Abscesses of the liver: treatment, symptoms, causes, prevention
Liver abscesses are dangerous because they can lead to severe consequences, sometimes up to sepsis and death. By the way, such a disease can be both primary and secondary. According to statistics, the abscess is manifested against the background of other liver diseases not more often than in 3-5% of cases.
Nevertheless, many people are interested in questions about the course of such a pathology, because the sooner the violations are observed, the sooner the person will receive appropriate treatment. So where is the liver located in a person and what are the main causes of its defeat? How to determine the first signs of an abscess? What complications can the disease cause? Do you need surgery or ailment can be treated with conservative medicine? Many readers are interested in answering these questions.
Abscess: what is it?
Naturally, many people first want to understand the basic anatomical terms and explanations. Where is the liver located? It is a large organ that is in the upper right quadrant of the abdomen( right hypochondrium).
It should be noted that, due to the lack of pain receptors in the body, these or other liver damage may not be accompanied by physical discomfort or pain. Therefore, it is worthwhile to closely monitor the work of the whole organism. This vital organ purifies human blood from toxins and harmful substances, takes part in metabolism, is a depot of glycogen( energy reserves), produces bile acids and regulates digestion processes.
Unfortunately, some people face such a complex diagnosis as an abscess. What it is? This is a purulent inflammation of the tissues, which is accompanied by their so-called melting. As a result of such a process, a cavity is formed inside the abscess, where purulent masses begin to accumulate. As development develops, the formation grows in size, and sometimes it can break up, freeing purulent contents.
According to statistical studies, liver abscesses are usually the result of other diseases of this organ. Men suffer from this pathology a little more often than female representatives. The disease is most common in regions with a low level of sanitary conditions and contaminated water. This group includes Chile, Brazil, Peru, India, Tibet, Nepal, Pakistan, Iraq, Iran, the countries of South Africa.
The classification system of the disease
To date, there are many classification schemes for this pathology. For example, liver abscesses can be primary( a purulent process is formed in the parenchyma of a healthy liver) and secondary( appears against the background of another inflammatory disease).Depending on the nature of the infection, the disease is divided into parasitic and bacterial.
If we take as a criterion the path of infection, then we can distinguish:
- hematogenous abscesses( infection comes with blood flow);
- cholangiogenic forms of the disease( the pathogen gets out of the bile ducts);
- contact( inflammation spreads from nearby organs);
- post-traumatic( it is a complication after injury or surgery);
- cryptogenic( the causes of such forms of pathology are not fully understood).
Liver abscesses can be single or multiple, large or small. Allocate complicated and uncomplicated forms of the disease.
Liver abscess: causes of
The most common cause of the development of a purulent inflammatory process is the penetration into the tissue of the infection. As a rule, the role of pathogen is played by bacterial microorganisms, including E. coli, staphylococci, streptococci and some others.
In addition, parasitic tissue damage is possible. For example, amoebic liver abscess( tropical form of the disease) is widely known. Also purulent inflammation can develop against a background of invasion by ascarids, echinococci, alveococci.
So, an abscess and, as a consequence, a violation of liver function can develop with:
- Penetration of pathogens into the liver through the biliary tract. This is observed in diseases such as cholangitis, cholelithiasis, cholecystitis, cancerous lesions of the bile duct.
- Infection can penetrate along with blood flow through the portal or hepatic veins. Abscess can be a complication in septic lesions of the heart, intestines, spleen, stomach, pancreas.
- Sometimes pathogens penetrate into liver tissue and cells in the presence of infectious inflammation of nearby organs. Therefore, the risk factors include appendicitis, diverticulosis( inflammation of the connective tissue partitions of the large intestine), ulcerative colitis, inflammation of the peritoneum, purulent peritonitis.
- An abscess can be the result of a liver injury, which happens, for example, with a penetrating wound in the abdominal cavity.
- Tissue infection can occur during surgery on the abdominal organs.
First signs of
disease How does liver abscess appear? Symptoms can be divided into two groups. In the early period of the development of the disease, there are mainly signs of intoxication of the body. First, as a rule, there is a fever, general weakness, chills, aches in the body. The patient complains of constant fatigue and drowsiness, dizziness, noise in the ears, headaches. Appetite is sharply reduced.
