Liver abscess – the inflammatory disease which is characterized by education in a liver of the cavity filled with pus owing to any other diseases or primary damage (the reason of formation of abscess is much more rare remains obscure – in 10% of cases). It is shown by pains in the right podreberye, temperature increase, yellowness of skin. The diagnosis is made by collecting the anamnesis, survey, performing ultrasonography of a liver, application of auxiliary methods of researches. Treatment can be conservative (antibiotic treatment) or surgical (opening of abscess). The forecast of a disease at a timely initiation of treatment favorable.
Abscess of a liver is a destructive disease at which in tissue of a liver the cavity with purulent contents is formed. Today the set of the causes of abscesses in a liver is defined, but the most significant of them are appendicitis, cholelithiasis and sepsis. Such abscesses are rather difficult in diagnostics therefore the newest techniques of definition and treatment of this state are constantly developed. At active introduction of modern methods, such as MPT, MCKT and others, diagnosis of this disease does not cause difficulties. Also more modern techniques of treatment are developed – even more often at detection of an abscess in a liver surgeons resort to its laparoscopic or tonkoigolny drainage, and expanded laparotomichesky operations gradually consign to the past.
In gastroenterology there are several classifications of this disease. Distinguish single and multiple abscesses. In the place of emergence allocate abscess of the left or right share of a liver. Abscesses classify by an etiology on bacterial and parasitic.
All abscesses of a liver on the cause can be primary or secondary. Different authors interpret this division in different ways – a number of experts speaks about primary center of an infection, others – about existence or lack of changes in liver tissue before developing of abscess. They meet in one: the cause of primary abscess usually does not manage to be defined (such abscesses call cryptogene).
Secondary abscesses are divided on the way of spread of an infection to a liver: on bilious ways at cholecystitis, a holangita, cholelithiasis, cancer of bilious ways; on blood vessels at sepsis; kontaktno at emergence of inflammatory processes in an abdominal cavity: appendicitis, divertikulit, nonspecific ulcer colitis at persons with an immunosuppression. Also infectious agent can get at liver injuries, during liver operation, at infection of various cysts of a liver (parasitic and not parasitic), from the centers of disintegration of tumors and specific granulomas of a liver.
The main condition of formation of an abscess in a liver is a decrease in the general and local immunity. Formation of abscess can be caused by various activators, most often it is a hemolytic streptococcus, golden staphylococcus, enterobakteriya, colibacillus, a klebsiyella; can initiate this process and anaerobic microorganisms. Very often at crops of pus the mixed flora is allocated. It is noticed that this disease men have more often. At the same time the amoebic etiology meets more often in age group of 20-35 years, and bacterial it is more often noted after 40 years.
Liver abscess symptoms
Formation of abscess in tissue of a liver is usually characterized by developing of pains in the right podreberye which can irradiate under a shovel or in a shoulder on the right. The patient notes strengthening of pains in situation on the left side. Intensity of pain can decrease in situation on the right side with the knees tightened to a breast. The dull ache aching, constant. Also the feeling of weight in the right podreberye is noted. The liver is increased in sizes, acts from under a costal arch. At a palpation of a liver or when pressing on podreberye in a projection of abscess considerable morbidity is noted.
The dispepsichesky phenomena can disturb: decrease or lack of appetite, nausea, meteorizm, liquid chair (diarrhea). Temperature to febrilny figures (above 38 °C) increases, there is a fever with a cold snap of legs, emergence of goose-pimples on them. The phenomena of the hardest intoxication, tachycardia, pouring sweats are noted.
Loss of weight – often the only complaint at the first stages of development of abscess in this connection diagnostics at early stages is difficult. At later stages there is a yellowness mucous and skin. At a compression of vessels of a liver or their trombirovaniya owing to inflammatory process ascites can develop (a liquid congestion in an abdominal cavity).
The main feature of a course of abscesses of a liver is that the clinic often masks the main disease against the background of which abscess therefore from the beginning of formation of pathological process before its diagnosing often there passes the long time developed.
