Amoebic abscess of a liver
Amoebic abscess of a liver – the congestion of purulent exudate delimited from surrounding fabrics in a liver owing to an amoebic invasion. Pathology is shown by pain in the right podreberye of various intensity, a gepatomegaliya, fever, a fever, perspiration, yellowness of skin and a skler, nausea and vomiting. Diagnostics is based on data of survey, ultrasonography of a liver, the analysis a calla, serological blood test. Conservatively appoint antiprotozoan, antibacterial medicines. According to indications carry out chreskozhny or open aspiration and sanitation of a cavity of abscess.
Amoebic abscess of a liver
Amoebic abscess of a liver – a pyoinflammatory disease of which education of one or several isolated cavities in a hepatic parenchyma as a result of pathogenic influence of a dysenteric amoeba is characteristic. Abscess settles down in the right share of body more often, and its contents are presented by dense brown exudate ("paste of anchovies"). Defeat baking against the background of an intestinal amebiaz is observed in 25% of cases. The disease occurs mainly at men of young and middle age (30-45 years). Pathology is widespread in the countries with tropical and subtropical climate (regions of South America, Asia, Africa), in a midland the peak of incidence falls on the summer period.
Reasons of amoebic abscess of a liver
The disease is caused by a monocelled parasite – a dysenteric amoeba of Entamoeba histolytica. The pathogenic microorganism gets into digestive tract of the person in the enteralny way at the use of the infected water, products of plant origin, at contact with the polluted use objects (plates, spoons, etc.). The sick person or the carrier of an amebiaz is a source of an infection. In intestines the parasite passes into an active phase, breeds and eats biological material of the owner (bacteria, blood cells). After achievement of the highest form of development (fabric) the amoeba through a submucous layer of intestines on system of a vorotny vein will get into a liver where continues the life cycle and reproduction.
The probability of development of pathology increases at the persons who are abusing alcohol, accepting glucocorticoid medicines, completed a course of chemotherapy and radiation therapy and having oncological diseases. More diseases are subject people of young age and pregnant women.
Having got with blood current into a liver, parasites by means of release of proteolytic enzymes have toxic effect on hepatocytes, causing their disintegration and destruction. Fusion and a necrosis of the limited site of a parenchyma with formation of the single or multiple isolated cavities filled with the necrotic mass and waste products of a microorganism results. At the further course of a disease contents of abscess can be infected (more often with colibacillus) with development of pyoinflammatory process and coloring of contents in flavovirent color. In rare instances there is a self-sterilization of amoebic abscess at which exudate gets a pastelike consistence and dark brown coloring.
Intra hepatic cavities can be single and multiple. A single (solitary) abscess, increasing in sizes, 10-15 cm sometimes have a diameter. Multiple abscesses arise seldom and have the small diameter (from 0,5 to 2 cm). Allocate the sharp and chronic course of a disease. The sharp form arises suddenly and is followed by fever of gektichesky type, the expressed symptoms of intoxication. At a chronic current temperature is more often subfebrilny, pathology proceeds without bright clinical manifestations with the periods of an aggravation and remission.
Symptoms of amoebic abscess of a liver
The clinical picture of a disease depends on sharpness of process, an arrangement of abscess and expressiveness of an intoksikatsionny syndrome. In certain cases into the forefront symptoms of amoebic colitis against the background of which damage of a liver develops act. Clinical displays of a disease can arise as in several days, and months/years from the infection moment. The sharp course of disease is characterized by temperature increase of a body to subfebrilny in the beginning, and after accession of a secondary infection − to febrilny values, the expressed weakness, plentiful sweating, nausea, vomiting, a loss of appetite, sharp loss of weight, an ikterichnost a skler and integuments.
In a debut of a disease there is a stupid, aching pain and feeling of weight in the right half of a stomach. In process of increase in the sizes of a liver intensity and frequency of painful attacks which gradually pass into the acute pain abating when changing position of a body increases. At abscess of the right share of body pain is localized in a zone of the right podreberye and irradiates in the right shoulder, a shovel, the right part of a back and a neck. At an abscess arrangement in the left share the pain syndrome arises in a zone an epigastriya and gives to a left shoulder-blade, okolopupochny and left side areas of a stomach.
