Liver abscesses are dangerous because they can lead to serious consequences, sometimes up to sepsis and death. By the way, such a disease can be both primary and secondary. According to statistics, an abscess appears against the background of other liver diseases no more often than in 3-5% of cases.
However, many people are interested in questions about the course of such a pathology, because the sooner violations are noticed, the sooner a person will receive appropriate treatment. So where is the human liver located and what are the main causes of its damage? How to identify the first signs of an abscess? What complications can the disease lead to? Is surgery necessary or can the disease be treated with conservative medicine? The answers to these questions are of interest to many readers.
Abscess: what is it?
Naturally, many people want to understand basic anatomical terms and explanations first. Where is the human liver located? This is a large organ located in the upper right quadrant of the abdomen (right hypochondrium).
It is worth noting that, due to the absence of pain receptors in the organ, certain liver damage can andnot be accompanied by physical discomfort or pain. Therefore, it is worth carefully monitoring the work of the whole organism. This vital organ cleanses the human blood of toxins and harmful substances, takes part in metabolism, is a glycogen depot (energy reserves), produces bile acids and regulates digestion.
Unfortunately, some people are faced with such a difficult 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 this process, a cavity is formed inside the abscess, where purulent masses begin to accumulate. As the formation develops, it increases in size, and sometimes it can break, releasing 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 women. The disease is most common in regions with poor sanitation and polluted water. This group includes Chile, Brazil, Peru, India, Tibet, Nepal, Pakistan, Iraq, Iran, South African countries.
Disease classification system
Today, there are many classification schemes for this pathology. For example, liver abscesses can be primary (a purulent process forms in the parenchyma of a he althy liver) and secondary (appears against the background of another inflammatory disease). Depending on the nature of the infection,diseases are divided into parasitic and bacterial.
If we take the path of infection as a criterion, then they distinguish:
- hematogenous abscesses (infection gets through the bloodstream);
- cholangiogenic forms of the disease (the pathogen comes from the biliary tract);
- contact (inflammation spreads from nearby organs);
- post-traumatic (we are talking about 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. There are complicated and uncomplicated forms of the disease.
Liver Abscess: Causes
The most common reason for the development of a purulent inflammatory process is the penetration into the tissues of the infection. As a rule, the role of the pathogen is played by bacterial microorganisms, including E. coli, staphylococci, streptococci and some others.
In addition, parasitic tissue damage is also possible. For example, amoebic liver abscess (a tropical form of the disease) is widely known. Also, purulent inflammation can develop against the background of invasion by roundworms, echinococci, alveococci.
So, an abscess and, as a result, liver dysfunction can develop when:
- The penetration of pathogens into the liver through the biliary tract. This is observed in diseases such as cholangitis, cholelithiasis, cholecystitis, cancer of the bile duct.
- Infection can penetrate along with the blood flow through the portal or hepatic veins. An abscess can be a complication of septic lesions of the heart, intestines, spleen, stomach, pancreas.
- Sometimes pathogens penetrate the tissues and cells of the liver in the presence of infectious inflammation of nearby organs. Therefore, risk factors include appendicitis, diverticulosis (inflammation of the connective tissue partitions of the large intestine), ulcerative colitis, inflammation of the peritoneum, purulent peritonitis.
- Abscess can be the result of trauma to the liver, such as a penetrating injury to the abdomen.
- Tissue infection can occur during abdominal surgery.
First signs of disease
How does a liver abscess manifest itself? Symptoms can be divided into two groups. In the early period of the development of the disease, signs of intoxication of the body are mainly manifested. First, as a rule, there is a fever, general weakness, chills, body aches. The patient complains of constant fatigue and drowsiness, dizziness, tinnitus, headaches. Appetite drops sharply.
Subsequently the symptoms become more pronounced. For example, one can observe the release of a large amount of sticky sweat. Blurred vision, hallucinations, impaired attention and memory are also possible. Patients complain of constant nausea. From time to time there is vomiting, and the contents of the intestine.
