Liver Abscesses.pdf

Nursing

1. Justin V Sebastian

2. •Two categories of liver abscess have been identified:
amebic and pyogenic.
•Amebic liver abscesses are most commonly caused by
Entamoeba histolytica.
•Most amebic liver abscesses occur in the developing
countries of the tropics and subtropics because of poor
sanitation and hygiene.
•Pyogenic liver abscesses are much less common but are
more common in developed countries than the amebic
type.

3. Pathophysiology
•Whenever an infection develops anywhere along the biliary or GI
tract, infecting organisms may reach the liver through the biliary
system, portal venous system, or hepatic arterial or lymphatic
system.
•Most bacteria are destroyed promptly, but occasionally some gain a
foothold.
•The bacterial toxins destroy the neighboring liver cells, and the
resulting necrotic tissue serves as a protective wall for the
organisms.
•Meanwhile, leukocytes migrate into the infected area.
•The result is an abscess cavity full of a liquid containing living and
dead leukocytes, liquefied liver cells, and bacteria.

4. Clinical Manifestations
•Fever with chills and diaphoresis, malaise, anorexia,
nausea, vomiting, and weight loss may occur.
•The patient may complain of dull abdominal pain and
tenderness in the right upper quadrant of the abdomen.
•Hepatomegaly, jaundice and anemia.
•Sepsis and shock may be severe and life-threatening.

5. Diagnosis
•Blood cultures are obtained but may not identify the
organism.
•Aspiration of the liver abscess, guided by ultrasound, CT,
or MRI, may be performed to assist in diagnosis and to
obtain cultures of the organism.
•Percutaneous drainage of pyogenic abscesses is carried
out to evacuate the abscess material and promote healing.
•A catheter may be left in place for continuous drainage;
the patient must be instructed about its management.

6. Medical Management
•Treatment includes IV antibiotic therapy; the specific
antibiotic used in treatment depends on the organism
identified.
•Continuous supportive care is indicated because of the
serious condition of the patient.
•Open surgical drainage may be required if antibiotic
therapy and percutaneous drainage are ineffective.

7. Medical Management
•The nursing management depends on the patient’s physical status and the medical
management that is indicated.
•For patients who undergo evacuation and drainage of the abscess, monitoring of
the drainage and skin care are imperative.
•Vital signs are monitored to detect changes in the patient’s physical status.
•Deterioration in vital signs or the onset of new symptoms such as increasing pain,
which may indicate rupture or extension of the abscess, is reported promptly.
•The nurse administers IV antibiotic therapy as prescribed.
•The white blood cell count and other laboratory test results are monitored closely
for changes consistent with worsening infection.
•The nurse prepares the patient for discharge by providing instruction about
symptom management, signs and symptoms that should be reported to the
physician, management of drainage, and the importance of taking antibiotics as
prescribed.