Liver abscess

　　Liver abscess is a suppurative inflammation of the liver, caused by amebae or bacterial infection. The onset of amebic liver abscess is closely related to amebic colitis, and most of the abscesses are solitary; the bacterial invasion route of bacterial liver abscess, in addition to sepsis, can be caused by direct spread of intra-abdominal infection, or can also enter the liver through umbilical vessels and portal vein due to umbilical infection. Ascariasis in the bile duct can also be a predisposing factor for bacterial liver abscess. Common bacteria include Staphylococcus aureus, Streptococcus, etc. In addition, during open liver injury, bacteria can enter the liver directly through the foreign body causing injury or from the wound; bacteria can also come from broken small bile ducts. There are some liver abscesses of unknown etiology, known as cryptogenic liver abscess, which may be related to hidden lesions already existing in the liver. When the body's resistance is weakened, pathogenic bacteria reproduce in the liver, leading to liver abscess. Some people point out that 25% of cryptogenic liver abscesses are accompanied by diabetes.

　　Liver abscess can mainly cause three types of complications, namely blood source dissemination, secondary bacterial infection, and abscess rupture. Most cases show gradual weight loss, weight loss, fatigue, and show a poor physical condition. In advanced cases, gastrointestinal bleeding, ascites, and liver failure may occur due to portal vein compression. Obstruction of the common bile duct by the abscess can cause multiple liver abscesses, and it is common to form abscesses in the gallbladder cavity or surrounding area where tumors occur.

　　The liver is often enlarged, with localized edema and marked tenderness at the costal interspaces corresponding to the abscess. Some patients may have jaundice. If the abscess perforates into the pleural cavity, it can cause empyema, lung abscess, or peritonitis if it perforates into the abdominal cavity. There is irregular pyretic fever, especially in bacterial liver abscess, which is more significant. There is persistent pain in the liver area, which increases dramatically with deep breathing and body movement. Due to the different locations of the abscess, corresponding respiratory and abdominal symptoms can occur. There is often a history of diarrhea.

　　If the primary disease focus can be treated early and postoperative treatment can be strengthened, liver abscess can be prevented. Even if there is early infection in the liver, if timely integrated traditional Chinese and Western medicine treatment is given, the whole-body support therapy is strengthened, the body's resistance is enhanced, and antibiotics are used rationally, liver abscess can also be prevented. In recent years, biliary tract infection has become an important cause of liver abscess, so timely treatment of biliary tract diseases can reduce the incidence of liver abscess.

　　Liver abscess is a suppurative inflammation of the liver, caused by infection with amebae or bacteria. The specific examination is as follows:

　　1. Laboratory examination

　　White blood cells and neutrophils increase, especially in bacterial liver abscess, which can reach (20～30)×10/L. In some cases of amoebic liver abscess, amebic cysts or trophozoites can be found in the feces. Enzyme-linked immunosorbent assay (ELISA) can measure antibodies against amebae in the blood, which can help determine the nature of the abscess, with a positive rate of 85％～95％.

　　2. Liver puncture

　　Amoebic liver abscess can extract chocolate-colored pus; bacterial liver abscess can extract yellow-green or yellowish pus, and culture can obtain the pathogenic bacteria. The pus should be tested for AFP to exclude liver cancer liquefaction.

　　3. Kassoni skin test

　　It can exclude echinococcosis of the liver.

　　4. X-ray examination

　　It can be seen that the right diaphragm is elevated, with limited mobility, and sometimes pleural reaction or effusion can be seen.

　　5. B-ultrasound examination

　　It has a relatively definite value for diagnosis and determining the location of the abscess. It needs to be differentiated from liver cancer when the abscess liquefies incompletely in the early stage.

　　6. CT examination

　　It can be seen that there are single or multiple round or oval areas with clear boundaries and uneven density, with bubbles inside. The density of the abscess cavity remains unchanged after enhancement scanning, and the wall has irregularly increased density, known as 'annular moon sign' or 'solar halo sign'.

　　The diet for liver abscess patients is similar to that for other liver diseases, mainly focusing on low-fat foods, eating easily digestible foods, and eating nutritious foods.

　　1. Abstain from drinking alcohol:Since the main component of alcohol is alcohol, it has a direct damaging effect on the liver. If alcohol is consumed in large quantities, it will increase the burden on the liver, making the condition more severe. Therefore, it is not advisable for patients with liver abscess to drink alcohol in their diet.

　　2. Avoid eating ginger:The main components of ginger, volatile oil, gingerol, and safrole, can cause liver cells in patients with liver abscess to proliferate, necrose, and hyperplasia of the interstitial tissue, causing inflammation infiltration and abnormal liver function. Therefore, patients with liver abscess should avoid eating ginger.

　　3. Avoid eating garlic:Certain components in garlic have a stimulating effect on the stomach and intestines, which can inhibit the secretion of digestive juices in the intestines, affect appetite and the digestion of food, and exacerbate the symptoms of anorexia, aversion to greasy food, and nausea in patients with liver abscess.

　　For larger abscess cavities, there is an estimated risk of perforation, or there is already perforation with peritonitis, abscess meningitis, and cholangiogenic liver abscess or chronic liver abscess, active incision and drainage should be performed. The commonly used methods of drainage include the following:

　　1. Peritoneal incision and drainage:This method can achieve sufficient and effective drainage. Not only can it determine the diagnosis of the abscess, but it can also explore the primary lesion or complications, and provide corresponding treatment. The method is to make a diagonal incision below the right rib, enter the abdomen after entering, clearly locate the abscess, and use a moist saline pad to protect the surgical field around to prevent pus from contaminating the abdominal cavity. After extracting pus with a needle, insert a straight hemostat along the needle tip into the abscess cavity, drain the pus, and then insert the finger into the abscess cavity, gently separate the intracavitary septal tissue, and rinse the abscess cavity with normal saline repeatedly and suction it clean. Place a double lumen tube under negative pressure drainage in the abscess cavity. Cover the surrounding area of the drainage tube with omentum, and lead the drainage tube out through the incision or another wound. Send the pus for bacterial culture. This type of operation is commonly used.

　　2. Incision and drainage of extraperitoneal abscess:Liver abscesses located at the anterior lobe of the right lobe or the left lobe can be drained by a peritoneal extraperitoneal approach through the anterior abdominal wall, which is already closely adhered to the anterior abdominal wall. The method is to make a diagonal incision below the right rib area, cut through the layers of the abdominal wall to reach the peritoneum, but do not cut the peritoneum, and use the finger to separate outside the peritoneum. Reach the abscess site, puncture to extract pus, and then incise and drain.

　　3. Incision and drainage of posterior abscess:An abscess located at the right lobe of the liver at the top or posterior side can be drained by incising the abscess and draining it. Lying on the left side, make an incision along the outer side of the twelfth rib, expose the external oblique muscle, and separate upwards with the fingers along the retroperitoneal fat behind the kidney, exposing the retroperitoneal space below the liver up to the abscess. After puncturing and extracting pus, incise the abscess cavity to drain, place a tube for drainage.