One of the main symptoms of amoebic abscess is the gepatomegaliya. This syndrome is observed at the big sizes of an abscess. During the fizikalny research the liver is palpated and acts from under edge of a costal arch on 3-6 cm, and at the huge sizes of abscess protrusion of body in the field of the right podreberye is possible. Gepatomegaliya leads to a sdavleniye of nearby bodies (intestines, a diaphragm) that can cause locks, the increased gas generation, breath difficulty, short wind. The chronic form of amoebic abscess differs in an insignificant hyperthermia which can remain for a long time (weeks, months), weakness and an indisposition.
The most dangerous complications are connected with violation of integrity of a cover of amoebic abscess. At break of an abscess in an abdominal cavity peritonitis, develops in a pleural cavity ‒ an amoebic empiyema of a pleura. Hit of an infection in a blood-groove leads to sepsis, infectious toxic shock. At penetration of pathogenic microorganisms into pulmonary fabric there is pneumonia, lung abscess, gepatobronkhialny fistula. Hit of parasites in a cavity of a pericardium is complicated by development of the squeezing perikardit who can cause violation of a warm rhythm, heart failure and a tamponada of heart. As a result of a hematogenic dissemination of the activator formation of abscesses of a brain is possible.
Due to the long asymptomatic period and frequent lack of specific manifestations verification of the diagnosis can cause considerable difficulties. Often the disease is found at late stages at development of complications. At suspicion of pathology the following inspections are appointed:
- Survey of the doctor. At inquiry an important role is played by the epidemiological anamnesis (stay in tropical countries, the use of water from unchecked sources, dirty fruit and vegetables). During a stomach palpation the expert (the gastroenterologist, the surgeon, the infectiologist) pays attention to the increased borders of a liver and pain in a podreberye on the right.
- Ultrasonography of a liver. This method allows to define localization, the sizes, structure of amoebic abscess. At a research roundish gipoekhogenny subcapsular education in a hepatic parenchyma with non-uniform contents is visualized.
- Laboratory diagnostics. In the general blood test it is noted , acceleration of SOE, in the biochemical analysis - increase in the ALT, nuclear Heating Plant level, alkaline phosphatase, bilirubin, general protein. For identification of a fabric form of the activator appoint a research a calla. Serological tests (RGA, RNIF, IEF, RSK, etc.) are carried out for definition of specific antibodies in blood serum.
In difficult and disputable situations for more detailed studying of structure of body carry out liver MSKT. Differential diagnosis of a disease is carried out with abscesses of other etiology (bacterial, tubercular, ekhinokokkovy, etc.), good-quality and malignant new growths of a liver.
Treatment of amoebic abscess of a liver
Treatment of pathology is directed to oppression of fabric forms of parasites and the termination of purulent process. All patients with suspicion of amoebic abscess are subject to hospitalization in profile office. The basis of conservative therapy is made by the combined purpose of antiprotozoan, antimicrobic, antibacterial medicines. Along with etiotropny treatment carry out dezintoksikatsionny and symptomatic therapy anti-inflammatory, anesthetics.
To the heavy komorbidny patients who did not answer an initial therapeutic course under control of ultrasonography carry out tonkoigolny aspiration of contents of abscess for the purpose of capture of material for a research and sanitation of the center. After removal of contents enter solutions of antibiotics or anti-septic tanks into a cavity. Open surgical intervention is carried out at inefficiency of conservative therapy within 2-3 days, at multiple and huge abscesses. In this case carry out opening, drainage, careful processing of a cavity antiseptic solution then sanify an abdominal cavity and take in a wound.
Forecast and prevention
The forecast of a disease depends on the size of amoebic abscess and existence of complications. At timely diagnostics and competent treatment the forecast favorable. Development of complications can lead to serious zhizneugrozhayushchy consequences up to a lethal outcome (20% at pulmonary complications, 40-70% at kardialny complications). Preventive actions are aimed at providing the population with qualitative drinking water, observance of rules of personal hygiene (washing of hands, vegetables and fruit). Early identification of patients and carriers of an infection, their treatment and the prevention of infection of healthy people is of great importance. After recovery patients within a year are subject to dispensary observation. Medical control consists in quarterly passing of laboratory researches (the analysis a calla, serological reactions).