Challenges in Management and Liver Abscess in General Hospitals with Limited Facilities: A Case Report

Abstract

Introduction: Liver abscess is a mass containing pus in the liver which can develop into an intra-abdominal infection. Poor environment and sanitation, as well as difficulty in accessing clean water, are risk factors for liver abscesses. We report the findings of patients with liver abscesses, identification, and treatment from Waikabubak General Hospital. Case Presentation: Male, 34 years old, came to hospital with symptoms such as right upper abdominal pain since 1 week ago, accompanied by fever and nausea, vomiting. Two weeks previously the patient was said to have loose stools with a frequency of 3-4x/day. The patient is a farmer, drinks boiled tap water every day, and lives in a place with poor sanitation. Physical examination showed icteric sclera, liver palpable 3 fingers below the costal arch, and tenderness (+). Laboratories showed leukocytosis with a predominance of neutrophils and elevated liver enzymes. Ultrasound results showed a mass in the right lobe measuring +/- 4.2 x 4.16cm. The patient was treated with cefotaxime and metronidazole, as well as symptomatic management. Over a week showed clinical improvement, as well as a decrease in the size of the abscess. Discussion: The diagnosis is made from anamnesis, physical examination, and limited support. Determining the cause of an abscess is a challenge, the results of leukocytosis with a predominance of neutrophils are a reference in management. Environment and lifestyle are risk factors for liver abscess. Conclusion: Immediate and appropriate treatment can reduce the rate of complications. Government participation is needed to improve the quality of health and improve the quality of life of the people of West Sumba.