What is a biliary liver abscess? What are the causes, clinical manifestations, examinations, diagnosis, complications, and treatment of biliary liver abscess?

What is a biliary liver abscess? What are the causes, clinical manifestations, examinations, diagnosis, complications, and treatment of biliary liver abscess?

What is a biliary liver abscess? What are the causes, clinical manifestations, examinations, diagnosis, complications, and treatment of biliary liver abscess?

Biliary liver abscess

Biliary liver abscess is a bile duct obstruction caused by gallstones, bile duct stricture, etc., and liver abscess caused by infection. It is one of the serious complications of hepatolithiasis. The disease is a multiple abscess in the liver, often associated with acute obstructive suppurative cholangitis. The clinical onset is more rapid, mainly manifested as symptoms of acute infection. The age of good hair is 21 to 40 years old, more men than women.

Cause
Bile duct stones, aphids, biliary stenosis and other biliary obstruction and inflammation, bacteria along the bile duct, invade the liver to cause inflammation, and then form a number of small abscesses, and later gradually merge into a larger abscess. Abscesses are often multiple and communicate with the bile duct, a rare abscess. In the original bile duct stones, the bile ducts are more dilated and thickened, and a large amount of fibrous tissue is proliferated in the portal tube area, which is not easy to be broken. The pathogens of biliary hepatic abscess infection are mainly Escherichia coli, followed by anaerobic streptococcus.


Clinical manifestation

1.Symptom
Patients with previous bile duct stones, bile duct surgery, repeated cholangitis and other history of biliary diseases, so often have gallstones, bile duct inflammation and obstruction and other primary manifestations, followed by sudden chills, high fever, liver pain and a lot of sweating. Pain in the liver area is persistent dull pain, radiating to the right shoulder, or causing chest pain, and may cause irritating cough and difficulty breathing. Due to septic reaction and consumption, severe illness occurs in a short period of time, accompanied by anemia and hypoproteinemia.

2. Signs
The body temperature can reach 102 ~ 104℉, mostly relaxation heat. If the lesion is in the right anterior hepatic lobe, local uplift can be seen, the skin has edema, the liver is large and tender, the upper right abdomen tenderness is obvious or abdominal muscle tension is present; the lesion is in the left lobe of the liver and the above symptoms appear under the xiphoid process. Critical illness; some patients may have jaundice.

An examination

1.Blood routine
The white blood cell count and the proportion of neutrophils were significantly increased, showing nuclear left shift or poisoning particles.

2. Liver function test
Liver function is often mildly abnormal, and the levels of alanine aminotransferase and aspartate aminotransferase are slightly elevated, and obstructive jaundice occurs. Both total bilirubin and direct bilirubin increased significantly.

3. Blood culture
Pathogenic bacteria can be found.

4. X-ray inspection
Visible liver enlargement, right diaphragmatic elevation, right lower lobe atelectasis, pleural response and reactive pleural effusion.

5.B Ultra
A strong light-like image of the intrahepatic bile duct stones, bile duct dilatation, and intrahepatic liquid dark areas.

6.CT
Helps to identify the presence and location of abscesses.

7.MRI
Helps to differentiate the diagnosis.

Diagnosis
With a history of bile duct stones and bile duct infection, sudden high fever, pain in the liver area, liver enlargement and tenderness and snoring pain, should consider the possibility of liver abscess, combined with B-ultrasound and other tests, most can be clearly diagnosed. X-ray, CT, MRI examinations are helpful for diagnosis and differential diagnosis.

Complication
The disease can cause a variety of complications, such as diffuse peritonitis, underarm abscess, pleurisy, empyema, pericardial empyema, bile duct hemorrhage, and even lead to sepsis, sepsis, toxic shock, multiple organ dysfunction syndrome, etc. .


Treatment
1.Non-surgical treatment
For the localized inflammation of the acute phase, there is no large abscess and only a few small abscesses, which can be treated with non-surgical treatment. Use high-dose antibiotics and systemic supportive measures to promote abscess self-healing.

2. B-guided percutaneous puncture drainage tube drainage?
It is suitable for a single large abscess. Under the guidance of B-ultrasound, the puncture is puncture with a thick needle. After repeatedly flushing the pus, the catheter is placed in order to prepare for postoperative drainage. This method is simple, less invasive, and satisfactory in efficacy. It is especially suitable for elderly, frail and critically ill patients. Puncture or drainage can not completely replace surgical drainage.

3. Surgical treatment

• Abscess incision and drainage: For the primary biliary tract, surgical treatment is required, and the abscess is large. It may or may have been worn to cause local peritonitis and requires surgery. At present, laparoscopic liver abscess is often used for incision and drainage.
• Liver resection: For some chronic abscesses, or abscesses, the wall of the abscess does not collapse, leaving a dead space and intrahepatic bile duct combined with multiple abscesses of the left lobe of the liver.