What does a bubble with pus on the liver mean. How and why does a liver abscess form? Signs, diagnosis, treatment. Symptoms and course of the disease

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With abscesses of the liver of microbial origin, surgical treatment, which includes both measures to strengthen the body's defenses, and local effects on the pathological focus. The latter is possible in different versions, depending on the number, size and topography of abscesses. With single abscesses, it is advisable to start treatment with abscess puncture.

As already mentioned in the diagnostic section, it is possible to perform a puncture through intact skin, according to the location of the abscess under ultrasound control or during laparoscopy. Upon receipt of pus, it is sent for sowing in order to determine the nature of the microflora and its sensitivity to antibiotics.

The cavity is emptied and drained after washing with antiseptic liquids. Abscesses contain thick pus and areas of hepatic tissue sequesters, so simply puncture is usually not enough, and abscess puncture is resorted to after opening the abdominal cavity with a small incision with drainage of sufficient diameter.

If the abscess is localized on the diaphragmatic surface of the liver, then laparotomy can be performed according to Melnikov with resection of sections of the ribs according to the location of the abscess.

If the abdominal cavity is opened according to Melnikov, then the edges of the diaphragm incision should be sutured to the edges of the wound in order to delimit the subdiaphragmatic space from the rest of the abdominal cavity.

An abscess on the diaphragmatic surface of the liver can be opened from an incision under the twelfth rib according to M.M. Solovyov.

In the case of localization of the abscess in the posterior upper sections of the right lobe of the liver, it is possible to access it through the sections of the liver that are not covered by the peritoneum, from the posterior access.

When opening liver abscesses, it should be borne in mind that in the immediate vicinity of the abscess cavity there is an extensive network of blood vessels overflowing with blood due to the presence of an inflammatory process. Hence the likelihood of massive bleeding from the walls of the cavity, both during the opening of the abscess, and in the postoperative period. During the operation, bleeding vessels, both in the walls of the cavity and inside it, must be carefully sheathed, and in the postoperative period, the possibility of arrosive bleeding should be taken into account.

With small multiple abscesses, it is possible to start treatment with a transumbilical infusion of broad-spectrum antibiotics and resort to surgical intervention in cases where infusion treatment fails.

With large abscesses with a pronounced pyogenic capsule and with multiple abscesses, the operation of choice is liver resection.

The first to remove the left lobe of the liver for an abscess was Caprio (1931) (according to T. Tung, 1962). A.V. Melnikov (1956) reported on 11 operations performed by Soviet surgeons. T. Tung (1962) carried out 132 resections of the liver for cholangitis abscesses and abscesses caused by the introduction of ascaris into the liver. Active tactics for liver abscesses are defended by J. Patel, L. Leger (1975). B.I. Alperovich, with liver abscesses, performed 6 liver resections without lethal outcomes.

Treatment of amoebic liver abscesses involves the general treatment of amebiasis with emetine in combination with punctures of the abscess or abscesses. At the same time, the contents of the abscess are aspirated and 5 ml of 0.5% metronidazole or 5 ml of 5% chloroquine (delagil) with antibiotics are introduced into its cavity. A 1:1000 solution of emetine can be injected into the abscess cavity. O.G. Babaev (1972) used chloroquine for the treatment of amoebic abscesses, which, in his opinion, gives the best results.

All surgeons involved in the treatment of amoebic liver abscesses by surgery note a high mortality rate when using surgical methods of treatment. At the same time, the treatment of amoebic abscesses by punctures with the introduction of chloroquine gives better results. In the case of a combination of microbial flora with amoebae, one should resort to surgical intervention - opening abscesses in the liver. Amoebic abscess ruptures also require surgery.

Liver abscess - a disease that occurs as a result of purulent inflammation of the liver tissues, their death and the formation of a cavity filled with pus.

Purulent-destructive education can be single or multiple. With a diffuse form, multiple abscesses are formed, as a rule, quite small. Single - larger, sometimes there are two or three abscesses.

