Appendicits was the leading cause of pyogenic abscess in the past. Biliary disease has become the leading cause today (Table 13.6).

Route of bacterial spread to the liver include:

• the portal system (most common)

• the hepatic artery (bacteremia)

• direct extension from subhepatic or subdiaphragmatic infection

• directly from during trauma

Organisms most commonly involved in pyogenic liver abscess are Escherichia coli, Klebsiella, and Enterococcus. Bacteroides and Streptococcal species are also found.

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