LIVER ABSCESS

DEFINITION: A liver abscess is a localized collection of pus and organisms within the parenchyma of the liver. This occurs when the liver is invaded by the bacteria or protozoa. These organisms destroy the liver tissue, producing a necrotic cavity filled with infective agents, liquefied liver cells and tissue, and leukocytes. The infectious necrotic tissue walls of the abscess from the healthy liver. Pyogenic liver abscess occurs when bacteria invade the liver. Infecting organisms include Escherichia coli and Klebsiella, Enterobacter, Salmonella, Staphylococcus, and Enterococcus species. A pyogenic abscess is generally solitary and confined to the right lobe, but occasionally abscess is multiple. The usual cause is acute cholangitis, which occurs as a complication cholelithiasis. May also result from liver trauma, abdominal peritonitis, and sepsis, or an abscess can extend to the liver after pneumonia or bacterial endocarditis. Amebic hepatic abscess is caused by protozoan Entamoeba histolytica. This may occur after amebic dysentery. Usually occurs in the form of single abscess in the right hepatic lobe.

ANATOMY AND PHYSIOLOGY OF THE LIVER

Right lobe Left lobe

Inferior vena cava Hepatic artery Hepatic portal vein

Connective tissue Portal triad: Bile duct Branch of hepatic artery

Hepatic laminae

Hepatocyte

Branch of hepatic portal vein Central vein (a) Overview of histological components of liver

Hepatic sinusoids

and endocrine functions. Bile canaliculi. malaise. 4. 5. From central veins the blood flows into the hepatic veins. vomiting. Hepatomegaly. . Hepatic sinusoids. 3. and weight loss may occur. Hepatic laminae are complex three-dimensional arrangements. nausea. Hepatic sinusoids converge and deliver blood into a central vein. SIGNS AND SYMPTOMS Fever with chills and diaphoresis. and other foreign matter in the venous blood draining from the gastrointestinal tract.Bile canaliculi To hepatic vein Central vein Hepatic sinusoid Portal triad: Bile duct Branch of hepatic portal vein vein Branch of hepatic artery Hepatocyte Stellate reticuloendothelial (Kupffer) cell Connective Tissue Hepatic laminae Hepatic sinusoids (b) Details of histological components of liver 1. bacteria. anorexia. anemia. These are small ducts between hepatocytes that collect bile produced by the hepatocytes. These are highly permeable blood capillaries between rows of hepatocytes that receive oxygenated blood from branches of the hepatic artery and nutrient-rich deoxygenated blood from branches of the hepatic portal vein. secretory. Fixed phagocytes that destroy worn-out white and red blood cells. Stellate reticuloendothelial (Kupffer) cells. Hepatocytes are the major functional cells of the liver and perform a wide array of metabolic. jaundice. The patient may complain of dull abdominal pain and tenderness in the right upper quadrant of the abdomen. which drain into the inferior vena cava. The hepatic laminae are plates of hepatocytes one cell thick bordered on either side by the endothelial-lined vascular spaces called hepatic sinusoids. 2. Grooves in the cell membranes between neighboring hepatocytes provide spaces for canaliculi into which the hepatocytes secrete bile. and pleural effusion may develop.

is reported promptly. teaching clients to avoid contaminated water and foods is especially important. The nurse prepares the patient for discharge by providing instruction about symptom management. Nursing interventions include teaching hikers to treat water and food handlers to wash hands thoroughly. monitoring of the drainage and skin care are imperative. Clients who have a liver abscess require supportive care to prevent dehydration from the accompanying fever. . vomiting and anorexia. NURSING MANAGEMENT: A major aspect of nursing care is prevention. signs and symptoms that should be reported to the physician. For patients who undergo evacuation and drainage of an abscess. Careful monitoring of fluid and electrolyte status is indicated. management of drainage. The nurse administers IV antibiotic therapy as prescribed. Abscess resulting from amoebic infestation require treatment with metronidazole (Flagyl) or chloroquine phodphate (Aralen phosphate) instead of broad spectrum antibiotics.MEDICAL MANAGEMENT: Treatment includes IV antibiotic therapy. Vital signs are monitored to detect changes in the patient’s physical status. as are comfort measures for abdominal pain. which may indicate rupture or extension of the abscess. Open surgical drainage may be required if antibiotic therapy and percutaneous drainage are ineffective. The white blood cell count and other laboratory test results are monitored closely for changes consistent with worsening infection. the specific antibiotic used in treatment depends on the organism identified. Strategies must be implemented to contain the drainage and to protect the patient from other sources of infection. and the importance of taking antibiotics as prescribed. nausea. Deterioration in vital signs or the onset of new symptoms such as increasing pain.

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