Liver abscess is a limited cavity located in the liver and filled with pus. Develops as a result of other diseases or primary lesions. It is manifested by pain in the right hypochondrium, fever, jaundice of the skin. The diagnosis is made by collecting anamnesis, examination, ultrasound of the liver, the use of auxiliary research methods. Treatment can be conservative (antibiotic therapy) or surgical (opening of an abscess). The prognosis of the disease with the timely start of treatment is favorable.
K75.0 Liver Abscess
Liver abscess is a destructive disease in which a cavity with purulent contents forms in the liver tissue. To date, many causes of liver abscesses have been identified, but the most significant of them are appendicitis, cholelithiasis and sepsis. Such abscesses are quite difficult to diagnose, so the latest methods for determining and treating this condition are constantly being developed. More modern methods of treatment are used – more and more often, when an abscess is detected in the liver, surgeons resort to laparoscopic or fine-needle drainage, and extended laparotomy operations are gradually becoming a thing of the past.
Causes of liver abscess
The main condition for the formation of an abscess in the liver is a decrease in general and local immunity. The formation of an abscess can be caused by various pathogens, most often it is hemolytic Streptococcus, Staphylococcus aureus, Enterobacteria, E. coli, Klebsiella, anaerobic microorganisms. Often, when sowing pus, mixed flora is released. Men are more likely to suffer from the disease. Amoebic etiology prevails in the age group of 20-35 years, and bacterial – after 40 years. Liver abscesses are divided along the path of infection:
- along the biliary tract in cholecystitis, cholangitis, cholelithiasis, cancer of the biliary tract;
- contact with the occurrence of inflammatory processes in the abdominal cavity: appendicitis, diverticulitis, ulcerative colitis in persons with immunosuppression;
- by blood vessels in sepsis.
Also, an infectious agent can enter the organ with liver injuries, during liver surgery, with infection of various liver cysts (parasitic and non-parasitic), from foci of tumor decay and specific granulomas. Sometimes the cause of the pathology cannot be established.
In abdominal surgery , there are several classifications of liver abscess:
- By quantity: single and multiple abscesses.
- At the place of occurrence: lesion of the left or right lobe of the liver.
- By etiology: bacterial and parasitic abscesses.
Due to the development of pathology can be primary or secondary. Different authors interpret this division in different ways – a number of experts speak about the primary focus of infection, others – about the presence or absence of changes in liver tissue before the abscess. They agree on one thing: the cause of the primary abscess usually cannot be determined (such abscesses are called cryptogenic).
Symptoms of liver abscess
The formation of an abscess is usually characterized by the occurrence of pain in the right hypochondrium, which can radiate under the shoulder blade or into the shoulder on the right. The patient notes an increase in pain in the position on the left side. The intensity of pain may decrease in the position on the right side with the knees pulled up to the chest. The pain is dull, aching, constant. There is also a feeling of heaviness in the right hypochondrium. The liver is enlarged in size, protruding from under the costal arch. When palpation of the liver or when pressing on the hypochondrium in the projection of the abscess, significant pain is noted.
Dyspeptic phenomena may disturb: decreased or lack of appetite, nausea, flatulence, loose stools (diarrhea). The temperature rises to febrile numbers (above 38 ° C), chills occur with the cooling of the legs, the appearance of goose bumps on them. There are phenomena of severe intoxication, tachycardia, torrential sweats.
Weight loss is often the only complaint in the early stages of the development of an abscess, and therefore diagnosis in the early stages is difficult. In the later stages, jaundice of the mucous membranes and skin appears. With compression of the liver vessels or their thrombosis due to the inflammatory process, ascites (accumulation of fluid in the abdominal cavity) may appear.
The main feature of the course of liver abscesses is that the clinic is often masked by the underlying disease, against which the abscess developed, therefore, a long time often passes from the beginning of the formation of the pathological process to its diagnosis.