Abscess symptoms associated withLiver dysfunction
As the disease develops, other disorders join the symptoms of intoxication. As a rule, they indicate that a serious violation of liver function is already present.
Patients begin to complain of pain in the right hypochondrium. At first, this is only discomfort, which becomes more and more pronounced as the abscess grows. Pain may worsen depending on food intake, physical activity, drug therapy for other diseases, etc.
Due to loss of appetite, nausea and vomiting, there is a gradual decrease in body weight. During a physical exam, your doctor may check for hepatomegaly (enlargement of the liver) and splenomegaly (enlargement of the spleen).
On the other hand, some patients report rapid weight gain, which is associated with the development of ascites. Free fluid begins to accumulate in the abdominal cavity, so patients have an increase, even protrusion of the stomach.
The signs of an abscess include yellowness of the skin, which is associated with the development of jaundice. Often, against the background of this pathology, the appearance or exacerbation of hemorrhoids is observed. If inflammation of the liver tissues is accompanied by an increase in pressure in the hepatic vessels, then bleeding from the veins of the gastrointestinal tract is possible. Such a complication can manifest itself, for example, by vomiting, which resembles coffee grounds in consistency, or by the formation of black, tarry stools.
Modern diagnostic methods
If you have symptoms, see a doctor immediately. A purulent abscess is incredibly dangerous. The sooner the patient is provided with qualified assistance, the higher the chances of a successful recovery.
To begin with, the specialist will get acquainted with the complaints of the person, conduct a general examination. In the process of diagnosis, analyzes are extremely important. For example, during a general blood test, a decrease in hemoglobin levels, a decrease in the number of erythrocytes and platelets can be noted. Along with this, the level of ESR increases, the number of leukocytes increases significantly, which in itself indicates the presence of inflammation.
When an abscess is often observed darkening of the urine. During laboratory tests, you may notice an abnormal number of red blood cells and white blood cells. Liver tests are also carried out, 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, with a liver abscess, shows a decrease in blood clotting. This disease is characterized by discoloration of the feces. A stool test can detect the presence of blood.
Instrumental studies are also an important stage of diagnostics. The most popular and affordable is an x-ray of the abdominal organs, which can show the presence of a rounded cavity with clear 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 the purulent formation.
Pretty accurate, but alsoExaminations such as computed tomography and magnetic resonance imaging are expensive. Such procedures help to accurately diagnose, determine the exact location, number and size of abscesses, and sometimes even determine the cause of the development of the inflammatory process. Sometimes patients are also prescribed a biopsy - during the procedure, the internal contents of the identified neoplasm are taken, followed by analysis in the laboratory.
Much less often, diagnostic laparoscopy is performed, during which the doctor examines the internal organs (in this case, the liver) using special cameras inserted inside through a puncture in the abdominal wall. The procedure is quite dangerous, as there is a high risk of damage to the abscess with an instant outpouring of purulent masses.
What complications are possible?
Liver abscesses are serious disorders that should never be ignored. If left untreated, the formation may rupture, releasing purulent contents outward. The consequence of such a rupture may be purulent gastritis (purulent contents enter the tissues of the stomach), peritonitis (after rupture, purulent masses spread throughout the abdominal cavity), pleurisy (the contents of the abscess enter the pleural cavity), pericarditis (pus in the pericardial cavity, which is extremely dangerous for the heart). muscles), enteritis (breakthrough formation occurs in the intestines).
There are other equally serious complications. For example, against the background of a rupture, a subdiaphragmatic abscess may develop, in which a large amount of purulent masses accumulate directly under the diaphragm. The consequences cancarry 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 enlarged 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 diseased liver is not something to be taken lightly. If you have the slightest symptoms, you should consult a doctor.
