What Is a Liver Abscess?

Liver abscess is a liver purulent lesion caused by a variety of microorganisms such as bacteria, fungi, or amoeba, and if not actively treated, the mortality rate can reach 10% to 30%. The liver has a rich pipeline system, including the biliary system, portal system, hepatic arteriovenous system, and lymphatic system, which greatly increases the probability of microbial parasitism and infection. There are three types of liver abscesses. Bacterial liver abscesses are often caused by mixed infections caused by multiple bacteria, about 80%, amoebic liver abscesses are about 10%, and fungal liver abscesses are less than 10%.

Basic Information

English name

liverabscess

Visiting department

Internal medicine

Common symptoms

Pain, edema

Contagious

no

Causes of liver abscess

The incidence of amoebic liver abscess is closely related to amoeba colitis, and most of the abscesses are single; the bacterial invasion pathway of bacterial liver abscess can be caused by the direct spread of intra-abdominal infection, in addition to sepsis, and can also be caused by the umbilicus Infection enters the liver through the umbilical vessels and portal veins, and biliary tapeworms can also be the cause of bacterial liver abscesses. Common bacteria are Staphylococcus aureus and Streptococcus. In addition, during open liver injury, bacteria can cause liver abscesses with wounded foreign bodies or direct invasion from wounds; bacteria can also come from ruptured small bile ducts. Some unexplained liver abscesses, called cryptogenic liver abscesses, may be related to existing occult lesions in the liver. When this occult lesion weakens, the pathogens multiply in the liver and liver abscesses occur. It has been pointed out that 25% of cryptogenic liver abscesses are accompanied by diabetes.

Clinical manifestations of liver abscess

Symptoms

Irregular septic fever, especially bacterial liver abscess is more significant. Persistent pain in the liver area increases dramatically with deep breathing and body movement. Respiratory and abdominal symptoms can occur due to different abscess locations. Has a history of diarrhea.

2. Signs

The liver is often swollen, and most have localized edema and marked tenderness in the intercostal space equivalent to the abscess. Some patients may develop jaundice. If the abscess penetrates to the thorax, empyema appears, and the lung abscess or puncture to the abdominal cavity develops peritonitis.

Liver abscess examination

Laboratory inspection

Elevated white blood cells and neutrophils, especially bacterial liver abscesses, can reach (20-30) × 10 ⁹ / L. Amoebic cysts or trophozoites can be found in feces of amoebic liver abscesses. ELISA Adsorption (ELISA) measurement of anti-amoeba antibodies in the blood can help determine the nature of the abscess, with a positive rate of 85% to 95%.

2. Liver puncture

Amoebic liver abscess can extract chocolate-colored pus; bacterial can extract yellow-green or yellow-white pus, and culture can obtain pathogenic bacteria. The pus should be tested for AFP to exclude liquefaction of liver cancer.

3. Cassoni skin test

Can exclude liver hydatid disease.

4.X-ray inspection

Elevation of the right diaphragm is seen, limited mobility, and sometimes pleural reactions or effusions.

5. Type B Ultrasound

It has a certain value for diagnosis and determination of the abscess location, and it needs to be distinguished from liver cancer when the abscess is not fully liquefied.

6.CT inspection

Single or multiple circular or oval-shaped low-density areas with clear boundaries and uneven density can be seen, and bubbles can be seen inside. There is no change in the density of the pus cavity in the enhanced scan, and the cavity wall is strengthened with irregularly increased density, which is called "circumferential sign" or "sun halo sign".

Liver abscess treatment

Bacterial liver abscess

(1) Antibiotics For localized inflammation of the liver in the acute phase, abscesses have not yet formed, or multiple small abscesses should be actively treated with conservative medical treatment. While treating the primary lesion, large-dose antibiotics and systemic supportive therapies are used to control inflammation and promote the absorption of inflammation.

(2) Antibiotic + percutaneous puncture drainage While using antibiotics throughout the body, for a single large liver abscess, puncture and pus under the guidance of B-ultrasound. Inject antibiotics into the pus cavity as much as possible after the pus has been sucked. Repeated puncture and pus suction can also be used to drain the pus. At the same time, the pus cavity is flushed and antibiotics are injected. After the abscess shrinks, the drainage tube is pulled out after no pus is drawn.

(3) Antibiotic + surgical drainage For large liver abscesses, it is estimated that there may be puncture, or it has been punctured and caused peritonitis, empyema, and biliary liver abscess or chronic liver abscess. When antibiotics are applied systemically, they should be actively used. A surgical abscess was performed for drainage and drainage.

(4) Antibiotic + surgical resection For chronic thick-walled liver abscess and liver abscess after incision and drainage, the abscess wall does not collapse, dead space or long-term pus non-union is left unhealed, and intrahepatic bile duct stones are combined with multiple left liver extrahepatic Abscesses and liver lobes that have been severely damaged and have lost normal function can be treated with lobectomy.

2. Amoebic liver abscess, fungal liver abscess

For the treatment of amoebic liver abscess and fungal liver abscess, first consider conservative medical treatment, use of anti-amoeba drugs and antifungal drugs throughout the body, and other treatment principles are basically the same as those of bacterial liver abscess.