Liver abscess can be complicated by the breakthrough of pus into the abdominal or pleural cavities, pericardial cavity, neighboring organs (intestines, stomach). If the vessel wall is destroyed, severe bleeding is possible. It is also possible to spread infection with the formation of a subdiaphragmatic abscess, the development of sepsis with the formation of abscesses in other organs (lungs, brain, kidneys, etc.).
Diagnostics of liver abscess
For the timely diagnosis of liver abscess, the correct and detailed collection of anamnesis is of great importance. At the same time, it turns out that there are chronic foci of infection in the patient’s body, and in the anamnesis – severe infectious diseases, tumors, operations, injuries. It is necessary to find out what the patient himself associates with the occurrence of complaints, when they appeared and how their nature has changed since their occurrence.
- Ultrasound of the liver. According to ultrasound of the hepatobiliary system, it is also possible to detect a cavity filled with fluid and pus clots in the liver, determine its size and topography. At the same time, under the control of ultrasound, it is possible to conduct a fine-needle biopsy of the abscess with the determination of the nature of the effusion, the sensitivity of the flora to antibiotics. This procedure is therapeutic and diagnostic, since the liver abscess is drained at the same time.
- Radiography of the abdominal area. Classical and modern methods are used to clarify the diagnosis. During radiography, it is possible to detect an area of enlightenment in the liver with a fluid level, fluid in the pleural cavity (reactive pleurisy), restriction of the mobility of the diaphragm on the right.
- Tomography. MRI of the abdominal cavity allows you to determine the number and location of abscesses, their size, help to develop optimal treatment tactics and an operation plan. With difficulties in diagnosis or the impossibility of carrying out these studies, angiography and radioisotope scanning of the liver can be performed – both of these methods can reveal a defect in blood supply and isotope accumulation in the liver corresponding to the location and size of the abscess.
- Laboratory tests. Laboratory tests usually show changes characteristic of inflammatory diseases (a decrease in the level of hemoglobin and erythrocytes, an increase in the pool of leukocytes, changes in the leukoformula). In the biochemical analysis of blood, indicators indicating damage to liver tissue (AST, ALT, alkaline phosphatase, bilirubin) increase.
In the most difficult cases, diagnostic laparoscopy is resorted to. At the same time, a special video tool is inserted into the abdominal cavity, allowing you to examine the organs, determine the diagnosis, and, if possible, drain the abscess. Differential diagnosis of liver abscess is performed with subdiaphragmatic abscess, purulent pleurisy, purulent cholecystitis.
Treatment of liver abscess
Treatment tactics in each case are developed individually. In the presence of a small single or multiple small abscesses, the tactics will be conservative.
An antibiotic is prescribed in accordance with the crops and the sensitivity of the microflora (with amoebic etiology of the abscess, antiparasitic drugs are prescribed). Since the sowing of pus allows the pathogen to be isolated only in a third of cases, third-generation cephalosporins, macrolides and aminoglycosides are empirically prescribed. If percutaneous drainage of the cavity is possible, drainage tubes are installed in it, through which an antibiotic and antiseptic solutions are also injected into the cavity.
If surgical treatment is necessary, they try to resort to minimally invasive techniques (endoscopic drainage), however, with difficult localization of the process, preference is given to classical laparotomy with the opening of a liver abscess. All patients with a transferred abscess are prescribed a special diet No. 5, restorative therapy. Appropriate treatment of the disease that led to the formation of an abscess is necessarily carried out. Patients of this profile are observed by a hepatologist surgeon. If necessary, an infectious disease specialist is involved.
Prognosis and prevention
The prognosis with timely and adequate treatment of a single liver abscess is favorable – up to 90% of patients recover. With multiple small ulcers or the absence of treatment of a single focus, a fatal outcome is very likely. Prevention of this disease is the prevention of infection with amoebiasis (first of all, personal hygiene), timely detection and treatment of diseases that can lead to the formation of ulcers in the liver.