Definition
Definition
The non-amoebic liver abscess (in English hepatic abscess) also called pyogenic liver abscess, are abscesses due to infection by certain germs such as:
- Escherichia coli
- Enterobacter aerogenes.
- Streptococcus (in English streptococcus).
- Some anaerobic germs (in English anaerobes).
Symptoms
Symptoms
Symptoms of a non-amoebic liver abscess include:
- Hyperthermia (fever).
- Chills.
- Declining general condition.
Medical exam
Physical examination
The patient's examination reveals an increase in liver volume (hepatomegaly) accompanied by pain. Sometimes, there is also a jaundice (in English jaundice). The rest of the examination sometimes shows an elevation of the diaphragm right, and a reaction of the pleura pulmonary.
Labo
Laboratory tests reveal an increase in the number of white blood cells (hyperleukocytosis), and an increase in e hepatic most often alkaline phosphatases (in English alkaline phosphatase).
Additional examination
Additional examinations include:
- L'scan which reveals low-echoic areas whose edges are not well defined.
- La computed tomography which highlights abscesses containing pus, they are single or multiple. They sometimes appear in the form of tiny abscesses especially when it is a cholangitis occurring following an obstruction in the bile ducts.
To make a diagnosis with certainty, it is necessary to be able to demonstrate an increase in the volume of the liver accompanied by pain, and possibly an obstruction in the bile ducts.
Cause
Cause
The microbes reach the liver (in English liver) in different ways:
- Using the bile ducts as it happens during thecholangitis, bile stasis, the calculation, the gallbladder cancer.
- Through the portal vein : in this case the pathogenic germs come from an abscess located inside the abdomen, and following a appendicitis, to one diverticulitis, to one pylephlebitis, an infection of the pancreas or spleen.
- When they pass through thehepatic artery microbes contaminate the liver because of a sepsis, or a endocarditis.
- Following a liver cirrhosis or a neighborhood infection as occurs during a amoebic abscess, a benign cyst, or a malignant cyst, abdominal trauma, liver puncture.
- In rare cases, no cause is found for a non-amoebic liver abscess.
Treatment
Treatment
Treatments for a non-amoebic liver abscess include:
- The use of broad-spectrum antibiotics: Most often, specialists in gastroenterology or internal medicine use a combination of antibiotics such as ampicillin + gentamicin, and cephalosporin + gentamicin. An antibiogram is performed to determine with certainty which antibiotic is effective.
- Percutaneous drainage: consists of setting up catheters which will drain the abscess.
- Surgery consists of carrying out a hepatotomy (intervention on the liver) in order to drain the abscess, this action is indicated in the presence of multiple abscesses, and when the contents of the abscess are viscous or when it is difficult to access them.
In the case of micro-abscesses secondary to an obstruction of the bile duct, it is sufficient to restore the flow of bile in its natural channels, and to put the patient on antibiotic therapy for long periods.
Evolution
Premature
Non-amoebic liver abscess may lead to complications:
- An abscess located under the diaphragm.
- The rupture of the abscess inside the pleura of the lungs, or even in the lung itself: the pericardium (in English pericardium) or the peritoneum (in English peritoneum).