Liver Abscess – causes, symptoms, treatment
The main germ responsible for the formation of liver abscess are: colibacillus, streptococci, staphylococci and anaerobes rarely. The circumstances in which microorganisms can invade the liver parenchyma are:
– Wounds that liver is direct inoculated;
– Blood way;
– Venous blood-way through the portal vein, with the starting point of infectious lesions of the digestive tract;
– Extension of a suppurative process in the neighborhood, especially apendicular, angiocolitis (angiocolitis is an inflammation of the biliary tract) or subphrenic (below the diaphragm);
– A special form is the amoebas abscess due to Entamoeba histolitica, frequent in warm countries.
Liver abscesses can be single or multiple. The uniques are located in most cases the right lobe of the liver.
Abscess size is variable from miliary abscesses (size of a grain of millet) to purulent bulky bags occupying an entire lobe of the liver.
The content of an abscess consists of a creamy pus, pale green, which contains germ cells, altered blood, bile and liver tissue necrotic debris. The body reacts to form a capsule around the abscess.
Sometimes the abscess may perforate into a neighboring organ in subphrenic space (below the diaphragm) or in the large peritoneal cavity.
In terms of clinical onset is variable.
In abscesses secondary to other abdominal infections, formation leads to worsening of pre-existing septic situation: chills, fever, profuse sweating (abundant), digestive disorders with nausea and vomiting. The condition is progressively impaired.
In primitive or suppurations abscesses less virulent, the onset is insidious with fatigue, fever, right upper quadrant pain (abdominal region located immediately below the last coast). Then be installed the sepsis with impaired general state.
Locally, at the inspection, we see a more pronounced venous drawing in the right upper quadrant. Palpable, liver is enlarged, painful, sometimes with localized abdominal contracture.
Regarding investigations, the biological report: hyperleukocytosis (WBC increased) with neutrophilia (increased number of neutrophils), secondary anemia, increased ESR, elevated alkaline phosphatases.
Imaging that can be performed for diagnosis of liver abscesses are: ultrasound, computer tomography, magnetic resonance imaging, abdominal and chest radiography, liver scan with technetium 99, selective arteriography (may show one or more avascular areas depending on the uniqueness of multiplicity of the abscesses).
Coproparasitological examination can be made for Entamoeba histolytica (is the etiologic agent of amoebas abscess) coprologic examination for Entamoeba antigens and serological testing for Entamoeba.
Liver abscesses can develop into a series of serious complications with bleeding by erosion or rupture of vessels in pleura, lung, subfrenic space, digestive organs or large peritoneal cavity.
Treatment of liver abscesses is both medically and surgically.
Medical treatment is of great importance and is based on intensive antibiotic therapy.
Surgical treatment is indicated only in single abscess. Consists of incision and drainage of the collection.