In most cases, a liver abscess develops as a secondary disease, more often in middle-aged and older people. The prognosis of the course of the disease is always very serious and the complete recovery of the patient depends on a number of concomitant pathology factors.

Causes of a liver abscess

• hematogenous - the infection spreads with blood flow through the vessels of the body;
• cholangiogenic - the infection enters the liver cells from the biliary tract;
• contact and post-traumatic- occur after open and closed injuries of the abdomen;
• cryptogenic - the source of infection has not been established.

Liver abscess occurs as a complication after dysentery, purulent infection of the body, purulent cholangitis and pylephlebitis. Injuries and intoxications that impair liver function can also lead to abscesses.

Symptoms of a liver abscess

The signs of this disease are often atypical, that is, the overall clinical picture may resemble any of the severe diseases of the internal organs:

• heart disease, etc.

A liver abscess develops slowly, and symptoms also appear slowly. Due to the development of the internal inflammatory process, the body temperature is constantly elevated. It may be accompanied by shaking chills, feverishness, and profuse sweating.

Weakness, nausea, sometimes vomiting appear, the patient loses his appetite, and body weight decreases. In the right hypochondrium, constant, dull pains are noted, extending to the lower back, right scapular region and shoulder. They are preceded by . On percussion, an increase in the size of the liver is detected, and on palpation, its increased soreness is noted.

Weight loss is often the only complaint in the early stages of an abscess, making early diagnosis difficult. In later stages, yellowness of the mucous membranes and skin appears. With compression of the liver vessels or their thrombosis due to the inflammatory process, ascites (accumulation of fluid in the abdominal cavity) may appear.

The main feature of the course of liver abscesses is that the clinic is often masked by the underlying disease, against which the abscess developed, therefore, it often takes a long time from the beginning of the formation of the pathological process to its diagnosis.

Diagnostics

At the initial stages of development in the body of purulent cavities, their identification is difficult. The doctor can suggest a pathology when clarifying complaints, when examining a patient.

From diagnostic surveys are prescribed:

1. X-ray examination.
2. Ultrasound examination (ultrasound) of the liver.
3. Spiral computed tomography (SCT).
4. Magnetic resonance imaging (MRI).
5. Puncture fine needle aspiration biopsy (PTAB).
6. Radioisotope scanning of the liver.

In the most difficult cases resort to diagnostic laparoscopy. At the same time, a special video instrument is introduced into the abdominal cavity, which allows you to examine the organs, determine the diagnosis, and, if possible, drain the abscess.

How to treat a liver abscess

Depending on the cause of the liver abscess, as well as the severity of the symptoms of the disease, a treatment regimen is determined.
Therapy of a liver abscess is carried out by conservative and surgical methods. In bacterial forms, depending on the type of pathogen, antibiotics are required, in amoebic forms, anti-amoebic drugs.

Single abscesses are drained under ultrasound guidance, this stage of treatment is necessary for the release of pus. Multiple treated conservatively. An extensive surgical intervention is resorted to when the abscess is located in hard-to-reach places and, if necessary, surgical treatment of the underlying disease. To create a high therapeutic concentration of the antibiotic in the tissues of the organ, the drug is often administered through the hepatic vein, after which a catheter is inserted into it.

All patients with an abscess are prescribed a special diet No. 5, rehabilitation therapy. Be sure to carry out appropriate treatment of the disease that led to the formation of an abscess. Patients of this profile are observed jointly by a gastroenterologist and a surgeon. If necessary, an infectious disease specialist is involved.

The prognosis depends on the form of liver abscess, the severity of symptoms and the effectiveness of the treatment. In the case of a single liver abscess, with timely measures taken, the prognosis may be favorable. About 90% of patients recover, although the treatment is very long. With multiple small abscesses or the absence of treatment of a single abscess, a lethal outcome is very likely.

liver abscess

Liver abscess - a purulent-destructive formation in the liver, which appears as a result of purulent inflammation of the tissues.

As a rule, a liver abscess develops secondary to other liver diseases. Most often people of middle and advanced age are ill. Most often, a liver abscess occurs in men.