Medicated treatment of abscess
What do doctors offer to patients diagnosed with liver abscess? Treatment at the initial stages can be medical, especially if the inflammatory process progresses slowly, the neoplasm does not grow, there is no risk of its rupture.
First of all, therapy is aimed at removing the cause of inflammation, i.e., at eliminating the infection. During the diagnosis, doctors manage to find out under the influence of which particular microorganism an abscess appeared. If it is a bacterial form of the disease, then antibiotics are prescribed. The most effective today are third-generation cephalosporins (Cefoperazole, Ceftriaxone), protected penicillins (Amoxiclav, Augmentin), third- or fourth-generation fluoroquinolones (Ciprofloxacin, Levofloxacin, Norfloxacin).
If the abscess is associated with the activity of parasites, then the patient is prescribed a course of antiprotozoal therapy, in particular, taking metronidazole or its analogues. At onceIt should be noted that the treatment is carried out in a hospital. Medication regimen and doses can only be determined by the attending physician.
In addition, depending on the condition of the patient, symptomatic therapy is prescribed:
- detox includes Ringer's solution or 5% glucose;
- in the presence of severe pain, drugs such as No-shpa (relieves spasm) and Ibuprofen (relieves pain and fever, inhibits the development of the inflammatory process) are prescribed;
- it is also necessary to take enterosorbents, for example, "Smecta" between meals;
- in the presence of internal bleeding, sodium etamsylate is prescribed, which stops blood loss;
- if the patient suffers from persistent vomiting, anti-emetics such as Metoclopromide or Cerucal may be prescribed.
Surgery: when is it needed?
In some cases, drug treatment is not able to eliminate a liver abscess. An operation is necessary in such cases. In addition, surgery is mandatory for emergencies (such as a ruptured abscess).
Today, there are several ways of surgical treatment. The simplest is the drainage of an abscess. The essence of the procedure is as follows: through small incisions, two special tubes are inserted into the abscess cavity. Through one of them, a solution with an antibacterial drug is constantly supplied, and through the other, the contents of the purulent formation are removed to the outside. Usually,this treatment lasts about 3-4 days.
Unfortunately, this technique does not work when an abscess ruptures or in the presence of multiple lesions. In such cases, a laparotomy is performed. The surgeon gets access to the liver through an incision in 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 suturing he althy liver tissue. Naturally, such an operation is more dangerous (there is a risk of infection) and time-consuming, and the rehabilitation period lasts quite a long time. However, in some cases, this is the only way to save the patient's life.
By the way, along with surgery, drug therapy is often performed. It is also worth noting that self-medication for this disease is strictly prohibited, since any untested remedy, even herbal decoction, can aggravate the situation. Only the attending physician is authorized to prescribe medications.
Diet for abscess
Since the liver is an organ that is directly connected with the digestive tract and the hematopoietic system, nutrition is of great importance for a patient suffering from certain disorders. The right diet will speed up the process of therapy, help the body recover from surgery, and prevent relapses.
Patients during and after the treatment of an abscess are recommended to switch to fractional meals - you need to eat often (up to 6-7 times a day), but portions should be small. This will make the process easierdigestion and help prevent the development of putrefaction and fermentation in the intestines.
From the diet you need to exclude solid and coarse food. Experts recommend eating cereals and some cereals, vegetable soups, lean meats and some types of fish. Vegetables and fruits should be present in the diet, but by no means fresh - they need to be boiled, baked, stewed. You can also include fermented milk products in the menu, but with a low percentage of fat content. Teas, rosehip broth, compotes and fruit drinks are recommended to drink.
There are products that you should say goodbye to during treatment and rehabilitation. Their list includes fatty, fried, smoked foods, various pickles, canned food and marinades, sauces, fatty poultry and meat, spices. Also, patients should give up sweets and pastries, eggs, whole milk and soda. Alcohol is strictly contraindicated.
Correct and, most importantly, timely therapy gives good results. Quite often, full recovery is achieved.