Later the symptoms become more pronounced. For example, you can observe the release of a large amount of sticky sweat. Also, blurred vision, hallucinations, impaired attention and memory. Patients complain of constant nausea. From time to time, vomiting occurs, and the contents of the intestine.
Symptoms of abscess associated with liver abnormalities
As the disease progresses, other disorders join the symptoms of intoxication. As a rule, they testify that there is already a serious violation of the liver function.
Patients begin to complain of pain in the right hypochondrium. At first, this is only discomfort, which as the abscess grows becomes more pronounced. The pain syndrome can worsen depending on the intake of food, physical activity, drug therapy of other diseases, etc.
Due to a decrease in appetite, nausea and vomiting, a gradual decrease in body weight is observed. During the medical examination, the doctor can determine the presence of hepatomegaly( enlargement of the liver in size) and splenomegaly( increase in the size of the spleen).
On the other hand, some patients report a rapid weight gain, which is associated with the development of ascites. Free liquid begins to accumulate in the abdominal cavity, so the patients are enlarged, even the bulge is protruding.
To attributes of an abscess it is possible to carry and yellowness of integuments that is connected with jaundice development. Often against the background of this pathology, there is an appearance or exacerbation of hemorrhoids. If the inflammation of the liver tissue is accompanied by increased pressure in the hepatic vessels, it is possible bleeding from the veins of the gastrointestinal tract. This complication can be manifested, for example, by vomiting, in a consistency resembling a coffee grounds, or by the formation of a black tarry stool.
Current diagnostic methods for
If symptoms persist, seek medical attention immediately. A purulent abscess is incredibly dangerous. The sooner the patient is provided with qualified care, the higher the chances of a successful recovery.
To begin with, the specialist will get familiar with the complaints of the person, will conduct a general inspection. In the process of diagnosis, analysis is extremely important. For example, during a general blood test, you can note a decrease in hemoglobin, a decrease in the number of red blood cells and platelets. Along with this, the level of ESR increases, the number of leukocytes significantly increases, which in itself indicates the presence of inflammation.
With an abscess, darkening of the urine is often observed. During laboratory tests, an abnormal number of erythrocytes and leukocytes can be seen. Also, liver tests are performed, during which it is possible to get ahead of the increase in the level of alkaline phosphatase, direct and total bilirubin. Sometimes an additional coagulogram is performed, which in liver abscess shows a decrease in blood coagulability. Characteristic of this disease is fecal discoloration. When analyzing stool, blood can be detected.
An important stage in the diagnosis are instrumental studies. The most popular and affordable is the X-ray of the abdominal organs, which can show the presence of a rounded cavity with sharp edges, located in the liver parenchyma - this is an abscess. With the help of ultrasound equipment, it is possible to confirm the diagnosis and determine the size of purulent formation.
Quite accurate, but also costly are such studies as computer and magnetic resonance imaging. Such procedures help to accurately diagnose, determine the exact location, the number and size of abscesses, and sometimes even establish the cause of the inflammatory process. Sometimes patients are assigned a biopsy - during the procedure, the internal contents of the detected tumor are sampled and then analyzed in the laboratory.
Diagnostic laparoscopy is much less common, during which the doctor examines the internal organs( in this case, the liver) with the help of special chambers inserted inside through the puncture of the abdominal wall. The procedure is quite dangerous, since the risk of damage to the abscess with an instant outflow of purulent masses is high.
What complications are possible?
Abscesses of the liver are serious disorders that can not be ignored in any case. In the absence of treatment, the formation may burst, secreting purulent contents. The consequence of such a break can be purulent gastritis( purulent contents enter the stomach tissue), peritonitis( after the rupture purulent masses spread through the abdominal cavity), pleurisy( the contents of the abscess get into the pleural cavity), pericarditis( pus in the pericardial cavity, which is extremely dangerous for the cardiacmuscle), enteritis( breakthrough formation occurs in the intestine).
There are other, no less serious complications. For example, against the background of a rupture, a sub-diaphragmatic abscess can develop, in which a large amount of purulent mass accumulates directly under the diaphragm. The consequences include heavy blood loss as a result of bleeding from the liver. Sometimes patients develop ascites, which is accompanied by the accumulation of a large amount of fluid in the abdominal cavity. As a result of an increase in the abscess, portal hypertension is possible - a condition that is associated with an increase in blood pressure in the portal vein, which in turn is accompanied by bleeding from the veins of the digestive tract.