Causes

There are the following causes of liver abscess:

Infectious lesions of the liver in various hepatic extrahepatic diseases (cholelithiasis, cholecystitis, cholanigte, cancer of the intrahepatic bile ducts).

Infectious lesions of the liver with sepsis. The infection can enter the liver through the blood vessels (portal or hepatic vein).

The spread of the infectious process in the liver tissue in inflammatory diseases of the abdominal organs (with appendicitis, diverticulitis, ulcerative colitis, and others).

Liver injury (surgical and non-surgical).

Infectious lesion of a cyst or hematoma of the liver.

According to medical observations, most often a liver abscess is caused by appendicitis and gallstone disease.

Symptoms

The main symptoms of a liver abscess are:

Increase in body temperature (above 38 degrees);

Pain in the right hypochondrium;

hepatomegaly;

feeling of heaviness in the right side;

deterioration in appetite;

Decrease in body weight;

·jaundice;

Diagnostics

Diagnosis for amoebic abscess includes:

analysis of the anamnesis of the disease and complaints of the patient;

physical examination, in which the doctor notes the weight loss of the patient, fever and pain on palpation of the liver;

·general blood analysis;

x-ray examination of the liver;

Ultrasound examination of the liver;

spiral computed tomography;

·Magnetic resonance imaging;

Puncture fine-needle aspiration biopsy performed under ultrasound control;

radioisotope scanning;

diagnostic laparoscopy;

Other research methods (at the discretion of the doctor).

Types of disease

Depending on the number of abscesses, single and multiple liver abscesses are distinguished. Depending on the location, abscesses of the right lobe of the liver and abscesses of the left lobe of the liver are distinguished.

If an abscess appeared in a previously unchanged area, then they speak of a primary liver abscess. Secondary abscesses develop against the background of other diseases.

Patient's actions

If you suspect a liver abscess, you should see a doctor as soon as possible.

Treatment

Treatment of a liver abscess should be complex, including diet therapy, conservative and (if indicated) surgical treatment.

With a liver abscess, fractional nutrition (5-6 times a day) in small portions is shown. Spicy, fatty, smoked and fried foods should be excluded from the diet. The use of table salt is limited (up to 3 grams per day). The patient's diet should be high in protein (meat, dairy and legumes are indicated). The diet should include a high content of vitamins and minerals.

With bacterial abscesses, the patient is shown a course of antibiotic therapy and other antibacterial drugs (metrogil, etc.). With amoebic liver damage, anti-amoebic drugs are prescribed.

For therapeutic purposes, with a liver abscess, percutaneous drainage of the abscess is performed under ultrasound control. Antibiotics may also be injected into the abscess cavity.

Surgical treatment of an abscess is performed if there are several large abscesses or if drainage is not possible.

Complications

With a liver abscess, the following complications may develop:

rupture of an abscess

bleeding from the vessels of the liver;

subdiaphragmatic abscess.

Prevention

Primary prevention of liver abscess involves the prevention of diseases that can potentially cause a liver abscess. Primary prevention comes down to following the principles of healthy eating and personal hygiene.

Secondary prevention of liver abscess provides timely and adequate treatment of infectious and inflammatory diseases, against which the development of a liver abscess is possible.

Liver abscess is an inflammatory disease characterized by the appearance of a cavity filled with pus in the parenchyma of the organ. The reasons for this phenomenon may vary, but in most cases, the activity of bacteria or helminths (amebic liver abscess) plays a leading role. Diagnosis is carried out on the basis of clinical signs, as well as the results of additional studies (ultrasound, MRI, CT). Treatment in the first stages can be medication (antibiotic therapy), if necessary, the abscess is opened surgically. Full-fledged laparoscopic operations are practically not used, and pus is removed with a needle.

