Key Notes

Infections of the liver Infective hepatitis is usually viral. Non-viral causes of hepatitis include Coxiella burnettii (Q-fever), Leptospira species (Weil’s disease), Brucella (brucellosis), and Mycobacterium tuberculosis. Liver abscesses can be amoebic (due to Entamoeba histolytica) or pyogenic (usually a polymicrobial infection).

Biliary tract infections Cholecystitis is usually secondary to gallstones, but may be complicated by infection. Empyema of the gallbladder is a serious infection where the gallbladder literally becomes a ‘bag of pus’. Cholangitis is usually secondary to obstruction of the biliary tree (e.g. gallstones, malignancy). These infections usually involve coliforms, pseudomonads, enterococci and anaerobes. Treatment is with high-dose broad-spectrum antibiotics and appropriate surgical intervention.

Infections of the spleen Splenomegaly can occur with a variety of infections including glandular fever (Epstein-Barr virus), brucellosis, visceral leishmaniasis and schistosomiasis (secondary to portal hypertension). Splenic abscesses can occur in patients with infective endocarditis or immunosuppressed patients (e.g. hepatosplenic candidiasis). Pyogenic infections of the spleen are rare.

Infections of the pancreas Pancreatitis can be due to infection (e.g. mumps virus) as well as non-infective causes (e.g. gallstones, alcohol, and trauma). Secondary bacterial infection can occur in severe pancreatitis. Coliforms, streptococci, staphylococci, pseudomonads and anaerobes are the principal pathogens.

Peritonitis Spontaneous (primary) bacterial peritonitis is rare, but is more frequently seen in patients with ascites. Peritonitis is more commonly a complication of other intra-abdominal pathology (e.g. appendicitis, carcinoma of the colon), and is usually a polymicrobial infection (e.g. coliforms, anaerobes). Broad-spectrum antibiotic therapy is given as an adjunct to surgery. Peritonitis is also a recognized complication in patients with renal failure on continuous ambulatory peritoneal dialysis (CAPD).

Intra-abdominal collections Intra-abdominal collections or abscesses are usually found under the diaphragm (subphrenic) or in the pelvis. Infections are often polymicrobial (e.g. coliforms, streptococci and anaerobes) and usually occur as a complication of peritonitis, gastrointestinal or gynecological pathology or surgery. Treatment is by drainage of pus and antibiotic therapy.

Related topics

Viral hepatitis (B2–4)