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liver abscess
Clinical manifestations of liver abscess
Clinical manifestations of liver abscess include irregular, purulent fever, especially noticeable in bacterial liver abscesses. The fever is irregular and typically high, preceded by chills, followed by persistent pain in the liver area, which worsens with deep breaths or movement. Depending on the location of the abscess, it can lead to corresponding respiratory and abdominal symptoms, often with a history of diarrhea. If the abscess ruptures, it can evolve into purulent peritonitis with pyothorax. Special signs include liver enlargement, and in the intercostal space corresponding to the abscess, there's localized edema and clear tenderness. Some patients may exhibit jaundice. If the abscess breaks into the chest cavity, lung abscesses can occur, or if it perforates into the abdominal cavity, peritonitis may develop.
Why is there a low fever with a liver abscess?
Why do patients with liver abscesses continuously have a low fever? This is because a liver abscess is a purulent liver condition caused by various microorganisms such as bacteria, fungi, or amoebas, indicating severe inflammation due to the presence of pus in the liver, resulting in a fever. But why is it a low fever? The reason may be attributed to the fact that it is inherently a bacterial infection. Treatment requires prolonged use of high-dose, full-course antibiotics. During this process, some bacteria might not be completely eradicated, or some residual bacteria continue to linger in the liver, thereby easily causing fever. Fever is a manifestation of the body's self-protection, so there is no need for excessive worry or anxiety. With proper full-course treatment, the disease can be cured. (Please use medication under the guidance of a doctor.)
Will ferritin be high in hepatic abscess?
Will ferritin levels rise in cases of liver abscess? First, we need to understand the significance of ferritin testing. I can also tell you that ferritin does not necessarily increase during a liver abscess. The main form of iron in the body is present as serum ferritin. Clinically, its relationship with the aforementioned diseases is something we can discuss. The first one is related to iron-deficiency anemia. Generally, early stages of iron deficiency do not directly cause significant anemia, but they will lead to a reduction in iron stores. There are many methods for determining serum iron content in clinical laboratories, but none are as sensitive and reliable as serum ferritin. The second point is its relationship with tumors. Ferritin acts as a soluble tissue protein that stores iron in the body. It consists of a protein shell and an iron core, with the iron core having a strong capacity to bind and store iron, maintaining the supply of iron and the relative stability of hemoglobin. The liver is the site of synthesis of serum ferritin and also the organ that clears it. Normally, only a small amount is found in the serum, so during acute or chronic liver damage, or liver cancer, a noticeable increase occurs. Therefore, when liver abscesses affect liver function or cause destruction of liver cells, it can also lead to increased ferritin levels. However, in the early stages of a liver abscess, if treatment is proactive, ferritin levels might not increase.
Principles of medical treatment for liver abscess
The principle is early diagnosis and early treatment, including the management of the primary disease, and then avoiding the occurrence of complications. Non-surgical treatment requires the use of effective and sufficient amounts of antibacterial drugs, proactive supportive care, and enhancement of the body's resistance. For a single larger abscess, it can be punctured and drained under ultrasound guidance, or continuously flushed and drained through percutaneous catheter placement, and treated with injection of antibiotics. However, the antibiotic treatment for liver abscess requires a sufficient amount and full course of symptomatic supportive care to suppress the spread of inflammation and facilitate rapid absorption of inflammation. At the same time, we can adopt some traditional Chinese medicine methods and treatment approaches to reduce swelling and drain pus, which synergistically enhance the treatment effect.
What is good to eat for a liver abscess?
You should eat a diet that is easy to digest, high in vitamins, low in fat, and high in calories. Avoid fatty, greasy, spicy, and stimulating foods. So, what types of food can we choose? We can choose foods like millet and pig stomach, including beans, because beans are high in protein, calcium, iron, and vitamin B. You can also eat seafood such as hairtail and yellow croaker, which can enhance immunity, repair damaged tissue cells, and strengthen the body's resistance to prevent viral infections. Additionally, you can eat fruits that clear heat and detoxify, relieve irritability, and quench thirst, such as dragon fruit, pears, apples, etc. You can also consume foods that are rich in potassium.
Does liver abscess have a connection with drinking alcohol?
