liver abscess,vidradhi ayurvedic correlation explains simply about liver abscess its clinical features necessary investigations treatment and ayurvedic parlance
2. Definition
• Liver abscess is a pus-filled pocket of fluid within the liver.
• A liver abscess can develop from several different sources, including
a blood infection, an abdominal infection, or an abdominal injury
which has been become infected.
• The annual incidence of liver abscess has been estimated at 2.3
cases per 100,000 populations and is higher among men than
women.
• It is common in India with 2nd highest incidence due to poor
sanitation, overcrowding and inadequate nutrition.
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7. Pyogenic liver abscess
• Pathogens
• Escherichia coli
• Staphylococcus aureus and
• Haemolytic streptococcus
• Bacteroides and anaerobes
• Proteus and klebsiella
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8. Clinical features
• Fever-Hectic,
Picket fence pattern
• Chill and sweating
• Pain –continuous,
right subcoastal area or epigastrium
may radiate to flanks
referral pain in right shoulder
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15. Treatment
• Antibiotic therapy
• Surgical drainage
• Antibiotic therapy-medicines focusing on gram negative bacteria
& enteric anaerobes
IV metronidazole and aminoglycoside
Ampicillin or pencillin-in pts with sepsis
Rx continued for 4-8 weeks
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16. Surgical drainage
• Percutaneously under USG or CT
• Percutaneous needle aspiration
•
Percutaneous drainage requires local anaesthesia and minimal
sedation.
• PNA is advantageous in allowing smaller and multiple lesions to be
sampled for culture and to obviate the need for catheter placement,
which may be difficult under certain circumstances
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17. • Percutaneous catheter drainage
• PCD allows controlled drainage of large abscesses over a
period of time with minimal haemodynamic and physiological
stress to the patient. It is also the only definitive treatment for
those with no other surgical pathology.
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18. • RESECTION
• Liver resection is part of the surgical armamentaria.Specific
indications include liver carbuncle and associated
hepatolithiasis, especially in the left lobe, commonly found in
recurrent pyogenic cholangitis.
• liver lesion with concomitant infection requires treatment
of the sepsis before surgery is undertaken.
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20. • Two stages
• amoebic hepatitis- due to increased lymphocyte, fatty
changes, lysis of hepatic cells
• amoebic abscess-entamoeba enter liver-portal thrombosis and
infarction-cytolytic activity-liquefaction of surrounding stromal
and parenchymal structures-formation of abscess
• Liver enlarged
• Contents mixture of RBCs, leukocytes, liver cells
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21. • Chocolate or reddish brown colour-anchovy sauce appearance
• Microscopically-central necrotic zone
• middle zone with destruction of
parenchymal cells
• outer zone fibrous capsule
• Pus is sterile if not associated with secondary infection
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22. complications
• Abscess-burst into pleural cavity, lung, peritoneal cavity
• When burst into pleural cavity empyema may result
• Burst into lung may cause broncho hepatic fistula, lung
abscess or pneumonia
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23. Clinical features
• Develops after attack of amoebic dysentery
• Mainly develops in carrier who has not shown definitive
symptoms and signs of amoebic dysentery
• Symptoms:
• Fever-may shoot up to 39degree Celsius, but less than
pyogenic type, associated with chills and sweating
• Pain-felt over right intercoastal spaces
• Slight bulging and pitting edema present
• Referred pain to right shoulder
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24. On examination
• Tender hepatomegaly
• Tenderness and rigidity may be felt below the right coastal
margin
• If left lobe affected-tender swelling in epigastric region
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25. Special investigations
• Blood examination-leucocytosis in early stage, chronic
condition anaemia present
• Serological tests-to detect antibodies to entameoba
histolytica, antiboby titres will be high in these cases.
• Examination of stool: presence of amoeba in stool
• Sigmoidoscopy reveal amoebic ulcers
• Radiography-elevation and fixation of right cupola of
diaphragm
• Aspiration of abscess contents reveals 100% diagnosis
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26. Treatment
• Amoebicidal drugs-metronidazole-500-750mg,TDs-5-10 days
• Needle aspiration: done with support of radiological imaging
• Indications for aspiration
• persistence of clinical features of amoebic abscess following a
course of amoebicidal drugs
• clinical or radiographic presence of hepatic abscess
• Technique of aspiration-wide bore needle passes in between 9th
and 10th interspace between the anterior and posterior axillary
lines.
• Surgical drainage when associated with secondary infections and
in amoebic peritonitis 26
29. • Abhyantara vidradhi nidanas
Asatmya ,viruddha,shuska ,asamsrushta bhojana
• Ativyayama, vyavaya, vega dharana
Produces aggravation of doshas- गुल्मरुवपणम्
• Give rise to abscess inside abdomen(र्ल्मीकर्त्समुन्नध्दमन्तिः),
which may grow into groin ,kidney, liver or spleen and other
organs and near by structures
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31. Sadhya asadhyata
• Vidradhi above nabhi asadhya
• Below nabhi sadhya
• Abscess located near heart ,umbilicus and tridoshaja is yapya
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32. Chikitsa
• Acc Su.Chi.16
• Shopha Chikitsa should be adopted here at first
• Pitta and rakta vidradhi Chikitsa can be adopted here.
• Varunadi gana Kashaya along ushakadi gana dravyas be given.
• Ghrita prepared with above said drugs can be used for
virechana.
• Madhushigru-for pana, lepana and bhojana with prakshepa
dravyas
• Shilajatu with pitta and raktahara drugs can be given.
• Siravyadhana in arm is indicated in raktaja and pittaja condition.
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35. conclusion
• These types of diseases which develop via pathogens could be
prevented by maintaining hygiene .
• People with attack of amoebic dysentery or other infections
could be cautious about its later outcome and by getting proper
management at proper time.
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