suppurative portal phlebitis
Introduction
Introduction to suppurative portal veinitis Suppurative portal venous inflammation refers to the suppurative inflammation of the portal vein and its intrahepatic branches. This disease often coexists with multiple bacterial liver abscesses. The supply of the portal vein branches, such as suppurative lesions, can lead to the occurrence of this disease. The extent of the lesion may involve the portal vein or its branches, or the entire intrahepatic portal vein branch. basic knowledge The proportion of illness: 0.004%-0.008% Susceptible people: no specific population Mode of infection: non-infectious Complications: gastrointestinal bleeding peritonitis
Cause
Causes of suppurative portal phlebitis
(1) Causes of the disease
All organs with portal vein branch drainage can cause this disease. The most common diseases are appendicitis, appendicitis abscess, abdominal abscess, suppurative cholangitis, liver abscess, etc., followed by colon, ileum diverticulum Inflammation, necrotizing pancreatitis, pelvic purulent lesions, prostate abscess, bile duct and hemorrhoids, postoperative infection, gastrointestinal malignant tumor, intra-abdominal vascular thrombosis, etc., infants with umbilical vein infection, appendicitis and appendix in young adults Abscess is the most common. The elderly often have secondary infections such as biliary obstruction and malignant tumors. The pathogens are mainly Gram-negative bacteria, and most of the Escherichia coli are also infected with anaerobic bacteria.
(two) pathogenesis
Mainly due to the infection of thrombus in the lesion, along the venous blood reflux to the portal vein, invading the portal vein system and causing portal vein purulent inflammation, multiple liver abscess and sepsis and other pathological changes, liver abscess lesions vary in size, the larger diameter can reach 2.5 Cm, small liver abscess can only be seen under the microscope, gas-producing bacteria can cause gas in the portal vein, suppurative portal phlebitis can also lead to portal vein thrombosis and portal hypertension.
The extent of the lesion may involve the main stem of the portal vein and its branches, or the entire portal vein of the liver. The affected intima and intima are acute suppurative inflammatory changes. The local blood vessels of the lesion may be dilated, the wall of the vessel may be destroyed, and there may be pus and blood clots. Exudate, in severe cases, may have perforation of the wall, hemorrhage, etc.; abscess may form after the portal vein and the mesentery. Suppurative lesions may spread directly along the branches of the portal vein, or enter the liver by bacterial emboli, forming different sizes. Liver abscess, and can spread to the liver capsule to cause hepatic capsular inflammation and perihepatitis.
1. Visual observation
The liver is swollen, the surface is smooth, and the abscess is prominent. The splenic vein is caused by splenic vein disease, and the spleen is also common. When the lesion invades the biliary tract, underarm, kidney, lung and brain, it can cause underarm abscess, lung and brain. Abscess, peritonitis, etc.
2. Histological examination
There is suppurative inflammation in the middle layer of the intima of the portal vein, and there are thrombus and pus inside. If the wall of the tube is damaged, there may be bleeding.
Prevention
Suppurative portal phlebitis prevention
1. To prevent the disease by the cause of the disease is the main means to prevent this disease.
2. Early diagnosis, early treatment, as far as possible to find the pathogen, to treat the cause.
3. Actively participate in outdoor sports, increase your personal physique and improve your immunity.
4. Regularly participate in the physical examination of the unit or individual organization, and find that the condition is timely to the hospital.
Complication
Complications of suppurative portal phlebitis Complications, gastrointestinal bleeding, peritonitis
1 sepsis.
2 gastrointestinal bleeding.
3 peritonitis.
4 lung abscess.
Symptom
Suppurative portal vein symptoms common symptoms high fever abdominal distension diarrhea ascites nausea yellow appendix abscess abdominal muscle tension liver swelling black stool
1. Symptoms of primary disease
The disease is often secondary to a variety of conditions, such as secondary to appendix abscess, tenderness and rebound tenderness in the right lower abdomen; when there is hepatobiliary purulent disease, it can be manifested as liver enlargement, pain in the liver area, right upper abdomen or Murphy Point tenderness, prostate abscess and purulent infection of the female reproductive organs may have corresponding clinical manifestations.
2. Sepsis symptoms
There are relaxation heat, chills and so on.
3. The condition of the liver
Liver enlargement, moderate texture, pain and tenderness in the liver area, accompanied by mild jaundice.
4. Other situations
Abdominal muscle tension, but can be caused by abdominal distension caused by abdominal distension, 1/4 splenomegaly, spleen venous spleen is huge, because of gastrointestinal congestion can have hematemesis and melena, 1/5 patients have early disease Nausea, vomiting and diarrhea, ascites can occur in people with chronic liver disease.
For patients with abdominal suppurative infection, should be alert to portal phlebitis, according to the primary disease, sepsis, liver swelling, three major symptoms, combined with laboratory and imaging examination can be diagnosed.
Examine
Examination of suppurative portal phlebitis
Almost all patients have obvious increase of white blood cells in blood routine examination, mainly neutrophil increased, often accompanied by mild to moderate anemia, increased erythrocyte sedimentation rate, abnormal liver function in about 1/4 of patients, blood bacterial culture due to liver Filtration is often negative, only positive in the liver veins, so blood culture should be repeated, the most common pathogens are Gram-negative bacilli, and there are mixed infections of anaerobic bacteria.
1. Imaging examination
(1) X-ray: chest X-ray examination can show signs of diaphragmatic elevation, restricted diaphragm movement and reactive pleural effusion, and abdominal plain film can sometimes see gas shadows in the portal vein.
(2) CT: can show changes in the gas in the portal vein, enhanced light transmission of the portal vein and its branches, especially in the CT enhanced scan, such as seeing portal vein thrombosis and extending to the splenic vein or mesenteric vein, also CT diagnosis Importantly, the intrahepatic portal vein is consistent with the intrahepatic bile duct, but the intrahepatic portal vein thrombosis and the obstructive dilatation of the intrahepatic bile duct are significantly different. In the enhanced scan, a lower density portal vein branch is associated with the obstructive dilated bile duct. However, there is no such sign after the thrombus of the portal vein forms a thrombus.
(3) B-ultrasound: In particular, ultrasound Doppler is very helpful for diagnosis. Ultrasound Doppler can accurately determine the extent and extent of lesions and spread, and can repeatedly detect and detect dynamic changes during treatment. It shows that the wall of the affected portal vein is thickened, the echo is weakened, the inner wall is not smooth, the outside is blurred, the lumen is dilated, and the embolism and other lesions are visible in the cavity.
(4) angiography: direct portal venography, selective angiography also has a certain help in the diagnosis of this disease, can be seen in the portal vein thrombosis and there is centrifugal blood flow.
Diagnosis
Diagnosis and differentiation of suppurative portal phlebitis
In the early stage of the disease, only sepsis and no clinical manifestations of the liver, should be distinguished from bacterial endocarditis, osteomyelitis, mastitis caused by mastitis, such as typical symptoms, Need to be differentiated from hepatobiliary inflammation such as amoebic liver abscess, cholecystitis, gallbladder empyema, underarm abscess and other diseases.