Patients with liver abscesses are prohibited from drinking alcohol, because the main component of alcoholic beverages is ethanol, which needs to be metabolized by the liver and directly damages it. Excessive drinking can exacerbate the burden on the liver, worsening the condition. Therefore, patients with liver abscesses must absolutely avoid alcohol. If a patient insists on drinking, they should only do so in moderation three months after the abscess has healed. However, it is generally advised not to drink at all. It is beneficial for the liver if patients consume fresh vegetables and fruits and maintain a light diet, avoiding greasy and rich foods. This diet can also prevent the adhesion and aggregation of platelets, reduce the decline in white blood cells, and promote blood circulation and dispel stasis.
Can a liver abscess cause ascites?
Can liver abscess cause ascites? Some liver abscesses can cause ascites. Firstly, it must be understood why ascites occur. It is because the patient has poor resistance, internal infections, and is prone to worsened infections. A liver abscess involves significant energy consumption due to prolonged fever and intermittent fevers, which can reduce the liver’s capacity to synthesize albumin, leading to a decrease in colloid osmotic pressure within the blood vessels. This is accompanied by the formation of fluid accumulation in the abdominal cavity. Therefore, when a patient with a liver abscess develops ascites, there is no need to be overly anxious or nervous. Treatment can involve vigorous anti-infection measures, supplementation with albumin, and other supportive treatments to improve the symptoms and alleviate the patient's ascites, facilitating a quicker recovery.
What should I do if a liver abscess ruptures?
Firstly, we must keep our emotions stable, avoid being nervous, avoid anxiety, and avoid shouting loudly, as these can increase the likelihood of bleeding. Do not excessively increase the pressure in the abdominal cavity. So, what treatment methods do we have? There are two types of treatments: surgical and non-surgical. If the patient has a mild liver rupture and stable vital signs without persistent active bleeding, treatment can be administered through blood transfusion, fluid infusion, hemostasis, antibacterial drugs, and hepatoprotective drugs. However, it is crucial to closely monitor the patient's vital signs and regularly review the imaging studies of the condition. We must diligently observe any changes in the patient's condition. If evidence of active bleeding occurs during conservative treatment, then surgical intervention must be immediately performed.
Treatment of liver abscess
The treatment of liver abscesses is divided into medical and surgical treatment. Medical treatment mainly involves antibiotic therapy. For bacterial liver abscesses, especially during the acute phase when the inflammation is localized and an abscess has not yet formed, or there are multiple small abscesses, aggressive conservative medical treatment should be given. This involves the use of high doses of antibiotics and general supportive therapy to control the absorption of inflammation. The second method is antibiotics combined with percutaneous puncture drainage. For a single, larger liver abscess, aspiration of pus can be performed under ultrasound guidance. After aspirating as much pus as possible, antibiotics can be injected into the abscess cavity, followed by repeated punctures over several days, or a tube can be placed to drain the pus. When the abscess shrinks and the fluid output decreases, the tube can be removed. The third method is antibiotics combined with surgical drainage. For larger liver abscesses that have a potential to rupture and cause complications such as acute peritonitis and pyothorax, surgical incision and drainage should be performed urgently, alongside the use of systemic antibiotics. The fourth approach is antibiotics combined with surgical resection. For chronic liver abscesses, or those whose abscess walls do not collapse after drainage, leaving a dead space, or with sinus tracts that continually discharge pus without healing and where liver lobe destruction is severe with loss of normal functions, hepatic lobectomy can be performed.
Reasons why liver abscesses do not liquefy
The reasons for the non-liquefaction of liver abscesses, in my opinion, are several. The first is that the abscess is very large, and the second is the inappropriate use of antibiotics. So, what can we do to solve this problem? Firstly, liquefaction of a liver abscess takes time, and it is difficult for a large abscess or a single large abscess to be absorbed on its own. Therefore, it requires combining with percutaneous drainage. Often, even if the abscess has not fully liquefied, fine needle aspiration can still be performed to extract the pus for culture, and then identify the sensitive antibiotics. After administering a sufficient amount and course of the sensitive antibiotics, the liquefaction of the liver abscess can be accelerated and the pus can be expelled sooner.