Liver abscesses are dangerous in that 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 manifests itself against the background of other liver diseases no 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 noticed, the faster the 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 a disease cause? Is a surgical operation necessary or can an illness be treated with conservative medicine? The answers to these questions are of interest to many readers.
Abscess: what is it?
Naturally, for a start, many people want to deal with basic anatomical terms and explanations. Where is the human liver located? This is a large organ that is located in the upper right abdominal square (right hypochondrium).
It is worth noting that, due to the absence of pain receptors in the organ, certain liver damage may not be accompanied by physical discomfort or pain at all. Therefore, it is worthwhile to closely monitor the work of the whole organism. This vital organ cleanses the human blood of toxins and harmful substances, takes part in the metabolism, is a depot of glycogen (energy reserves), produces bile acids and regulates digestion.
Unfortunately, some people are faced with a diagnosis as complex as an abscess. What it is? This is a purulent inflammation of the tissues, which is accompanied by their so-called fusion. As a result of this process, a cavity is formed inside the abscess, where purulent masses begin to accumulate. As it develops, the formation increases in size, and sometimes it can tear, releasing purulent contents.
According to statistical studies, liver abscesses are usually the result of other diseases of this organ. Men suffer from a similar pathology a little more often than women. The disease is most common in regions with low levels of sanitary conditions and contaminated water. This group includes Chile, Brazil, Peru, India, Tibet, Nepal, Pakistan, Iraq, Iran, countries of South Africa.
Disease classification system
To date, there are many classification schemes for this pathology. For example, liver abscesses can be primary (a purulent process forms in the parenchyma of a healthy 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 spread of infection as a criterion, then we distinguish:
- hematogenous abscesses (the infection enters with a blood stream);
- cholangiogenic forms of the disease (the pathogen enters from the biliary tract);
- contact (inflammation spreads from nearby organs);
- post-traumatic (we are talking about a complication after an injury or surgery);
- cryptogenic (the causes of such forms of pathology are not fully understood).
Liver abscesses can be single or multiple, have large or small sizes. There are complicated and uncomplicated forms of the disease.
Liver abscess: causes
The most common cause of the development of a purulent inflammatory process is the penetration of infection into the tissues. 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 possible. For example, amoebic liver abscess (a tropical form of the disease) is widely known. Purulent inflammation can also develop against the background of invasion of roundworms, echinococci, alveococci.
So, an abscess and, as a consequence of it, impaired liver function can develop with:
- The penetration of pathogens into the liver through the biliary tract. Similar is observed in diseases such as cholangitis, cholelithiasis, cholecystitis, cancer of the bile duct.
- Infection can penetrate along with the blood stream 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, appendicitis, diverticulosis (inflammation of the connective tissue septa of the large intestine), ulcerative colitis, inflammation of the peritoneum, and purulent peritonitis are referred to risk factors.
- 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 the disease
How is a liver abscess manifested? Symptoms can be divided into two groups. In the early period of the development of the disease, mainly signs of intoxication are 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 is sharply reduced.
Subsequently, the symptoms become more pronounced. For example, a large amount of sticky sweat can be observed. Blurred vision, hallucinations, impaired attention and memory are also possible. Patients complain of constant nausea. From time to time, vomiting appears, with intestinal contents.
Symptoms of an abscess associated with impaired liver function
As the disease develops, other disorders join the symptoms of intoxication. As a rule, they indicate that a serious violation of liver function already exists.
Patients begin to complain of pain in the right hypochondrium. At first it’s just discomfort, which as the abscess grows, it becomes more pronounced. The pain syndrome may worsen depending on food intake, 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 a medical examination, the doctor can determine the presence of hepatomegaly (enlargement of the liver in size) and splenomegaly (enlargement of the size 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, therefore, in patients it increases, even the stomach protrudes.
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 tissue is accompanied by an increase in pressure in the liver vessels, then bleeding from the veins of the gastrointestinal tract is possible. Such a complication can be manifested, for example, by vomiting, which resembles coffee grounds in consistency, or by the formation of a black tarry stool.
Modern diagnostic methods
If you have symptoms, urgently need to see a doctor. A purulent abscess is incredibly dangerous. The sooner the patient is provided with qualified help, the higher the chances of a successful recovery.
To begin with, a specialist will familiarize himself with a person’s complaints and conduct a general inspection. In the process of diagnosis, analyzes are extremely important. For example, during a general blood test, a decrease in hemoglobin level, a decrease in the number of red blood cells 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.
With an abscess, a darkening of urine is often observed. During laboratory tests, you may notice an abnormal number of red blood cells and white blood cells. Hepatic tests are also performed, during which you can get ahead of the increase in the level of alkaline phosphatase, direct and total bilirubin. Sometimes a coagulogram is additionally performed, which with a liver abscess shows a decrease in blood coagulability. This disease is characterized by discoloration of feces. An analysis of feces can reveal the presence of blood.