As you can see, a sick liver is not something that can be taken lightly. If you have any symptoms, you need to see a doctor.
Medical treatment of abscess
What do doctors offer to patients who have been diagnosed with "liver abscess"?Treatment at the initial stages can be medicamentous, especially if the inflammatory process progresses slowly, the growth does not increase, there is no risk of its rupture.
First of all, therapy is aimed at removing the cause of inflammation, i.e., to eliminate infection. During the diagnosis, doctors are able to find out, under the influence of which microorganism appeared abscess. If it is a bacterial form of the disease, then the administration of antibiotics is prescribed. The most effective today are cephalosporins of the third generation( "Cefoperazol", "Ceftriaxone"), protected penicillins( Amoxiclav, Augmentin), third or fourth generation fluoroquinolones( Ciprofloxacin, Levofloxacin, Norfloxacin).
If the abscess is associated with the activity of parasites, the patient is prescribed a course of antiprotozoal therapy, in particular, the use of metronidazole or its analogues. Immediately it is worth noting that the treatment is carried out in a hospital. The dosage regimen and dosage can be determined only by the attending physician.
In addition, depending on the patient's condition, symptomatic therapy is prescribed:
- detoxification involves the administration of Ringer's solution or 5% glucose;
- , in the presence of severe pain, prescribe such drugs as "No-shpa"( relieves spasm) and "Ibuprofen"( relieves pain and fever, inhibits the development of the inflammatory process);
- also requires the reception of enterosorbents, for example, "Smekty" between meals;
- in the presence of internal bleeding appoint etamzilat sodium, which stops the loss of blood;
- if the patient suffers from persistent vomiting, prescription of antiemetic drugs, for example, "Metoclopromide" or "Cerucal", is possible.
Surgical treatment: when is it necessary?
In some cases, medical treatment is not able to eliminate liver abscess. The operation in such cases is necessary. In addition, surgical intervention is mandatory in emergency conditions( for example, rupture of an abscess).
To date, there are several ways of surgical treatment. The simplest is the drainage of the abscess. The essence of the procedure is as follows: through small incisions into the abscess cavity two special tubes are introduced. Through one of them the solution with an antibacterial preparation is constantly supplied, and through the other outward the contents of purulent formation are displayed. Typically, this treatment lasts about 3-4 days.
Unfortunately, this technique does not have an effect when the abscess ruptures or if there are multiple lesions. In such cases, a laparotomy is performed. Access to the liver surgeon gets through the incision of the abdominal cavity. During the operation, each abscess is opened, then, using an aspirator, the purulent contents are removed. Empty capsules are washed with an antiseptic solution, and then removed while simultaneously suturing healthy liver tissue. Naturally, such an operation is more dangerous( there is a risk of infection) and laborious, and the rehabilitation period lasts a long time. Nevertheless, in some cases this is the only way to save the patient's life.
By the way, along with surgical intervention, medication is often performed. It should also be noted that self-medication for this disease is strictly prohibited, since any unchecked remedy, even herbal decoction, can aggravate the situation. Only the attending physician has the right to prescribe medication.
Diet with abscess
Because the liver is an organ that is directly connected to the digestive tract and the hematopoiesis system, nutrition is of great importance for a patient suffering from certain disorders. The correct diet will speed up the process of therapy, help the body to recover from surgery, prevent the occurrence of relapses.
Patients during and after treatment of an abscess are advised to switch to a fractional diet - there is a need often( up to 6-7 times a day), but portions should be small. This will facilitate the process of digestion and help prevent the development of processes of putrefaction and fermentation in the intestine.
From the diet it is necessary to exclude hard and rough food. Experts recommend eating cereals and some cereals, vegetable soups, lean meat and some types of fish. Vegetables and fruits should be present in the diet, but in no case fresh - they need to cook, bake, stew. Also in the menu you can include dairy products, but with a low percentage of fat. Drink recommended teas, broth of dogrose, compotes and fruit drinks.
There are products with which for the time of treatment and rehabilitation should be said goodbye. To their list include fatty, fried, smoked foods, various pickles, canned food and marinades, sauces, fatty sorts of poultry and meat, spices. Also, patients should give up sweets and baked goods, eggs, whole milk and soda. Categorically contraindicated alcohol.
Correct and, most importantly, timely treatment provides good results. Quite often it is possible to achieve full recovery.