Escolar Documentos
Profissional Documentos
Cultura Documentos
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.
Hepatic laminae
Hepatocyte
Branch of hepatic portal vein Central vein (a) Overview of histological components of liver
Hepatic sinusoids
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
1. Hepatocytes are the major functional cells of the liver and perform a wide array of metabolic, secretory, and endocrine functions. 2. Hepatic laminae are complex three-dimensional arrangements. The hepatic laminae are plates of hepatocytes one cell thick bordered on either side by the endothelial-lined vascular spaces called hepatic sinusoids. Grooves in the cell membranes between neighboring hepatocytes provide spaces for canaliculi into which the hepatocytes secrete bile. 3. Bile canaliculi. These are small ducts between hepatocytes that collect bile produced by the hepatocytes. 4. Hepatic sinusoids. 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. Hepatic sinusoids converge and deliver blood into a central vein. From central veins the blood flows into the hepatic veins, which drain into the inferior vena cava. 5. Stellate reticuloendothelial (Kupffer) cells. Fixed phagocytes that destroy worn-out white and red blood cells, bacteria, and other foreign matter in the venous blood draining from the gastrointestinal tract. SIGNS AND SYMPTOMS 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, anemia, and pleural effusion may develop.
MEDICAL MANAGEMENT: Treatment includes IV antibiotic therapy; the specific antibiotic used in treatment depends on the organism identified. Open surgical drainage may be required if antibiotic therapy and percutaneous drainage are ineffective. Abscess resulting from amoebic infestation require treatment with metronidazole (Flagyl) or chloroquine phodphate (Aralen phosphate) instead of broad spectrum antibiotics.
NURSING MANAGEMENT: A major aspect of nursing care is prevention; teaching clients to avoid contaminated water and foods is especially important. Nursing interventions include teaching hikers to treat water and food handlers to wash hands thoroughly. Clients who have a liver abscess require supportive care to prevent dehydration from the accompanying fever, nausea, vomiting and anorexia. Careful monitoring of fluid and electrolyte status is indicated, as are comfort measures for abdominal pain. For patients who undergo evacuation and drainage of an abscess, monitoring of the drainage and skin care are imperative. Strategies must be implemented to contain the drainage and to protect the patient from other sources of infection. Vital signs are monitored to detect changes in the patients 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.