The concept of a liver abscess
Abscesses of the liver after extensive useAntibiotic became a rare disease. Liver abscess arise from the ascending biliary infections; hematogenous spread of infection at the portal venous system or via the hepatic artery in sepsis; the direct spread of infection in inflammatory diseases of the abdominal cavity; liver injury. In most cases, liver abscesses are a complication of severe, often purulent, cholangitis, which occurs when gallstones or cancer of the extrahepatic bile ducts. Other causes are sepsis, pylephlebitis, which can be a complication of destructive appendicitis, diverticulitis, colon cancer, ulcerative colitis.
Pyogenic abscesses can be solitary, but more often multiple. Single abscess often located in the right lobe.
The bacterial flora in the abscess showapproximately 50% of cases. When sepsis often sown Staphylococcus aureus, hemolytic streptococcus, with biliary abscesses increasingly finding E. coli or a mixed flora. In recent years, much attention is paid to the anaerobic flora, which is possible to detect only at planting pus a special environment.
The main symptoms of the disease
Abscess of liver disease is always secondary. Against the background of the clinical manifestations of the underlying disease or intermittent temperature gets hectic nature, there are chills, sweating, nausea, decreased appetit.Bol is a late symptom and usually occurs in single large abscesses. Often increases the liver and there is tenderness to palpation of its edge. Sometimes ikterichnost skin and sclera. In the analysis of blood - high leukocytosis with a shift to the left, and anemia. When blood cultures disease pathogen is detected in approximately 30%, often with abscesses septic origin. In Review abdominal X-rays show a high standing and limited mobility of the right dome of the diaphragm, it is possible accumulation of fluid in the pleural sinus. When gassing the flora on the background of the shadow of the liver can be determined by the level of liquid, sometimes found the top of the liver contour deformation. The diagnosis helps liver ultrasound, X-ray computer tomography, angiography and liver scan with technetium-99.
Treatment of liver abscess
Antibiotic treatment in accordance with thethe sensitivity of microflora. To create a greater antibiotic concentration in the liver, the introduction of a catheter into the hepatic artery or vein in the umbilical and after its release from the tool bougienage purpose of dilation. When single large or multiple large abscesses operative treatment - opening and drainage of abscess. The most gentle and at the same time an effective treatment (especially when multiple abscesses) is a percutaneous drainage of abscess under the control of a computer tomograph or an ultrasound scanner.
- subdiaphragmatic abscess
- a breakthrough in the free abdominal abscess, or pleural cavity
Forecast always very serious. When single large abscess drainage in the event of timely recover up to 90% of patients. Multiple abscesses and undrained single almost always lead to death.