An important stage of diagnosis is also instrumental research. The most popular and affordable is an abdominal x-ray, which can show the presence of a rounded cavity with clear edges located in the liver parenchyma - this is an abscess. Using ultrasound equipment, you can confirm the diagnosis and determine the size of the purulent formation.
Quite accurate, but also expensive are such studies as computed and magnetic resonance imaging. Such procedures help to accurately diagnose, determine the exact location, number and size of abscesses, and sometimes even establish the cause of the development of the inflammatory process. Sometimes a biopsy is also prescribed for patients - during the procedure, the internal contents of the detected neoplasm are sampled, followed by analysis in the laboratory.
Diagnostic laparoscopy is much less common , during which the doctor examines the internal organs (in this case, the liver) using special cameras inserted inside through the puncture of the abdominal wall. The procedure is quite dangerous, since there is a high risk of damage to the abscess with an instant outflow of purulent masses.
What complications are possible?
Liver abscesses are serious disorders that can in no way be ignored. If untreated, the formation may rupture, releasing purulent contents. The consequence of such a rupture can be purulent gastritis (purulent contents enter the stomach tissue), peritonitis (purulent masses spread through the abdominal cavity after rupture), pleurisy (abscess contents enter the pleural cavity), pericarditis (pus in the pericardial cavity, which is extremely dangerous for the heart muscle), enteritis (breakthrough formation occurs in the intestines).
There are other, no less serious complications. For example, against the background of a rupture, a subphrenic abscess may develop, in which a large amount of purulent mass accumulates directly below the diaphragm. The consequences include severe 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 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. When the slightest symptoms appear, consult a doctor.
Medication for abscess
What do doctors offer to patients who have been diagnosed with liver abscess? Treatment at the initial stages can be medication, especially if the inflammatory process progresses slowly, the neoplasm does not grow, there is no risk of rupture.
First of all, therapy is aimed at removing the cause of inflammation, that is, at eliminating the infection. During the diagnosis, doctors manage to find out under the influence of which microorganism an abscess appeared. If we are talking about the 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. It is immediately worth noting that treatment is carried out in a hospital setting. The dosage regimen and dose can only be determined by the attending physician.
In addition, depending on the condition of the patient, symptomatic therapy is prescribed:
- detoxification involves the introduction of Ringer's solution or 5% glucose;
- in the presence of severe pain, drugs such as No-shpa (relieve spasm) and Ibuprofen (relieve pain and fever, inhibit 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 ethamylate is prescribed, which stops blood loss;
- if the patient suffers from constant vomiting, it is possible to prescribe antiemetic drugs, for example, Metoclopromide or Cerucal.
Surgical treatment: when is it necessary?
In some cases, drug treatment is not able to eliminate the liver abscess. Operation in such cases is necessary. In addition, surgery is mandatory for emergency conditions (for example, rupture of an abscess).
Today, there are several methods of surgical treatment. The simplest is the drainage of the abscess. The essence of the procedure is as follows: through special 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 brought out. As a rule, such treatment lasts about 3-4 days.
Unfortunately, such a technique does not give an effect when the 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 abdominal incision. During the operation, each abscess is opened, then, using an aspirator, purulent contents are removed. Empty capsules are washed with an antiseptic solution, and then removed, while suturing healthy 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. Nevertheless, in some cases the only way to save the patient’s life.
By the way, along with surgical intervention, drug therapy is quite often carried out. It is also worth noting that self-medication for this disease is strictly prohibited, since any untested remedy, even a herbal decoction, can aggravate the situation. Only the attending physician has the right to prescribe medication.
Abscess diet
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 various disorders. A proper diet will speed up the therapy process, help the body recover after surgery, and prevent relapses.
Patients during and after treatment of the abscess are recommended to switch to fractional nutrition - you need to eat often (up to 6-7 times a day), but the portions should be small. This will facilitate the digestion process and help prevent the development of rotting and fermentation processes in the intestines.
Solid and rough foods must be excluded from the diet. Experts recommend eating cereals and some cereals, vegetable soups, lean meat and some varieties 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. They recommend drinking teas, a rosehip broth, compotes and fruit drinks.
There are products that you should say goodbye to during treatment and rehabilitation. Their list includes fatty, fried, smoked dishes, various pickles, canned food and marinades, sauces, fatty varieties of poultry and meat, spices. Also, patients should refuse sweets and pastries, eggs, whole milk and soda. Alcohol is strictly contraindicated.
Proper and, most importantly, timely treatment gives good results. Quite often it is possible to achieve a full recovery.