🧫 Pyogenic (bacterial) – polymicrobial (E. coli, Klebsiella, Streptococcus, Staphylococcus). Often arises from cholangitis, cholecystitis, diverticulitis, appendicitis, or penetrating trauma.
🪱 Amoebic – Entamoeba histolytica (~10%). Common in endemic areas.
🍄 Fungal – Candida; more common in immunocompromised patients.
🐕 Echinococcus – hydatid cysts, especially in the Middle East.

📌 Causes & Features

Cause	Clinical	Diagnosis	Treatment
Pyogenic	Fever + rigors, RUQ pain → shoulder tip pain, jaundice, hepatomegaly, weight loss.	USS/CT, blood cultures, aspiration & culture.	IV antibiotics (e.g. meropenem → tailor), image-guided drainage, surgery if refractory.
Amoebic	Gradual fever, RUQ pain, ± diarrhoea, weight loss.	USS (often single right lobe abscess), serology (anti-amoebic Abs), aspiration if uncertain.	Metronidazole ➡️ then luminal agent (e.g. diloxanide). Drain if large/persistent.
Fungal	Fever, RUQ pain, weight loss. Common in immunocompromised.	CT (multiple abscesses), blood culture/biopsy.	Antifungals (e.g. amphotericin B, fluconazole), drainage if large.
Echinococcus	Often asymptomatic; cyst rupture → anaphylaxis (urticaria, angioedema, shock).	USS/CT, serology (ELISA, WB), PCR in difficult cases.	Surgical resection if possible; if not → percutaneous aspiration + ethanol injection ➡️ albendazole.

🧑‍⚕️ Clinical Features

🌡️ Fever, chills, sweats, malaise.
🤢 Anorexia, weight loss.
RUQ tenderness, hepatomegaly.
Right shoulder/pleuritic chest pain, cough, hiccups.
⚠️ Hydatid cyst rupture → urticaria, angioedema, anaphylaxis.

🔍 Differentials

Hepatocellular carcinoma or liver mets.
Simple liver cysts, polycystic liver disease.

⚠️ Complications

Sepsis ± septic shock.
Empyema or peritonitis (if rupture).
Endophthalmitis (esp. Klebsiella).

🧪 Investigations

📊 Bloods: ↑ WCC, ↑ ALP (95%), ± ↑ AST/ALT, low albumin.
Clotting: check PT.
Blood cultures (aerobic & anaerobic).
Imaging: USS/CT (right lobe most affected – drains portal venous flow from gut).
Entamoeba: stool microscopy (low yield), serology (enzyme immunoassay, PCR).
Echinococcus: serology (ELISA, WB), PCR if needed.

💊 Management

Resuscitation: ABC, analgesia, IV fluids.
Broad-spectrum IV antibiotics → adjust by cultures.
Image-guided drainage (needle aspiration/catheter).
Amoebic abscess → Metronidazole (curative in 90%), then luminal agent.
Fungal → Amphotericin B or azole antifungals.
Echinococcus → surgical resection if feasible; otherwise PAIR (Puncture, Aspiration, Injection of ethanol, Re-aspiration) + albendazole.

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Liver abscess

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🦠 Aetiology