liver abscess
Introduction
Introduction to liver abscess Liver abscess can be caused by A. sinensis or bacterial infection. The incidence of amoebic liver abscess is closely related to amoebic colitis, and most of the abscess is single; bacterial bacterial invasive path of bacterial liver abscess except sepsis It can be caused by direct spread of intra-abdominal infection, or by umbilical infection through the umbilical blood vessels, portal vein into the liver, biliary aphids can also be the cause of bacterial liver abscess, common bacteria are Staphylococcus aureus, streptococcus, etc. . basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: abscess
Cause
Cause of liver abscess
Bacterial infections, especially in the intra-abdominal infection, when bacteria invade the liver, such as patients with weak resistance, liver abscess can occur. The liver receives a double blood supply from the hepatic artery and the portal vein, and communicates through the biliary tract and the intestine. Therefore, the liver is more likely to be infected with bacteria. Bacteria can invade the liver through the following pathways:
Hepatic artery (30%):
This is the second most common cause of bacterial liver abscess. When any part of the body has a purulent lesion, such as suppurative osteomyelitis, otitis media, or sputum, the bacteria can invade the liver through the hepatic artery.
Portal vein (20%):
This is a relatively rare route of invasion. Such as gangrenous appendicitis, sputum nucleus infection, bacillary dysentery, etc., bacteria can enter the liver through the portal vein. In recent years, with the extensive and effective application of antibiotics and advances in surgical treatment, cases of bacterial liver abscess secondary to other abdominal infections have been rare.
In addition, bacteria infecting the lesion near the liver can invade the liver through the lymphatic system. When the liver is open, the bacteria can invade the liver directly through the wound, causing an abscess.
Most of the pathogenic bacteria of bacterial liver abscess are Escherichia coli, Staphylococcus aureus, Anaerobic streptococcus, Bacteroides and the like. The volume of a single liver abscess can sometimes be large; the diameter of multiple liver abscesses can range from a few millimeters to a few centimeters, and several abscesses can also fuse into a large abscess.
Biliary tract (20%):
When biliary ascariasis, bile duct stones, etc., complicated with purulent cholangitis, the bacteria move up the bile duct and enter the liver, causing bacterial liver abscess.
Prevention
Liver abscess prevention
The prevention of liver abscess is mainly for the cause and active treatment of various diseases that can cause liver abscess.
Complication
Hepatic abscess complications Complications
Liver abscess can produce three types of complications, namely blood source spread, secondary bacterial infection and abscess piercing.
Symptom
Liver abscess symptoms Common symptoms Abdominal pain Right upper quadrant Pain jaundice Diarrhea Persistent pain Peritonitis Liver enlargement Edema
History and symptoms:
Irregular septic fever, especially bacterial liver abscess is more significant, persistent pain in the liver area, with deep breathing and body position movement, due to different parts of the abscess can produce the corresponding respiratory system, abdominal symptoms, often have a history of diarrhea Therefore, you should inquire about the past medical history, especially the history of fever and diarrhea, the onset of urgency, the location of abdominal pain, accompanying symptoms, diagnosis and treatment, and curative effect.
Physical examination found:
The liver is swollen. (Heart tenderness is related to the location of the abscess.) Most of the intercostal space is equivalent to abscess and localized edema and obvious tenderness. Some patients may have jaundice. If an abscess is worn through the chest, it will appear. Peritoneal empyema, lung abscess or perforation to the abdominal cavity.
Examine
Liver abscess check
1, blood routine blood culture: white blood cells and neutrophils increased, especially bacterial liver abscess, up to 20-30 × 109 / L, amebic liver abscess can even find amoeba cyst or Trophozoite, enzyme-linked immunosorbent assay (ELISA) for the determination of anti-amebic antibody in blood can help determine the nature of abscess, positive rate is 85-95%, liver puncture amebic liver abscess can extract chocolate pus; bacterial Yellow-green or yellow-white pus can be extracted, and pathogenic bacteria can be obtained by culture. The pus should be measured by AFP to exclude liver cancer liquefaction, and the Cassoni skin test can exclude liver hydatid disease.
2. X-ray examination shows that the right diaphragm is elevated, the mobility is limited, and sometimes the pleural reaction or effusion can be seen.
3, B-mode ultrasound examination has a certain value for the diagnosis and determination of the abscess site. When the early abscess liquefaction is incomplete, it needs to be differentiated from liver cancer.
4. CT examination shows that there are single or multiple circular or egg-shaped low-density areas with clear boundaries and uneven density. Bubbles are visible inside, and there is no change in the density of scanned abscesses. The wall has an increase in density and irregularity. "Circumferential sign" or "day halo sign".
Diagnosis
Diagnosis and differentiation of liver abscess
diagnosis
History and symptoms:
Irregular septic fever, especially bacterial liver abscess is more pronounced. Persistent pain in the liver area increases with deep breathing and body position. Due to the different parts of the abscess, the corresponding respiratory and abdominal symptoms can be produced. There is often a history of diarrhea. Therefore, you should inquire about the past medical history, especially the history of fever and diarrhea, the incidence of urgency, abdominal pain, accompanying symptoms, diagnosis and treatment and efficacy.
Physical examination found:
The liver is swollen, and (the liver tenderness is related to the position of the abscess). Most of the intercostal space is equivalent to abscess and localized edema and obvious tenderness. Some patients may have jaundice. If an abscess penetrates into the chest, empyema appears, lung abscess or perforation occurs in the abdominal cavity.
Differential diagnosis
Mainly need to be differentiated from liver cancer cysts.
