What are the clinical manifestations of bacterial liver abscess? What are the treatments for bacterial liver abscess?

What are the clinical manifestations of bacterial liver abscess? What are the treatments for bacterial liver abscess?

What are the clinical manifestations of bacterial liver abscess? What are the treatments for bacterial liver abscess?

Bacterial liver abscess

1. High fever, chills, loss of appetite, nausea and vomiting, excessive sweating, fatigue and weight loss are common symptoms.

2. Sustained pain in the right upper quadrant often involves pain or radiation pain in the right shoulder.

3. Most patients have varying degrees of toxic symptoms and systemic consumption, such as: fatigue, loss of appetite, nausea, vomiting, weight loss. Some patients may have swollen liver, tenderness in the right upper abdomen, splenomegaly, and ascites and jaundice in severe cases.

4. A huge liver abscess can break into the right chest and mediastinum. Acute peritonitis, empyema, bronchospasm, a small number of liver abscesses with bile duct traffic pierce the blood vessels, causing acute upper gastrointestinal bleeding.

5. Laboratory examination: white blood cell count, neutrophil ratio increased, hemoglobin often decreased, liver function may be abnormal.


6. B-ultrasound can determine the location and number of abscesses, the correct rate of diagnosis is 80% to 90%, pay attention to not miss a small abscess in fatty liver. CT examination has a higher detection rate for liver abscess, but it is differentiated from hepatic cysts and tumors. MRI can detect small abscesses.

7. Diagnostic hepatic puncture: Liver puncture and pus in B-ultrasound or CT positioning, bacterial culture and drug sensitivity test on pus, which is of great value for diagnosis and treatment.

Treatment

1. Non-surgical treatment: for liver abscesses that are not limited and multiple small.

• Antibacterial drugs: According to the "Guidelines for the Clinical Application of Antimicrobial Drugs", combined with the patient's condition to determine the choice and use time of antibacterial drugs. According to the possible source of infection and bacterial culture results, a sensitive, effective, sufficient amount of broad-spectrum antibiotics is administered intravenously. Commonly used in combination with third-generation cephalosporins and aminoglycosides.
• Maintain water, electrolytes, acid and alkali and nutrient balance, and improve the body's resistance.

2. Percutaneous transhepatic drainage: under the guidance of B-mode ultrasound or CT, percutaneous puncture drainage drainage, satisfactory results, can also be placed in the continuous drainage, if necessary, expand the sinus, into the thicker catheter to ensure smooth flow. The curative effect can reach 75% to 90%. Severe obstruction of blood coagulation, a large amount of ascites is a contraindication to puncture drainage. In our department, the drainage of the abscess is often used in some patients with percutaneous transhepatic drainage to promote the absorption of abscess.

3. Laparoscopic drainage: Suitable for large liver abscesses on the liver surface for laparoscopic operation.

4. Liver abscess incision and drainage: preoperative positioning with ultrasound abscess to determine the optimal drainage incision. Try to avoid the transthoracic approach and re-position the intraoperative puncture. Use an electric knife to cut open the abscess, use your fingers to probe the abscess and separate the lumen interval, and open the large-diameter hose for open external drainage.

5. Liver partial resection:

Indications:

• Chronic thick-walled liver abscess
• Localized liver abscess, mostly used in left intrahepatic bile duct stones or hepatic bile duct stenosis with left hepatic lobe and left lateral lobe abscess
• The formation of dead space after hepatic abscess incision and drainage, long-term unhealed wounds and sinus formation; chronic infection and perihepatic tissue atrophy caused by various reasons
• Liver abscess after trauma, liver abscess after liver ischemic necrosis due to other causes, can not form a complete abscess wall
• Complicated with bronchospasm or formation of bile duct bronchospasm, difficult to repair.

6. Etiology treatment: such as biliary liver abscess with biliary obstruction, biliary decompression drainage is very important.