Liver Abscess - Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Symptoms and treatment of liver abscess

A liver abscess is a consequence of an inflammatory process in the parenchyma of an organ, which led to necrosis and the formation of a cavity filled with pus. The main category of patients with liver abscess is middle-aged and older patients. The disease is secondary, that is, it occurs as a consequence of other pathologies. Among all purulent formations of the abdominal cavity, the share of liver abscess accounts for 48% of the total number of cases, that is, it is recorded quite often. Men get sick 2.5 times more often than women.

Content:

• Classification
• The causes and pathogenesis of liver abscess
• Symptoms
• Complications of the disease
• Diagnostics
• Liver abscess treatment

Classification

At the site of localization, an abscess of the right and left lobes of the liver is distinguished. An abscess in the right lobe occurs 5 times more often than in the left lobe.

By etiology:

• Parasitic;
• Bacterial.

By pathogenesis:

• Hematogenous abscess - the infection has entered the liver through the bloodstream;
• Cholangiogenic abscess - the source of infection has penetrated from the biliary tract;
• Contact, post-traumatic abscess - an abscess resulted from a wound or trauma to the abdominal organs;
• Cryptogenic abscess - has an unknown source of infection, occurs in 10% of cases.

Due to the occurrence, a primary and secondary abscess is distinguished. Single and multiple lesions of the liver with purulent cavities are diagnosed.

The causes and pathogenesis of liver abscess

An important condition for the spread of the inflammatory process in the liver tissues is a decrease in local and general immunity. Most often, the infectious process is provoked by streptococcus and Staphylococcus aureus, Klebsiella, Escherichia coli, enterobacteria, anaerobic bacilli, mixed flora. They enter the liver as a result of the following diseases and conditions:

• Cholelithiasis;
• Cholecystitis;
• Cholangitis;
• Oncological damage to the biliary tract (cholangiocarcinoma), pancreas;
• Sepsis, colorectal cancer;
• Appendicitis;
• Ulcerative colitis;
• Diverticulitis
• Invasion by echinococcus, roundworm, dysentery amoeba;
• The spread of colonies of the fungus of the genus Candida as a result of chemotherapy of the gastrointestinal tract or leukemia;
• The consequences of taking steroids and cytostatics;
• Liver trauma, complications after operations on this organ;

• Parasitic and nonparasitic cysts of the liver;
• Specific granulomas of the liver.

Once in the liver, colonies of bacteria multiply, destroying the cells of its parenchyma. As a result, an infiltrate, necrotic areas is formed. After melting of the liver tissue, a cavity is formed, filled with pus, bounded by a capsule of fibrous tissue.

Parasites enter the liver from the intestine through the portal vein system. So they take the form of tropoisotes and completely clog the capillaries of the liver. Hepatocytes are deprived of nutrition, there are areas of necrosis, where necrosis is formed.

At risk are patients suffering from cirrhosis of the liver, diabetes mellitus, pathologies of the pancreas, oncological diseases of the digestive tract, as well as the elderly, and those who have undergone liver transplantation.

Symptoms

The main symptom is constant dull aching pains under the right lower rib, radiating to the shoulder, under the scapula. The pain syndrome is accompanied by a feeling of heaviness, intensifies when the patient lies on his right side.

Other manifestations of an abscess:

• Enlargement of the liver, noticeable on palpation, it protrudes from under the costal arch;
• Tenderness to palpation;
• Decrease or lack of appetite;
• Nausea;
• Flatulence;
• Diarrhea;
• Hyperthermia, chills;
• Manifestations of intoxication (tachycardia, torrential sweat, weakness);
• Yellow color of the sclera of the eyes;
• Earthy complexion;
• A sharp loss of body weight;
• Hiccups caused by irritation of the diaphragm by an enlarged liver.

Complications of the disease

The prognosis for the development of a liver abscess can be extremely unfavorable if all possible measures are not taken to treat it.

Consequences of an untreated liver abscess:

• Peritonitis, sepsis resulting from the rupture of an abscess and the outpouring of pus, necrotic tissue into the abdominal cavity;
• Subphrenic abscess due to accumulation of pus under the dome of the diaphragm
• Pericarditis, pericardial cardiac tamponade due to the ingress of pus into the pericardial sac;
• Ascites;
• Bleeding due to increased pressure in the collar vein system;
• Abscess of the structures of the brain;
• Septic pulmonary embolism;
• The development of fistulas in the lungs and in the pleura due to the breakthrough of an amoebic abscess into the pleural cavity.

Diagnostics

Since liver abscess is difficult to differentiate from diseases similar in symptoms, it is important to correctly assess the patient's complaints, his anamnesis. The doctor finds out the nature of the complaints, the presence of foci of infections, operations, injuries, serious illnesses.

Laboratory tests when diagnosing liver abscess:

• General analysis of blood and urine - an increase in the number of leukocytes, decreased hemoglobin, a shift in the leukocyte formula is recorded;
• A blood test for biochemistry - an increase in bilirubin, alt, shp, ast;
• Bacterial blood culture - important when looking for an infectious agent;
• Analysis of feces for extraintestinal amebiasis, for cysts of dysentery amoeba;
• Study of the aspirate of purulent exudate taken with the help of percutaneous puncture.

Instrumental diagnostic methods:

• X-ray of the abdominal cavity - reveals signs of ascites, the presence in the liver of a cavity with fluid and pus;
• Ultrasound of the hepatobiliary system - determines the size and location of the abscess cavity;
• MRI, MSCT of the abdominal cavity - assesses the location, number and size of abscesses to clarify treatment tactics;
• radioisotope scanning of the liver - detects defects in the blood supply to the liver, localization of an abscess;
• diagnostic laparoscopy - a miniature camera and instruments are inserted through small incisions into the abdominal cavity to drain the abscess.

It is important to distinguish liver abscess from purulent cholecystitis, pleurisy, subphrenic abscess.

Liver abscess treatment

The treatment of liver abscess is carried out by a surgeon, gastroenterologist, and, if necessary, an infectious disease doctor. Standard tactics include antibiotic therapy in combination with minimally invasive interventions.

Possible manipulations and procedures:

• Drainage of an abscess under ultrasound control;
• Installation of drainage catheters for 3-7 days to remove pus with bacteriological examination of the aspirate;
• Intravenous administration of antibiotics (Amoxiclav, Clindamycin, Ceftriaxone);
• Treatment with antiprotozoal agents (Metronidazole, Tinidazole, Diloxanide);
• For candidiasis, drip injection of Amphotericin B;
• Surgical excision of the affected tissue in the treatment of complicated abscess;
• Diet No. 5 during the recovery period after a course of treatment.

To prevent the appearance of a liver abscess, diseases that provoke the development of this pathology should be promptly treated.

The author of the article: Gorshenina Elena Ivanovna | Gastroenterologist

Education: Diploma in the specialty "General Medicine" received at the Russian State Medical University named after N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.