Introduction
Liver abscesses are divided into a primary and a secondary course. The primary course of the liver abscess is caused by a bacterial colonization via the gall bladder and the bile ducts. The cause is either gallstones or parasites.
Secondary forms of liver abscesses usually start after operations or accidents, but also due to chronic tonsillitis, endocarditis, umbilical vein sepsis, late effects of diverticulitis, appendicitis, Crohn’s disease and ulcerative colitis. The pathogens causing a liver abscess are E. coli, enterococci, Klebsiellae or bacteroides. In most cases, the right lobe of the liver is affected by an abscess, the left lobe of the liver much less frequently. In 60% of cases, single abscesses are found in 40% several smaller abscesses.
Letilinie in a liver abscess
For the treatment of an amoebic liver abscess there is a guideline that lists how the diagnosis and therapy of this disease can be adequately performed. The physician can follow the guideline, but is not obliged to follow it. The amoebic liver abscess is caused by a pathogen called “Entamoeba histolytica”.
The abscess can develop into a life-threatening clinical picture, as it can cause serious complications (e.g. breakthrough into the free abdominal cavity). Well thought-out diagnostics and therapy are therefore crucial for the recovery of the patient. All in all, every patient with liver abscess must be treated as an inpatient in hospital.
Diagnosis according to guidelines: Every patient who was in the tropics or subtropics in the last few years before the onset of the disease and is now suffering from fever, chest / abdominal pain and increased inflammation values should be examined for a liver abscess. The same applies to any patient with fever after a stay in the tropics or subtropics who has been tested negative for other tropical diseases (e.g. malaria). The diagnosis is made on the basis of the patient’s clinical symptoms, his inflammatory values and finally the detection of a mass in the liver by ultrasound.
The diagnosis is confirmed by the detection of certain antibodies in the blood that act against the pathogen Entamoeba histolytica. Computer tomography (CT) or magnetic resonance imaging (MRI of the liver) can also be performed to assess the abscess in the liver. In this case an MRI of the liver would be performed.
Puncture of the abscess for direct detection of the pathogen is not always mandatory. Therapy according to guidelines:
Drug therapy with metronidazole is recommended for the treatment of amoebic liver abscess. This is an antibiotic that is effective against the pathogen.
It should first be administered via the vein. In order to also reach remaining pathogens in the intestine, therapy with another drug, paromomycin, is recommended. Since other pathogens, such as bacterial pathogens, are also possible before the final diagnosis is made, further antibiotics should first be given which also cover these other pathogens.
Ceftriaxone, for example, is suitable for this purpose. Monitoring according to guidelines:
During therapy, the condition of the patient should be monitored. This includes regular blood counts, ultrasound monitoring of the abscess, and stool samples in which no pathogen should be detectable after therapy with paromomomycin.
The patient’s general clinical condition should also improve noticeably soon after the start of therapy. Therapy according to guidelines: For the treatment of amoebic liver abscess a drug therapy with metronidazole is recommended. This is an antibiotic that is effective against the pathogen.
It should first be administered via the vein. In order to also reach remaining pathogens in the intestine, therapy with another drug, paromomycin, is recommended. Since other pathogens, such as bacterial pathogens, are also possible before the final diagnosis is made, further antibiotics should first be given which also cover these other pathogens.
Ceftriaxone, for example, is suitable for this purpose. Guideline monitoring: The patient’s condition should be monitored during therapy. This includes regular blood counts, ultrasound monitoring of the abscess, and stool samples in which no pathogen should be detectable after therapy with paromomomycin. The patient’s general clinical condition should also improve noticeably soon after the start of therapy.
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