Management of Pyogenic Liver Abscess in Older People

Introduction

Pyogenic means ‘producing pus’, and an abscess is the painful collection of pus usually caused by infection. Pus is a thick protein-containing fluid produced as a result of any infection. The pus-filled pocket of fluid formed within the liver is called a pyogenic liver abscess. The pus usually contains blood cells and dead tissues. It can be caused by infections due to one or more types of bacteria. Due to this reason, the pyogenic liver abscess is also known as a bacterial liver abscess. The person may experience pain in the chest and abdomen along with other symptoms related to the digestive system. If not treated properly, the liver abscess can be fatal.

What Causes Pyogenic Liver Abscess in the Elderly?

The leading causes of pyogenic liver abscess are the following:

• Infections in the Abdomen- Abdominal infections like appendicitis (infection and inflammation of appendix, a pouch attached to the large intestine), diverticulitis (development of small bulging pouches in the digestive tract), or a perforated bowel (loss of continuity of the bowel wall) can cause a liver abscess.

• Septicemia- Sepsis or septicemia is the poisoning of blood by bacteria. The circulation of infected blood can cause liver abscesses and may be fatal.

• Biliary Infection- Bile is a fluid that aids digestion, produced by the liver and stored in the gall bladder. Biliary disease refers to the infection or illness affecting the gall bladder (an organ that stores bile), bile duct (the tube that carries bile), and other structures involved in bile transportation.

• Cancer- Cancers of the pancreas (an organ of the digestive system) and colon (part of the large intestine) can cause a pyogenic liver abscess.

• Trauma- Trauma to the liver by injuries or accidents can also cause a liver abscess.

• Underlying Conditions- Underlying health conditions like diabetes (increased blood sugar level) can increase the risk of liver abscesses and other infections. Infections may get prolonged or worse in a diabetic patient.

What Are the Symptoms of Pyogenic Liver Abscess?

The person may experience the following symptoms in case of pyogenic liver abscess.

• Chest pain, especially on the right side.

• Abdominal pain, commonly on the right upper side and rarely the entire abdominal area.

• Right shoulder pain.

• Fever and chills.

• Vomiting and diarrhea.

• Gray or clay-colored stool.

• Dark-colored urine.

• Loss of appetite.

• Sudden loss of weight.

• Yellow skin.

• Tiredness.

How to Diagnose Pyogenic Liver Abscess in Older People?

The doctor may ask to give blood samples for culturing. Imaging techniques may also be done to diagnose the condition.

• Imaging Techniques- Ultrasonography and computed tomography (CT) help confirm the presence or absence of liver abscess. Computed tomography has an increased sensitivity to detect the same.

• Fine Needle Aspiration- Fine needle aspiration is the technique by which a thin needle is inserted into the affected area to collect the fluid or pus. The fluid is then used to observe under the microscope to diagnose the presence of infectious agents and abnormal cells.

• Blood Culture- Blood cultures help identify the type of bacteria present and help choose the required antibiotic.

• Serology- Serology studies a person’s serum (the clear liquid part of the blood after separating cells and proteins) and other body fluids to diagnose the presence of infections or diseases.

• Magnetic Resonance Imaging (MRI)- An MRI scanning of the abdomen can diagnose a pyogenic liver abscess.

• Complete Blood Count (CBC)- Complete blood count measures the count of blood cells. An alteration in the blood count may indicate the presence of infection.

• Liver Function Test- A liver function test diagnoses how well the liver is working. It tests the presence of abnormal levels of proteins and enzymes.

How to Treat Pyogenic Liver Abscess?

• Drainage- Since pyogenic liver abscess is the collection of fluid, drainage of the abscess is necessary in most cases. It is usually done by placing a tube into the liver through the skin. The drainage will be accompanied by antimicrobial treatment to reduce the infection.

• Medications- The proper diagnostic procedure can identify the kind of organism causing the abscess. The doctor will prescribe antimicrobial drugs to reduce the infection caused by the causative agent. In mild cases, the abscess can be treated by antibiotics alone. Initially, a parenteral (intra-venous) route may be chosen to deliver antibiotics to bring rapid action. Later the medications will be given orally.

• Surgery- In extreme cases, surgical intervention will be required to remove the abscess completely. The surgery will be accompanied by antibiotic treatment.

The surgical drainage or the presence of severe infection can lead to further complications. The infection can enter the blood and lead to the poisoning of the blood, called sepsis or septicemia. Sepsis can be treated with antibiotics and, if left untreated, can be fatal. Surgical drainage of the abscess can lead to the spread of infection and abscess development in other parts of the body.

How to Prevent Pyogenic Liver Abscess in the Elderly?

Watching out well the presence of any signs related to abscess development is necessary. The presence of abdominal pain, along with fever and digestion-related problems, can be due to an abscess. It may also show any single or combination of other symptoms. Prompt treatment at the apt time of abdomen infections and related areas may reduce the risk of developing a pyogenic liver abscess. But most cases are not preventable. Seeking immediate medical help is essential in the following cases:

• When the symptoms appear.

• Occurrence of severe abdominal pain.

• High and persisting fever.

• Confusion or decreased consciousness.

• Presence of symptoms during or after the treatment.

Conclusion

A pyogenic liver abscess can be a life-threatening condition in old-aged people if left untreated or becomes severe. The risk of death is also higher in the case of individuals who have developed a lot of liver abscesses. Seeking medical attention immediately if the symptoms start showing and doing adequate diagnostic tests is essential. Diagnosis will help the healthcare provider to decide on the treatment to be carried out. Being quick with one’s action can help save from worse health problems.