Causes of the disease

Purulent liver abscess occurs only with the participation of pathogenic microflora. The direct pathways for bacteria to enter the liver may vary. Among all the existing diseases that can lead to the development of an abscess, doctors distinguish:

• cholangitis - inflammation of the bile ducts;
• cholecystitis - inflammation of the gallbladder;
• stones in the gallbladder;
• rupture of the appendix with appendicitis;
• perforation of the walls of the stomach with peptic ulcer;
• any diseases that proceed like sepsis;
• effects of a liver cyst.

When microorganisms enter the liver parenchyma, they continue to multiply. This process occurs with purulent fusion of the tissues of the organ and the formation of a purulent mass. Over time, a cavity is formed with a dense fibrous capsule filled with pus. Thus, the body prevents further melting of the liver parenchyma and localizes inflammation.

Much less often, the disease is associated with fungal microflora, but this variant of its development is also possible. Pathogenic fungi infect liver tissue in patients with a weakened immune system, often after chemotherapy or leukemia.

The causative agent of amoebic abscess is a dysenteric amoeba that first causes dyspepsia and then migrates to the liver

Classification of hepatic abscesses

In the classification of this disease, it is important to determine the route of infection to the liver tissue. The pathogen can enter the liver in three different ways:

• hematogenous (with blood flow, through the portal vein or hepatic artery);
• cholangiogenic (through the bile ducts);
• contact (this path is associated with inflammation of the gallbladder and biliary tract);
• traumatic (with open or closed injuries of the abdominal cavity).

Depending on the localization of the process, one can distinguish:

• abscesses of the right lobe of the liver (diagnosed in about 2/3 of cases);
• abscesses of the left lobe.

There is another classification of abscesses. Among them are:

• primary - occur in previously intact liver parenchyma;
• secondary - associated with a complication of non-purulent liver diseases (cysts, tumors, tuberculous and syphilitic granulomas).

There are also single and multiple abscesses. More often there is one large focus of inflammation, but in some cases (amebic liver abscess, cholangiogenic pathway of pathogen penetration), there may be several.

Who is at risk?

At risk are patients over 70 years of age, as well as those who have a history of liver cirrhosis, diabetes mellitus, pathologies of the immune system of various origins, and diseases of the pancreas. According to statistics, men are more likely to suffer from this disease.

Symptoms

Symptoms of a liver abscess are nonspecific and resemble the course of other inflammatory diseases of the liver and biliary tract. Patients present with a typical set of clinical signs:

• general deterioration of health, weakness, malaise;
• a persistent increase in body temperature, which indicates the development of an inflammatory process in the body;
• pain in the right hypochondrium, which increases with palpation;
• the liver is enlarged and protrudes beyond the edges of the costal arch;
• yellowness of visible mucous membranes, earthy skin tone.

If the liver is enlarged and presses on the diaphragm, the patient may complain of coughing and shortness of breath. In this case, the pain can spread not only to the liver area, but also to the right shoulder and back. In some cases, the invasion of the disinteric amoeba is not manifested by all the complex symptoms, but only by pain, fever, or indigestion. Often the only clinical sign of an abscess is unexplained weight loss.

Possible Complications

Without timely treatment, the disease progresses, and dangerous complications cannot be avoided. In some cases, the process can even lead to death. The amount of pus increases, and surrounding healthy tissues are involved in the process. The area of ​​the liver, which is able to perform its functions, is sharply reduced.

Large abscesses pose a danger to the life of the patient

The most undesirable complication of a liver abscess is a subdiaphragmatic abscess. This phenomenon occurs as a result of rupture of the liver tissues with the outflow of pus into the cavity located under the dome of the diaphragm. It is also possible for pus to enter the pleural or peritoneal cavity with infection of the serous membranes, the development of peritonitis and sepsis - blood poisoning. If pus penetrates into the pericardial bags, pericarditis develops - inflammation of the outer shell of the heart. There is also a risk of lung tissue infection and fistula formation.

Due to increased pressure in the liver portal vein system, internal bleeding or ascites (accumulation of large amounts of fluid in the abdominal cavity) may occur. The infection can also enter the bloodstream and spread throughout the body. Secondary purulent foci occur in any organs and tissues, including the brain.

