Liver abscess is a dangerous disease. When the unit purulent lesions of the positive effect of the treatment is observed in almost all patients, but of course if the therapy was carried out in a timely manner. A multiple pus formation liver are often fatal.
Causes of
What it is? Liver abscesses are more prone to elderly people, long suffering from inflammatory diseases and food gepatobilliarnoy system. The reason may be a liver abscess bacteria and parasites (amoeba).
Depending on the route of infection distinguish between such forms of liver abscesses:
- holangiogennye - an infection gets into the liver cells with biliary tract;
- hematogenous - the infection spreads through the blood vessels of the body;
- contact and post-traumatic stress - occur after both open and closed abdominal injuries;
- cryptogenic - the source of infection is not installed.
Bacterial flora is the cause of the disease in 50% of all cases. Streptococcus, staphylococcus and the mixture of microorganisms found in bacterial seeding.
According encoding ICD-10 (International encoding tenth revision disease), liver abscess encrypted under paragraph K75.
Classification
Liver abscesses are divided into the following groups of species.
- Primary and secondary.
- Complicated suppurative process or complicated.
- Single and multiple.
- Pyogenic and amebic.
Complications include various unusual phenomena occurring with festering areas: first of all, is sepsis, purulent pericarditis, pleural empyema. The same disease can have complications in the form of a subphrenic abscess, and a breakthrough in recent pleural or peritoneal cavity.
Symptoms of liver abscess
When liver abscess major symptoms may occur as follows: a high body temperature;
- constant, aching, dull, extending to the right shoulder blade;
- hepatomegaly, chills, "goose bumps" 2-3 times a day;
- loss of appetite, nausea, vomiting possible;
- a significant increase in pulse rate;
- pain in the liver projection,
- rapid weight loss due to the phenomena of intoxication and dyspeptic disorders;
- yellowness of the skin, sclera, dark urine sallow complexion.
The symptoms of this serious disease may be accompanied by blood poisoning and convulsions. The patient in most cases there is fluid in the abdominal cavity, thereby significantly stomach It increases in size (this is especially noticeable on the background of strong thinness, weight loss due to the background intoxication).
Amebic liver abscess
Diseases caused by Entamoeba histolytica (dysentery amoeba) are mainly distributed in the countries with hot and tropics of Asia, Africa and South America, where amebic abscess constitute 80-90% of purulent lesions liver.
Pathogen exists in three forms:
| Luminal form. | Located in the intestinal lumen. It is a transition between the mature form and a cyst. It feeds on bacteria. It can be detected and the patient, and infection medium. |
| Vegetative or mature form. | Has a large size, is found only in human patients. It breeds in the large intestine, forming ulcers, and also affects the red blood cells of the patient. |
| Cyst. | A temporary form of the parasite exist in adverse environmental conditions. This form has no pathogenic properties can be detected and the patient, and a carrier. Excreted in the feces out. |
When intestinal amoebic liver disease occurs on different data, in 1-25% of cases. However, when overt manifestations of intestinal amebiasis may not be.
Diagnostics
The first step in the diagnosis of liver abscess is a thorough survey carried out by your doctor. It can detect an increase in liver (palpation), jaundice (e.g., in the form of yellowing of the skin or eye), palpitations and sweating skin. To detect liver abscess doctor prescribes blood tests. The outcome is usually observed a significant increase in the concentration of leukocytes in the blood due to concomitant bacterial infection, and increased markers of inflammation, such as acute protein phase CRP.
The doctor may prescribe other studies:
- Cultivation of bacteria from blood samples allows to detect 50% of the microbe responsible for the appearance of liver abscess. Material for the study is taken via puncture of the abdominal wall cavity, and extracting liquid from the affected area of the liver. The sample is then sent to the microbiological tests for the presence of colonies of bacteria, aerobic and anaerobic bacteria. Not recommended fence abscess content of samples with previously pledged drainage.
