Liver abscess

The liver abscess is called the focal purulent inflammation of the liver tissue.
Despite the use of antibiotics, abscesses of the liver continue to complicate the course of diseases of the abdominal and thoracic cavity. The etiology of liver abscesses diverse: appendicitis, diverticulitis, chronic nonspecific ulcerative colitis, perforation, ulcers of the stomach and liver, inflammatory diseases of the gallbladder and bile ducts. Liver abscess may occur metastatic by when endocarditis, mumps or osteomyelitis, typhoid fever, amoebic infections of the intestines, actinomycosis and other
Flora abscesses of the liver is very diverse: Escherichia coli (30,4%), Streptococcus (26,6%), Staphylococcus aureus (26,0%), Streptococcus viridans. Often found anaerobic flora, and at the same time, according to various authors, pus when sowing is sterile in 37-58%.
Symptomatology. Liver abscesses often occur atypical, in particular in 28% have pulmonary symptoms that resemble pneumonia and pleurisy (C. I. tricher and I. A. Miller, 1956). C. I. Kostyuk (1956) observed liver abscess, which flowed with the clinical picture septic endocarditis. Liver abscesses can occur at the place of liver damage when stab or gunshot wounds. In septic diseases of liver abscess may begin high fever, chills, severe pain, and symptoms of peritonitis if the abscess is located in the surface layers of the liver. During the gradual development of clinical symptoms are increased the sizes of a liver on edge of acts of hypochondrium, painful on palpation. There is istericeski sclera. With a moderate amount of the abscess, and liver enlargement, as a rule, appears appropriate protrusion of the lower half of the thorax and pogrebetskogo space, and the smoothing of intercostal spaces. Jaundice occurs more often in multiple abscesses. This symptom occurs when a single abscess, when the latter reaches a size and causes compression of the major bile ducts.
Frequent pain radiating to the right shoulder, right shoulder blade or below, in the area of nadrovia or along the colon. The patient lies still on the right side with their legs bent and drawn to belly by feet. In the study of blood there are changes, characteristic for purulent inflammation: neutrophilic leucocytosis (20-40 thousand to 1 mm3), with a shift to the left, aneosinophilia.
The functional liver samples are not changed. Chest x-ray may set high standing of the diaphragm and the absence of its tours. If liver abscess contains gas, we can see the horizontal level of the liquid in it. The big help in the diagnosis of liver abscess may have x-ray examination.
Diagnosis of liver abscess in the initial stage may present difficulties. The differential diagnosis should be borne in mind liver cancer. Splenoportography at last shows for the most part non-uniformity of the defect seeding. Cysts of the liver, in contrast, can produce very similar to the abscess picture of the x-ray inspection, but the clinical picture in them is quite different. Diagnostic puncture when the liver abscess invalid because of its danger. However, in the literature there are proposals to fill in contrast solution (yodolipola) abscess cavity with the medical purpose (introduction of antibiotics effective against flora abscess). Thus, puncture abscess simultaneously combines both diagnostics and therapy (N. C. Alberg, 1956; I. S. Evimizin, 1952). Peritoneoscope and pneumoperitoneum in the liver abscess meet different assessment. So, Meillialer (1957) argues for the use of laparoscopy, a Stucke (1957) recommends to refrain from the use and laparoscopy and pneumoperitoneum. We think that with all precautions both of these research method should be applied in the appropriate clinical setting. In abscesses of the liver as a diagnostic technique can be applied scanning with J 131.
In tropical countries, and in the USSR in the Central Asian republics and the Caucasus after amoebic dysentery meet abscesses of the liver, which are mostly localized in the right proportion. The emergence of amoebic liver abscess precedes the development of amoebic hepatitis. The symptoms are the last significant increase in liver size, her pain on palpation and when tapped on the edges; in the study of blood is usually found little leucocytosis (10-15 thousand per 1 mm3). Diagnosis amoebic hepatitis becomes significant at finding amoebae in Calais. Amoebae are mostly located in the marginal zone of abscesses. Therefore, in purulent punctate not find. Significant differential diagnostic differences between amoebic and pyogenic abscess not. Only when amebic abscess is more common jaundice. Also typical is the chocolate color pus amebic abscess that purchases conventional color when attaching the secondary pyogenic infection.
At the break of abscess develops or purulent peritonitis, or delimited subphrenic abscess that may accompany or serous effusion or empyema. Amoebic abscesses tend to break through the aperture in the pleura and lung tissues with the possible formation of hepatorenal fistula.
Multiple, small size abscesses can occur as a complication of intrahepatic stones (Bockus, 1964).
Treatment. Multiple small hepatic abscesses unavailable surgical treatment. Single liver abscesses subject to the possibility of an early showdown, drainage with antibiotics.
Treatment pyogenic and amebic abscess different. While the first treatment must be exclusively surgical treatment of the second should be conservative or conservative surgery.
In the treatment of liver abscesses new is the introduction of antibiotics through the umbilical vein (but Ostroverhova).
Prediction of surgical treatment of liver abscesses in the era of antibiotics has improved significantly, although there remains serious. Conservative therapy pyogenic abscess of the liver accompanied by a mortality rate of 90%.
Spontaneous healing may occur or as a result of abscess perforation in the gastrointestinal tract, or by melatonine.
Based therapy amebic abscess lie in the use of hydrochloric acid emetina. For subcutaneous injection is 2% solution of 1 ml 3 times a day. Sometimes used up to 5 injections a day. Thus, patients per day get 0.05-0.1 g hydrochloric emetina that in 3-4 times the usual recommended doses and well tolerated, the temperature drops, gradually passes intoxication. Liver literally melts" in my eyes, every day is decreasing in size, and within one or two weeks reaches the normal level.
As for the treatment of amebic abscess with relatively large cavities and abundant accumulation of pus, as shown by the experience and available data from the literature, as a rule, they cannot eliminate only one drug treatment, and it is necessary to apply in parallel, that, or the other surgery (R. O. Eolian, 1962).
Effective treatment for amebic abscess of the liver is chloroquine diphosphate. O. G. Babaev (1965), noting in practice the effectiveness of chloroquine diphosphate, opposes its low toxicity greater toxicity emetina. However, the risk of emetina by some authors exaggerated.
Kind of flow abscesses of the liver tubercular etiology. A. D. Cheremukhin (1952) gathered in the literature of the 19 cases of tuberculous abscesses (cavities) of the liver. The liver is affected by TB hematogenous or lymphogenous way. However, perhaps the primary lesion. Diagnosis of tuberculosis liver is very difficult, the disease is diagnosed as an abscess or a tumor. In most cases, tuberculosis liver is of secondary origin, but do not exclude the possibility primary and its defeat. Treatment of tubercular abscess of the liver should be comprehensive: streptomycin, ftivazide, PASK, etc. and resection of the affected area of the liver.