What is a liver abscess? What are the clinical manifestations, causes, examinations, and treatments for liver abscess?

What is a liver abscess? What are the clinical manifestations, causes, examinations, and treatments for liver abscess?

What is a liver abscess? What are the clinical manifestations, causes, examinations, and treatments for liver abscess?

Liver abscess
Liver abscess is a liver purulent lesion caused by various microorganisms such as bacteria, fungi or amoeba, and if it is not actively treated, the mortality rate can be as high as 10% to 30%. The liver has a rich pipeline system, including the biliary system, portal system, hepatic arteriovenous system and lymphatic system, which greatly increases the probability of microbial parasitism and infection. Liver abscesses are divided into three types, of which bacterial liver abscess is often a mixed infection caused by a variety of bacteria, about 80%, amebic liver abscess is about 10%, and fungal liver abscess is less than 10%.

Cause
The incidence of amebic liver abscess is closely related to amoebic colitis, and most of the abscess is single; bacterial bacterial invasion of bacterial liver abscess can be caused by direct spread of intra-abdominal infection, besides sepsis, or umbilical Infection through the umbilical blood vessels, the portal vein into the liver, biliary aphids can also be the cause of bacterial liver abscess. Common bacteria are Staphylococcus aureus, Streptococcus, and the like. In addition, in the case of open liver injury, the bacteria may cause liver abscess with the injury or direct invasion of the wound; the bacteria may also come from the ruptured small bile duct. There are some unexplained hepatic abscesses, called cryptogenic liver abscesses, which may be associated with occult lesions already present in the liver. When the body's resistance is weakened, the pathogenic bacteria multiply in the liver and a liver abscess occurs. It has been pointed out that 25% of cryptogenic liver abscesses are associated with diabetes.



Clinical manifestation

1.Symptom
Irregular septic fever, especially bacterial liver abscess is more pronounced. Persistent pain in the liver area increases dramatically with deep breathing and body position. Due to the different parts of the abscess, the corresponding respiratory and abdominal symptoms can be produced. There is often a history of diarrhea.

2. Signs
The liver is swollen, and most of them have localized edema and obvious tenderness in the intercostal space corresponding to the abscess. Some patients may have jaundice. If an abscess penetrates into the chest, empyema appears, lung abscess or perforation occurs in the abdominal cavity.


An examination

1.Laboratory examination
Elevated leukocytes and neutrophils, especially bacterial liver abscesses, can reach (20 ~ 30) × 109 / L, amebic liver abscess can even find amoeba cysts or trophozoites, ELISA Determination of anti-amebic antibody in blood by (ELISA) can help determine the nature of abscess, with a positive rate of 85% to 95%.

2. Liver puncture
Amoebic liver abscess can extract chocolate pus; bacterial can extract yellow-green or yellow-white pus, culture can obtain pathogenic bacteria. The pus should be measured by AFP to exclude liver cancer liquefaction.

3. Kassoni skin test
Hepatic hydatid disease can be excluded.

4. X-ray inspection
It can be seen that the right diaphragm is elevated, the mobility is limited, and sometimes the pleural reaction or effusion can be seen.

5.B type ultrasonic inspection
It has a certain value for the diagnosis and determination of the abscess. The early abscess liquefaction needs to be differentiated from liver cancer.

6. CT examination
It can be seen that single or multiple circular or oval circles have clear boundaries and uneven density, and bubbles are visible inside. There is no change in the density of the scanned abscess, and the wall has an increase in density irregularity, which is called "circumferential sign" or "day halo sign".


Treatment

1.Bacterial liver abscess

• Antibiotics For acute hepatic localized inflammation, abscesses have not formed or multiple small abscesses should be given positive medical conservative treatment. In the treatment of primary lesions, high-dose antibiotics and systemic supportive therapies are used to control inflammation and promote the absorption of inflammation.
• Antibiotics + percutaneous puncture drainage in the whole body using antibiotics, for a single larger liver abscess can be puncture under the guidance of B-ultrasound, as much as possible after inhaling pus, inject antibiotics into the abscess, can be separated Repeated puncture and pus on the day, you can also drain the pus, while flushing the abscess and injecting antibiotics, until the abscess is reduced, and the drainage tube is pulled out without pus.
• Antibiotics + surgical drainage for larger liver abscess, it is estimated that there may be worn out, or have worn out and caused peritonitis, empyema and biliary liver abscess or chronic liver abscess, and then systemic application of antibiotics, should be active Perform an abscess surgical incision and drainage.
• Antibiotics + surgical resection for chronic thick-walled liver abscess and liver abscess after incision and drainage, the abscess wall does not collapse, leaving a dead cavity or sinus long-term pus non-healing, and intrahepatic bile duct stones with left outer lobe multiple liver Abscess, and the liver lobe has been severely damaged, loss of normal function, feasible hepatectomy.

2. Amoebic liver abscess, fungal liver abscess
Amoebic liver abscess and fungal liver abscess treatment, first consider the conservative treatment of internal medicine, systemic use of anti-amebic drugs and anti-fungal drugs, other treatment principles and bacterial liver abscess are basically the same.