Abscess of a liver can be complicated by break of pus in belly or pleural cavities, a pericardium cavity, the next bodies (intestines, a stomach). At destruction of a wall of a vessel perhaps severe bleeding. Spread of an infection with formation of poddiafragmalny abscess, development of sepsis with formation of abscesses in other bodies is also possible (lungs, a brain, kidneys, etc.).
The correct and detailed collecting the anamnesis is of great importance for timely diagnosis of this disease. At the same time existence in an organism of the patient of the chronic centers of an infection, and in the anamnesis - serious infectious diseases, tumors, operations, injuries becomes clear. It is necessary to find out about what the patient connects with emergence of complaints when they appeared and as their character changed from the moment of emergence.
In laboratory analyses the changes characteristic of inflammatory diseases are usually noted (decrease in level of hemoglobin and erythrocytes, increase in a pool of leukocytes, changes in the leykoformul). In biochemical blood test the indicators demonstrating liver tissue damage raise (nuclear heating plant, ALT, ShchF, bilirubin).
For specification of the diagnosis classical and modern techniques are used. When carrying out a X-ray analysis of abdominal organs it is possible to find the site of an enlightenment in a liver with liquid level, liquid in a pleural cavity (jet pleurisy), restriction of mobility of a diaphragm on the right.
According to ultrasonography of gepatobiliarny system detection in a liver of the cavity filled with liquid and clots of pus, determination of its sizes and topography is also possible. At the same time under control of ultrasonography carrying out a tonkoigolny biopsy of abscess with definition of character of an exudate, sensitivity of flora to antibiotics is possible. This procedure is medical and diagnostic as drainage of abscess of a liver is at the same time made.
For specification of the diagnosis a number of additional researches is conducted. MRT or MSKT of an abdominal cavity allow to decide on quantity and an arrangement of abscesses, their sizes, help to develop optimum tactics of treatment and the plan of operation. At difficulties in diagnostics or impossibility of carrying out the specified researches it is possible to execute an angiography and radio isotope scanning of a liver – both of these methods can reveal the defect of blood supply and accumulation of isotope in a liver corresponding to an arrangement and the sizes of abscess.
In the most difficult cases resort to a diagnostic laparoscopy. At the same time the special video tools allowing to consider bodies, to decide on the diagnosis are entered into an abdominal cavity, and at an opportunity to carry out drainage of abscess. Differential diagnosis of abscess of a liver is carried out with poddiafragmalny abscess, purulent pleurisy, purulent cholecystitis.
Treatment of abscess of a liver
Treatment tactics in each case is developed individually. In the presence of small single or multiple small abscesses tactics will be conservative. The antibiotic according to crops and sensitivity of microflora (at an amoebic etiology of abscess appoint antiparasitic medicines) is appointed. As crops of pus allow to allocate the activator only in a third of cases, tsefalosporina of the third generation, macroleads and aminoglycosides are empirically appointed. If carrying out chreskozhny drainage of a cavity is possible, in it establish drainage tubes through which the antibiotic, antiseptic solutions is also entered into a cavity.
In need of surgical treatment try to resort to low-invasive techniques (endoscopic drainage), however at difficult localization of process preference is given to a classical laparotomy with opening of abscess of a liver.
To all patients with the postponed abscess the special diet No. 5, recovery therapy is appointed. The corresponding treatment of the disease which led to formation of an abscess is surely carried out. Patients of this profile are observed in common by the gastroenterologist and the surgeon. If necessary the infectiologist is attracted.
Forecast and prevention
The forecast at in due time begun and adequate treatment of a single abscess favorable – to 90% of patients recover. At multiple small abscesses or lack of treatment of a single abscess the lethal outcome is very probable.
Prevention of this disease is prevention of infection amebiazy (first of all respect for personal hygiene) and timely detection and treatment of diseases which can lead to formation of abscesses in a liver.