Diagnostic methods

• cysts;
• cholecystitis;
• subphrenic abscess;
• pleurisy with purulent capsules;
• tumors or metastases in the liver.

Diagnosis includes taking an anamnesis, questioning and examining the patient. The doctor needs to know whether a person had a risk of contracting a disinteric amoeba (this helminth is typical for a tropical climate), whether he had other diseases that provoke the development of an abscess. Next, you need to palpate the liver and collect tests.

On ultrasound, you can examine the liver, assess the degree of damage to it and detect the exact localization of the abscess. It is viewed as a heterogeneous formation of different volumes. This type of study will also determine the presence of partitions. If the abscess is small and has septa, it will make it difficult to drain.

Drainage is a minimally invasive procedure during which pus is removed with a long needle.

X-ray will allow you to determine the clarified area in the liver, filled with fluid. You can also find signs of ascites (abdominal dropsy) and limited diaphragm mobility.

Treatment of a liver abscess

The tactics of treatment is chosen individually. If a patient has one or more small abscesses, medication is prescribed. In more advanced cases, the abscess is drained, and with a large volume, a full-fledged laparoscopic operation is indicated.

Diet number 5

The diet is assigned to all patients. It is necessary for the proper functioning of the liver and removing from it the extra burden of removing toxins. Its main principles:

• completely eliminate fatty, fried, smoked foods from the diet;
• minimize salt intake;
• increase the protein content in the daily diet (fish, meat, milk protein);
• choose foods with a high level of vitamins and minerals: fish, buckwheat, fresh vegetables and fruits.

Patients are examined by a gastroenterologist.

Medical treatment

The choice of medicines depends on the type of pathogen. If bacteria were isolated during the study of pus and biopsy, they are destroyed with broad or narrow spectrum antibiotics. Specific anti-amoeba drugs are used against the disinteric amoeba. Additionally, a course of immunomodulators, hepatoprotectors and vitamins is prescribed.

Types of surgical treatment of abscesses

Whenever possible, surgeons choose a minimally invasive technique for treating an abscess. Under the control of an ultrasound machine, a long thin needle is inserted into the abscess cavity, through which pus is removed. Using the same device, you can rinse the formation cavity with antiseptics or antimicrobial solutions. For washing, bilateral drainage is used - two tubes, through one of which the liquid is introduced into the cavity, and from the other it is extracted.

If the abscess is large or has septa, the minimally invasive method is not used. Such patients are prescribed abdominal surgery with opening of the abdominal cavity and mechanical drainage of the abscess. Its edges are then sutured. The manipulation is performed under general anesthesia, and after it follows a long rehabilitation period.

Prevention and prognosis

The prognosis depends on the timeliness of the visit to the doctor and the presence of complications. If you start treatment on time, you can get by with medication, and the outcome will be favorable. Possible complications with infection of the serous membranes, sepsis or multiple abscesses endanger the life of the patient.

The only way to prevent is the responsibility of the person and the observance of hygiene rules

Disease prevention is a task not only of the population, but also of special sanitary services. It is mandatory to:

• identify carriers of amoebiasis at an early stage and isolate them in infectious diseases hospitals;
• check the sewers for a disinteric amoeba;
• monitor the purity of the products sold;
• prevent carriers of amoebic infection from working in catering networks;
• check reservoirs, carry out their regular cleaning.

Personal hygiene must be taken care of by yourself. These activities include washing hands before every meal and timely health checks. It is not recommended to buy food in spontaneous markets or draw water from natural sources. When the first signs of discomfort appear, you should immediately consult a doctor.

An abscess of the liver is its inflammation with the formation of a cavity filled with pus. The danger of the disease lies in the high probability of death if the treatment is not started in time. It is worth remembering that the disease may not manifest itself with characteristic signs of liver damage (pain in the right hypochondrium and an increase in the organ), but with general symptoms - fever and weakness. The success of treatment depends on the conscientiousness of the patient: the sooner he seeks help from specialists, the greater his chances for a full recovery.

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