Liver
AbscessIntroduction: An abscess is a local accumulation
of pus in an organ. As this accumulation of pus in the beginning is contained
in a cyst-like structure, it can be difficult to diagnose. However, as time goes
on the pathogens in this abscess cavity are exerting pressure and are eating their
way more and more into the healthy surrounding liver tissue. Here is an
image
of a CT scan of a liver abscess. The end result can be that an overwhelming
infection suddenly can gain entrance into the blood stream at which point the
patient gets extremely sick with septicemia. A liver abscess can originate
from a variety of conditions as follows. •Bile ducts can get infected
when a gallstone is present and the infection can travel against the bile flow
into the liver tissue (=ascending cholangitis). •Bacteria can reach the
liver through the systemic circulation in the case of septicemia (blood poisoning
with bacteria). •Another mode of transmission is via the portal vein
system in the case of appendicitis or diverticulitis, where the pus from an appendicitis
or from a case of diverticulitis of the colon reaches the liver through the portal
vein system. •Finally, sharp or blunt trauma can cause an abscess. In
the case of a knife wound or a shot gun wound the bacteria are directly introduced
into the liver tissue. In the case of blunt trauma from a blow to
the upper abdomen a hematoma forms on the surface or inside the liver. A hematoma
is a localized blood collection, which tends to attract bacteria that happen to
travel through the blood. Normally they are immediately removed by white blood
cells. However, in a hematoma, there is no circulation of white blood cells, but
blood serves as an ideal growth medium for the bacteria, which by chance have
found their way into the liver. After they have multiplied enough, the digestive
enzymes eat a cavity into the liver tissue, where pus forms and a membrane demarcates
it from the healthy tissue. This forms the wall of the abscess. The pathogens
that cause liver abscesses are quite varied. Common bacteria are streptococci
or staphylococci, which usually originated systemically through the blood stream.
Abscesses due to the infected biliary tract grow E.coli and Klebsiella bacteria.
E. coli and anaerobic bacteria are usually isolated from an intraabdominal infection
that was transmitted via the portal vein system. An amebic abscess from Entamoeba
histolytica( which is a parasite) has a better prognosis than the bacterial abscesses
and responds well to appropriate medication. Symptoms:
When there are several abscesses in the liver, the symptoms are acute with acute
right upper abdominal pain, vomiting, nausea, weight loss, a fever and weakness.
The patient might also experience right chest pain( due to pleuritic irritation)and
might be jaundiced, particularly with biliary tract disease. In other cases with
a single liver abscess it might take several weeks to see symptoms develop. There
might be only a fever, malaise, weight loss and nausea. Then gradually the other
symptoms develop as more and more pus is produced in the abscess cavity. Diagnosis:
Before treatment can be instituted, the surgeon will want to be
absolutely sure where the abscess is. A CT scan or MRI scan are the most sensitive
tests, but an ultrasound
of the liver can detect abscesses of more than 2 cm (=0.8 inch) in
diameter. The imaging studies are in addition to the normal basic history
and physical examination. Blood tests would also be useful with high white blood
cell readings and elvated liver enzymes. Treatment:
Treatment depends on the pathogen, which has caused the abscess.
For instance, an amebic abscess will respond well to chemotherapy with metronidazole,
emetine or chloroquine. Other (bacterial) abscesses will be treated with the appropriate
antibiotic first and often with percutaneous needle aspiration pus can also be
sucked out. Surgery is reserved only for those patients, where these other measures
did not resolve the abscess. Usually for prevention of recurrence patients are
put on antibiotics for several weeks. Complications: The
abscess can rupture or spread locally. This can cause such things as a subphrenic
abscess( an abscess between the liver and the right diaphragm), a rupture into
the right pleural cavity, into the right lung, bleeding into the abscess, rupture
of the abscess into the peritoneal cavity with development of generalized peritonitis
and septicemia. Despite the best therapy the mortality rate of a liver abscess
is still between 10% and 30%. Pain relief: There is an FDA
approved non-drug method available, IceWave
patches from Lifewave, which will control pain. This is mentioned in the
book "Breakthrough" by Suzanne Somers (Ref. 9) where newer insights
of antiaging medicine are also reviewed. Although the patches are placed over
acupuncture points, there are no needles involved. Nanotechnology, a newer technology,
was used in the manufacturing of these patches and infrared (heat) waves from
body heat are utilized to stimulate an acupuncture point, which modifies pain
perception and reduces pain to half or less. Medically this would be considered
an excellent pain reliever. For more info on the patches see the IceWave patches
from Lifewave link above (click "products"). In the US a 5 pack of the
IceWave spray is available that can be directly sprayed onto the skin in the area
where the pain is located. |
