An abscess in the liver is a collection of thick fluid or pus and is usually caused by the presence of bacterial, parasitic, and/or fungal organisms that spread from a person’s digestive tract. Pus is composed of white blood cells, dead cells, and bacteria that are formed when our body fights against the infection. Abscess is normally accompanied by swelling and inflammation in the areas surrounding the liver causing pain and swelling in the abdomen.
Compared to liver abscess, liver cysts have no pus. It usually develops incidentally or congenitally; and so, it is difficult to predict its exact prevalence. Most of the patients suffering from liver cysts are diagnosed above the age of 40.
Listed below are different types of liver cysts:
These are usually congenital and are lined with biliary type epithelium (fluid cyst is continuously secreted and re-accumulated after aspiration). Most of the cysts are single and are associated with symptoms, such as discomfort, pain, and upper abdominal bloating. However, studies have shown that only 5% of the patients affected from liver cysts ever develop any symptoms. The vast majority of such cysts are left alone once diagnosed, unless patients are symptomatic.
Such cysts may demonstrate septae within the cyst, can be muliloculated, or have nodules along the cyst wall. These cyst characteristics are important to identify as complex cysts may be worrisome or have risk of cancer transformation.
Polycystic Liver Disease (PCLD/PLD):
It is a congenital condition and is usually related to autosomal dominant polycystic kidney syndrome with mutations in SEC63, PRKCSH, PKD1 or PKD2 genes. One may experience pain on tummy and right side of rib cage.
Cystadenoadenomas or cystadenocarcinomas are considered rare conditions. Patients may be asymptomatic or experience vague symptoms including bloating, fullness, and nausea. If the cysts are enlarged, patients may have abdominal pain. Typically, such cysts contain bile fluid as opposed to clear fluid in simple cysts.
These are mainly caused by the infestation of a parasite known as Echinococcus granulosus. Dogs, wolves, and other carnivores act as the hosts of the parasites, which pass-out eggs with their stools through which the eggs are ingested by the humans. The egg larvae invade the person’s mesenteric vessels and gastrointestinal tract, passing through the liver to complete its lifecycle. It is observed that people having direct contact with dogs, or those who raise sheep or cattle can be affected by this disease.
Patients with liver abscess may experience symptoms like fever, shivering, vomiting, weight loss, loss of appetite, weakness, pain in the liver, brownish urine, and jaundice. Liver abscess can be fatal, if it is not treated promptly.
Antibiotics: These are often the first line treatment offered by the doctors to treat the abscess. The antibiotic course may take approximately 1 to 2 months for full treatment.
Drainage: Patients that are diagnosed with large pyogenic liver abscess can be treated with image guided drainage with a CT scan or ultrasonography. Surgical drainage may be needed for liver abscesses which are larger than 5 cm size, multiloculated or multiple in nature.
Supportive measures: Other supportive measures to treat this condition includes, taking appropriate nutrition and adequate intake of fluids.
Liver cysts are commonly diagnosed during health screening and checkups, and usually display no obvious symptoms. Some cysts are potentially dangerous and life-threatening, hence specialist consultation for worrisome liver cysts is warranted.
Senior Consultant Surgeon
MBBS (Singapore), FRCS (Edinburgh), MMed (Surgery), MSc (Bioinformatics),
FAMS (General Surgery)
With 20 years of surgical experience, Dr Lee is trained and skilled in using minimally invasive techniques for liver, pancreas, gallbladder and hernia procedures.
His busy practice aside, Dr Lee is actively involved in postgraduate teaching and workshops for junior surgeons, and is still actively involved in academic research at the National University of Singapore.
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