver, as well as accidental trauma including:

  • Endoscopy of the bile-draining tubes

  • Trauma to the liver

What are the risk factors for a liver abscess?

A number of factors increase the risk of developing liver abscess. Not all people with risk factors will get liver abscess.

Risk factors for pyogenic liver abscess include:

  • Crohn’s disease

  • Current, primary abdominal or gastrointestinal infection

  • Diabetes

  • Recent abdominal surgery

  • Recent endoscopy of the bile-draining tubes

Risk factors for amebic liver abscess include:

  • Advanced age

  • Alcoholism or heavy alcohol ingestion

  • Compromised immune system due to such conditions as HIV/AIDS or other immunodeficiencies, taking corticosteroids, organ transplant, or cancer and cancer treatment

  • Poor nutritional status

  • Travel to regions where amebic infections are common

Reducing your risk of liver abscess

It is not always possible to avoid liver abscess. However, in many cases, you may be able to lower your risk of liver abscess by:

  • Avoiding contaminated food or water

  • Limiting travel in regions where amebic infections are common


How is a liver abscess treated?

Liver abscess is treated with both medications and surgical drainage. If you have amebic liver abscess, after the liver infection is cured, you will probably be prescribed another drug to kill any amebas remaining in the intestines so as to prevent recurrence of the abscess.

Surgical treatment of liver abscess is necessary in many cases to drain the abscess with a needle or small tube inserted through the abdomen. This surgical procedure is called laparoscopic or percutaneous drainage and aspiration.

Oral antibiotics for a liver abscess

Many different antibiotics may be used to treat liver abscess. The choice of antibiotics is generally determined by the nature of the infecting organism and the seriousness of the infection. Examples include:

  • Aminoglycosides, such as amikacin (Amikin) or gentamicin (Garamycin)
  • Clindamycin (Cleocin)
  • Combination piperacillin-tazobactam (Zosyn)
  • Metronidazole (Flagyl)

What are the potential complications of a liver abscess?

Complications of untreated or poorly controlled liver abscess can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan that you and your health care professional design specifically for you. Complications of liver abscess occur from rupture and include:

  • Empyema (pus accumulation in the chest)
  • Endocarditis (inflammation of the heart lining and heart valves)
  • Liver failure
  • Pleural effusion (accumulation of fluid around the lungs)
  • Sepsis (life-threatening blood infection)
  • Spread of infection
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5

  1. Pyogenic liver abscess. PubMed Health, a service of the NLM from the NIH.

  2. Amebic liver abscess. Medline Plus, a service of the National Library of Medicine National Institutes of Health.

  3. Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis 2004; 39:1654.

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