Liver abscess is one of the most difficult diseases to diagnose. On the one hand, with the help of MRI and other similar studies, the abscess is clearly visible, but on the other hand – often the first signs of the disease are weight loss and general malaise, lack of appetite, which by no means can be called a sufficient reason for the appointment of such studies. However, a careful questioning of the patient helps to suggest the development of a liver abscess, and early initiation of therapy contributes to the complete recovery of the patient.
What can cause a liver abscess
Gastroenterologists try to classify liver abscess on different grounds: abscesses are multiple or single, arose primarily or against the background of some other disease, caused by bacteria or parasites, affecting the right or the left lobe of the liver.
Cause of primary liver injury when it occurs scientists cannot determine the formation of a cavity with purulent contents, but with regard to the secondary effect on the liver, provoking the occurrence of an abscess – the culprit is called an infection that has penetrated the liver through the biliary tract or blood vessels, as well as through direct contact with a source of inflammation – for example, appendicitis or ulcerative colitis.
The most significant causes of liver abscess are called cholelithiasis and appendicitis. In addition, the disease can be triggered by cholangitis and cholecystitis, caused by an infection that has penetrated the liver during injuries and abdominal operations, formed with tumors and granulomas.
The main condition under which a liver abscess develops is considered to be a significant decrease in immunity, and the main infectious agent – hemolytic streptococcus. It often happens that laboratory analysis highlights a mixed infection – association of streptococcus with Klebsiella, Staphylococcus aureus, enterobacteria. Sometimes the causative agent of a liver abscess can have an amoebic etiology, and this type of inflammation is especially difficult to treat.
The main symptoms that determine the liver abscess
The first manifestations of a liver abscess, in addition to weight loss, are:
- nausea,
- diarrhea,
- flatulence,
- lack of appetite.
Then there is pain in the right hypochondrium – aching, dull, constant, slightly subsiding in the position on the right side with tucked knees, radiating under the right shoulder blade or in the shoulder.
The development of symptoms is manifested by a rise in temperature to febrile values, severe chills and pouring sweat, the legs become cold and covered with "goose bumps", the skin and sclera of the eyes turn yellow, tachycardia is noted.
On palpation, the liver is enlarged and protrudes from under the costal arch, and the patient complains that he is very hurt when touched. There are signs of very strong intoxication. If the inflammatory process compresses the vessels of the liver, ascites develops.
Peculiarities of diagnosis and treatment of liver abscess
The main problem with a liver abscess is in that it is not distinct against the background of the underlying disease that provoked it, and therefore it often takes too much time from the formation of an abscess to the start of its treatment. In this case, a liver abscess can be complicated by a breakthrough of purulent masses into neighboring organs or the abdominal cavity, and contribute to the development of severe bleeding and sepsis. Therefore, it is very important when a patient comes in with characteristic pain in the side and weight loss to ask him in detail about the surgeries, infectious diseases, injuries or tumors, about when his complaints arose and what he associates them with.
The treatment tactics in each case is determined individually: if the liver abscess is one and small, conservative therapy with antibacterial drugs, sometimes in combination with antiparasitic ones, can be prescribed. If surgical treatment is required, minimally invasive methods are preferred.
It is very important when admitting patients with complaints suggestive of a liver abscess to take the history very carefully in order to start treatment as soon as possible and avoid complications.
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