- In conducting x-ray revealed the cavity with the liquid level in the liver projection (pus) and a gas bubble over it. Also, when it is possible to identify some reactive changes on the part of the right side of the chest cavity - high standing and limited mobility of the dome of the diaphragm, the fluid in the pleural cavity, the symptoms of pneumonia in the right lung. These radiological symptoms specific to liver abscess, but their presence makes it possible to suspect a pathological process in the liver.
- Computer tomography or ultrasound allow visualization space with purulent fluid in the liver, together with accompanying edema. The skilled artisan should distinguish liver abscess from possible tumors or cysts.
Other laboratory tests may reveal an increased concentration of bilirubin and liver enzymes. When such disease damaged hepatocytes, which produce, in this case the blood substances which are indicators of damage.
Treating liver abscess
In the case of uncomplicated process, the treatment gives a good chance of recovery. If complications develop - the forecast is unfavorable, and increases the likelihood of death.
drug therapy
In cases of bacterial pyogenic abscesses in the complex treatment included antibiotic therapy. As a rule, it complements the surgical methods of draining the abscess.
Isolated use of conservative treatment is carried out rarely, only in cases where the patient will not survive surgery or when he has multiple abscesses, which can not be razdrenirovat. In these cases, patients require many months of antibiotic therapy with a constant and close supervision for the development of complications. Most often prescribe antibiotics, in addition to surgery.
Before receiving blood culture results of abscess or cavity contents and determine the type of pathogen doctors prescribe broad-spectrum antibiotics - carbapenems, cephalosporins of the third generation metronidazole. After receiving the results of the microbiological examination of treatment change, assigning drugs on the basis of susceptibility to them. The duration of antibacterial therapy may be from 6 weeks (with a single and well-drained abscess) to 3 months (when multiple liver abscesses).
- In the case of amoebic liver abscess in 90-95% of patients achieving recovery without surgery. They prescribe metronidazole. In most patients, improvement occurs within 72-96 hours. In case of failure of metronidazole used chloroquine to which is sometimes added emetine or digidroemetin. After successful treatment of amebic abscess, doctors prescribe diloxanide furoate, an amoeba that destroys the intestines.
- In the case of fungal abscesses conducted systemic antifungal therapy. This treatment is a supplement to surgical drainage of an abscess cavity. Doctors often prescribe amphotericin B or fluconazole.
Furthermore antibacterial or antifungal therapy, in patients with liver abscess may need infusion therapy (to correct water and electrolyte balance), pain relievers, and the elimination of nutritional deficiency substances.
Surgery
The operation is performed in case of failure of drug within 4 - 6 months or when there are complications of acute medical conditions.
- Percutaneous drainage of a liver abscess - two rubber tube is introduced into the cavity of an abscess in a fed liquid containing antibiotics from another output content. Duration of the procedure and takes 3 - 4 days;
- Laparotomy - middle abdominal incision. It is performed in the presence of multiple liver abscesses or developing complications. The surgical wound is derived liver abscess cavity all opened, the contents of which are aspirated special device aspirator. The empty, dried cavity excised to healthy body tissue and then sutured.
Remember that the traditional methods of treatment use is prohibited in this disease.
Diet
When establishing the diagnosis of food must be gentle, with the exception of fatty meals.
Food should not exert stress on the organ itself, bile ducts, and gastrointestinal system. You need to choose meals that contain large amounts of vitamins. In the postoperative period, the food should be pureed, you need to eat small portions.
Complications and prevention
liver abscess is terrible its complications. So, in cases when treatment is started late, possible breakthrough abscess, bleeding, which can also trigger blood poisoning.
As a result, a breakthrough may be formed peritonitis (inflammation extending into the shell abdomen) epinema pleura (when pus accumulates in the pleural sternum), as well as shell liver abscess pus can opening and is likely to get to the next authorities:
- into the abdominal cavity;
- intestines;
- pericardium;
- bronchi.
Primary prevention of liver abscesses prevention is to prevent and timely, proper treatment of diseases that affect the occurrence of ulcer. Parasitic forms are cautioned personal hygiene, sanitary regulations on food businesses.
