Piogenic liver abscess–A challenge for cooperation between family medicine and clinics

A liver abscess is defined as a pus-filled mass in the liver that can develop from an intra-abdominal infection disseminated from the portal vein or from injury to the liver. Liver abscesses can be broadly divided into two categories: amoebic and pyogenic. The clinical presentation of pyogenic liver abscess is nonspecific; thus, a high index of suspicion is required for timely diagnosis. The classic triad of right upper quadrant discomfort, fevers/chills, and malaise is only present in approximately 30% of patients. A 66-year-old patient reports to a family doctor for pain below the right costal arch that lasts for about eight days and occurs after strenuous physical work, and he is occasionally feverish to 38 degrees. No physical signs of ascites were found, liver, and spleen were unpalpable during the physical examination. He was examined by ultrasound of the abdomen and multiple focal liver lesions in both liver lobes were detected. He was referred to a gastroenterologist and CT showed multiple hypodense irregular formations intraparenchymal and sub-capsular in the liver. Micrococcus luteus and Enterococcus faecalis were detected in blood cultures. Ultrasound-guided drainage of the largest focal lesion was performed. Parenteral and i.v. antibiotic therapy is introduced into the therapy. In the further course, the patient was in good general condition, afebrile, laboratory parameters were in the reference interval and he was discharged for further home care. Without treatment, pyogenic liver abscess has a mortality rate of 100%. When treated, this value currently drops to about 2.5% and 14%. Recognition of the features of pyogenic abscess on imaging, laboratory findings and clinical picture allows early diagnosis and rapid introduction of appropriate therapy resulting in better prognosis and reduction of complications and risk of mortality