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Abscesses and Cysts
Liver cells

Liver Abscesses & Cysts

An abscess is a collection of pus (a thick fluid of blood, dead tissue and germs). Abscesses on the liver are caused by the presence of bacterial, parasitic, or fungal organisms spread from the digestive tract. It is estimated that less than a 0.25 per cent of the population of the UK have liver abscesses.

A cyst is similar to an abscess but without the pus.

There are a number of different types of cysts that may be found on the liver including so-called ‘simple’ cysts and multiple cysts linked to polycystic liver disease (PCLD). Polycystic cysts and simple cysts are ‘congenital’ (ie, present at birth). It is estimated that around five per cent of the population have liver cysts of one form or another.

Symptoms – simple cysts

Simple cysts are usually ‘asymptomatic’ meaning there are no discernible symptoms, although they can cause pain in the right-hand side of the ribs (liver area).

Symptoms – polycystic cysts

You may experience both tummy pains and pain in the right hand side of the rib cage (ie, the liver area). This may be first noticed during puberty.

Symptoms – abscesses

The signs and symptoms can include: fever, anorexia, sickness, weight-loss, weakness, pain in the liver, and jaundice (at a late stage).

Diagnosis – abscesses

Blood tests and analysis of small amounts of material extracted under ultrasound guidance is likely. These techniques may be supported by CT scanning.

Diagnosis – cysts

This is usually through CT or MRI scanning.

Treatment - cysts

Treatment of cysts will depend on the nature of the cysts discovered. Some are congenital (ie, present at birth) and some are caused by tapeworm infestation. A ‘simple’ (or fluid filled) cyst may be ‘deroofed’, if it is growing rapidly. This procedure is now more commonly performed by a ‘laproscopic intervention’ (ie, through small incisions in the abdomen and the use of fine instruments.) This procedure allows the trapped fluid to drain.

PCLD/PLD

There is also a disease known as polycystic liver disease (PCLD or PLD). This is present when the liver has many scattered cysts of various sizes caused by a genetic disease. It is often discovered by accident or during a diagnosis of kidney disease. These cysts rarely require treatment, but if they do ‘deroofing’ techniques may be used. In rare cases of PLD where the liver becomes very swollen a transplant may be needed. The course of treatment for the liver disease may be determined by the progress of any associated kidney disease.

Treatment - abscesses

Abscesses are usually treated by antibiotics in the first instance. However, antibiotics are not always sufficiently effective and therefore drainage - sometimes via a catheter - may be needed guided by either ultrasound or CT imaging. In extreme cases, where for example the abscess has ruptured, open surgery may be needed.

Prognosis/outlook

Untreated an abscess in the body is usually very serious and in the past mortality rates were high amongst sufferers. Today good drainage techniques and the use of chemotherapy have greatly improved life expectancy.

Cure rates for simple cysts after treatment are typically very high – 90 per cent or higher. For PCLD, the rates are somewhat lower.

To arrange a consultation with a liver consultant please contact The Princess Grace Hospital, Liver, Bile Duct and Pancreas Unit