Liver Abscess

Liver Abscess

A liver abscess is a type of infection in the liver brought on by a bacterial infection, parasites, fungi, and sterile necrosis that originates in the gastrointestinal tract and is characterized by the development of pus in the liver parenchyma.

An internal mass made of pus is known as a liver abscess. Abdominal infections like appendicitis or diverticulitis brought on by hematogenous spread through the portal vein are frequent causes.

Types

• Pyogenic abscess, which is most often polymicrobial, accounts for 80% of hepatic abscess cases in the United States
• Amebic abscess due to Entamoeba histolytic accounts for 10% of cases
• Fungal abscess, most often due to Candida species, accounts for fewer than 10% of cases.

Causes

• Streptococcus species (including Enterococcus),
• Escherichia species,
• Staphylococcus species,
• Klebsiella species (Higher rates in the Far East),
• Anaerobes (including Bacteroides species),
• Pseudomonas species,
• Proteus species.

Symptoms

• Blood flow to the area increases.
• The temperature of the area increases due to the increased blood supply.
• The area swells due to the accumulation of water, blood, and other fluids.
• It turns red.
• It hurts, because of irritation from the swelling and the chemical activity.
• The four signs ; heat, swelling, redness, and pain - the characteristics of inflammation.

Diagnosis

• Laboratory

To determine the hematologic abnormalities include hemoglobin, leukocytes, and liver function examination.

• Chest x-ray

Can be found in the form of the right diaphragm, decreased movement of the diaphragm, pleural effusion, lung collapse and lung abscess.

• Plain Abdominal X-ray

Abnormalities may include hepatomegaly, ileus picture, a picture of free air above the liver.

• Ultrasonography

Detecting abnormalities of biliary tract and diaphragm.

• Tomography

See abnormalities in the posterior and superior, but can not see the integrity of the diaphragm.

• Serology

Shows a high sensitivity to germs.

Treatment

• Although it has been effective in a small number of documented cases, antibiotic therapy is not frequently recommended as the only form of treatment. It could be the sole option for patients who are too unwell to undertake invasive operations or who have many abscesses that cannot be drained surgically or percutaneously. Patients in these situations will probably need to receive antibiotic medication for several months, along with serial imaging and close monitoring for any related problems.
• A frequent addition to percutaneous or surgical drainage is antimicrobial therapy.
• Open surgery can be carried out using either of the two methods below:
• Abdominal exploration and abscess drainage are made possible by a transperitoneal approach, which also reveals any previously unnoticed abscesses and the location of the etiologic source.
• A posterior transpleural method can be employed for high posterior lesions; while this allows for easier access to the abscess, it prevents the discovery of numerous lesions or a concomitant intra-abdominal disease.
• In some circumstances, a laparoscopic technique is also often employed. The whole abdomen may be examined using this minimally invasive technique, which also greatly lowers patient morbidity. The ideal demographic for this kind of intervention is being defined by a growing body of literature.
• For liver abscesses larger than 5 cm, a retrospective chart review compared percutaneous drainage to surgery. Morbidity was comparable between the two methods, but patients who underwent surgery had fewer follow-up procedures and treatment failures.

Nursing Management

• Observed vital signs, monitor Temperature,
• Apply cold compress on axilla if fever,
• Administered antipyretic : panadol as order,
• Suggested increase oral intake,
• Administered IVF as order,
• Apply thick cloth or thick blanket,
• Sent all c/s screening as order,
• Assess and checked signs and complaint of pain,
• Suggested deep breathing exercise and distraction technique,
• Apply compress on pain area,
• Suggest patients take little food but frequent,
• Administered soft diet, low residue, and hepatic diet,
• Administered painkiller, analgesic as order,
• Administered antacid, Zantac as order,
• Assess patient knowledge about cause, prognosis, medication and treatment of diseases,
• Checked and assess signs of anxiety, unable to sleep,
• Explain about patient condition, cause, prognosis, management and supportive therapy,
• Suggested patient to avoid alcohol drugs induced hepatotoxic,
• Explain that drainage will be d/c after less puss or drain and only temporary,
• To take all antibiotic as order,
• To prevent eat, drink from the good source.

References

• britannica.com/science/inflammation
• encyclopedia.com › Medicine › Diseases and Conditions › Pathology
• Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
• orgniz.com/topic/Hepatic%20diverticulum&item_type=topic
• patient.info/health/frostbite-leaflet
• revolvy.com/main/index.php?s=Enterococcus
• revolvy.com/main/index.php?s=Bacteroides%20infections&item_type=topic
• revolvy.co/topic/Liver%20abscess&item_type=topic