Common, serious, and potentially fatal, when should this liver disease be considered?

Author: Chen Jian, chief physician of Beijing Hospital

Reviewer: Yao Shukun, Chief Physician, China-Japan Friendship Hospital

Liver abscess is a common infectious disease in the surgical system. It is also a very serious disease that may be fatal.

Before antibiotics were used clinically, its mortality rate was very high, about 70%-80%, so it was considered an incurable disease.

At present, medicine has a more thorough study of microorganisms, and with the use of antibiotics, the mortality rate has dropped to 20%-30%, but there is still a certain mortality rate.

If liver abscess can be treated properly in the early stages, the mortality rate can be reduced to below 10%.

Therefore, liver abscess is considered to be a relatively serious infectious disease.

1. Is liver abscess caused by bacterial infection?

Liver abscess, in layman's terms, is a pus bag growing in the liver. In fact, it is the invasion of liver tissue by microorganisms, including bacteria, amoeba and fungi, which causes necrosis and liquefaction of liver tissue, which then accumulate in the liver to form an abscess.

Bacterial liver abscess is the most common type of liver abscess in clinical practice, accounting for approximately 80%-90%.

Figure 1 Original copyright image, no permission to reprint

As our hygiene habits are getting better and better, the probability of infection with amoebic liver abscess is getting lower and lower. It can be seen occasionally in rural areas. Among all patients with liver abscess, amoebic liver abscess accounts for less than 10%.

Fungal liver abscess is even rarer in clinical practice.

There is also a type of cryptogenic liver abscess, the cause of which cannot be found. It is not known whether it is caused by bacteria or other reasons. Cryptogenic liver abscess also exists, but it is relatively rare now.

So the most common types of liver abscesses are two types, amoebic liver abscess and bacterial liver abscess.

2. What is the cause of liver abscess?

Generally speaking, the main reason is that the human body's resistance is reduced. After bacteria and some other microorganisms invade, the human body cannot eliminate them, which will cause liver infection, bacteria accumulation in the liver, and then destroy liver tissue cells.

However, the liver is an organ in the abdominal cavity of the human body. It is not connected to the outside world, so how do bacteria and other microorganisms invade it? Generally speaking, there are four main ways:

One is a systemic infectious disease that enters the liver through the hepatic artery and accumulates.

The second is through the portal vein. This mainly refers to infectious diseases of the digestive tract, including amoebic enteritis, bacillary dysentery, gastroenteritis, appendicitis, and the translocation of intestinal bacteria caused by intestinal obstruction, all of which can enter the liver through the portal vein.

The third is the bile duct infection, which is more common in clinical hepatobiliary surgery. Because the bile duct and liver are directly connected, there are many cases of liver abscess caused by bile duct infection. For example, bile duct stones, cholangitis, acute suppurative cholecystitis, etc. can all cause liver abscess.

The last one is direct invasion and infection of organs around the liver, including abdominal abscess, gallbladder abscess rupture into the liver, bacterial infection after liver surgery, etc., all of which can directly form liver abscess.

3. What symptoms does liver abscess cause?

There are two aspects of the manifestation of liver abscess, one is local manifestation and the other is systemic manifestation.

Abscesses are caused by the accumulation of microorganisms after entering the liver. Bacteria and fungi can directly invade liver tissue or kill liver tissue after a large number of proliferation. At the same time, these microorganisms will also release a lot of toxic substances, which will cause liver tissue necrosis. Some toxins can also enter the whole body through the blood, and then a systemic inflammatory response syndrome will occur. For example, fever, 90% of patients with liver abscesses will have high fever, and this high fever is irregular and difficult to subside. It will also be accompanied by muscle aches, joint discomfort, fatigue, and abnormal digestive function.

Another is the manifestation of the primary disease. For example, for patients with diabetes, blood sugar will continue to rise. For patients with other diseases, the primary disease will also worsen. These are all systemic manifestations.

Local manifestations are changes in the abdomen. Because the liver is located in the right upper abdomen, liver abscesses generally cause dull pain, dull pain, distending pain, and discomfort in the right upper abdomen. During a physical examination, percussion pain in the right upper abdomen will occur. In addition, there will be abnormal digestive function and abdominal distension, but these are not typical manifestations.

Other manifestations are related to further examinations. For example, when liver abscess is suspected, a blood test will show an increase in white blood cells and an increase in the proportion of neutrophils. There are also some other manifestations of poisoning, such as elevated C-reactive protein.

Figure 2 Original copyright image, no permission to reprint

For most of us, it may be difficult to judge what disease we have based on the symptoms of the disease. Therefore, once the above-mentioned symptoms appear, it is recommended to seek medical attention in time and conduct further imaging examinations under the guidance of a doctor. If it is confirmed to be a liver abscess, it should be actively and reasonably treated as soon as possible to minimize the mortality rate.