Overview
Liver infection is an inflammatory lesion of the liver caused by invasion of bacteria, viruses or fungi into the liver, which can result in localized inflammatory injury of liver tissue, necrosis and liquefaction. It mainly includes hepatitis and liver abscess, among which viral hepatitis, bacterial liver abscess and amebic liver abscess are the most common.
Etiology
It is mainly caused by the invasion of bacteria, virus or fungus into the liver. The main pathogens causing bacterial liver abscess include Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa, anaerobes, etc. The invasion pathways include bloodstream dissemination, intra-abdominal infections such as direct spread, and umbilical cord infections (via umbilical blood vessels and portal vein). The main pathogens that cause viral hepatitis are the five hepatitis A, B, C, D and E viruses.
Symptoms
Patients with viral hepatitis present with lack of appetite, anorexia, generalized weakness, accompanied by nausea, vomiting, discomfort in the liver area, and may have varying degrees of jaundice and hepatomegaly. With the progress of the disease, it can develop into spider nevus, liver palm, cirrhosis. Patients with bacterial liver abscess may have irregular fever, persistent pain in the liver area, and corresponding respiratory and abdominal symptoms due to the different locations of the abscess.
Examination
1. Laboratory examination
(1) Blood test: In patients with liver abscess, white blood cell count and neutrophil ratio can be seen to increase, especially in bacterial liver abscess. In patients with viral hepatitis, blood biochemistry examination shows that alanine aminotransferase, menthionine aminotransferase, total bilirubin and conjugated bilirubin are elevated, and the level of serum total protein and albumin is decreased; urine bilirubin and urine bile are positive; and the prothrombin time and fibrin of some patients are also abnormal. Leukocyte count and neutrophilia are seen in febrile patients.
(2) Stool routine: amebic trophozoites can be seen in amebic liver abscess test.
2. Imaging
X-ray, ultrasound and CT may show changes in the liver area.
3. Pathogenetic examination
Take liver pus and blood samples, do bacterial culture or blood culture, check aerobic and anaerobic bacteria, and perform fungal examination if necessary.
Diagnosis
Diagnosis is established on the basis of clinical manifestations, pathogenetic examination, laboratory examination, imaging examination and other findings.
Treatment
1. Systemic supportive therapy.
2. When the pathogenic bacteria are not determined, broad-spectrum antibiotics should be used, and effective antibiotics should be used according to the results of bacterial culture and drug sensitivity test when conditions permit. Patients with viral hepatitis can be treated with antiviral and hepatoprotective therapy.
3. For patients with liver abscess, if the symptoms of systemic toxicity are serious and accompanied by complications, surgery should be considered.