Dr.(Major) R.S RENGAN M.S., D.N.B., Dip Laproscopic Surgery (University of Strasbourg)  

Senior Consultant, General & Laparoscopic surgery                                                                         For Appointment: 94440 42294

Apollo First Med Hospital,Chennai.

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Celebrate Life

Specialized centre for Gastrointestinal Surgery, Breast, Thyroid Endocrine, Vascular, Cancer & Cosmetic surgery

Liver

The liver is the largest organ in our body that sits on the right side of the stomach. It is reddish-brown in color and feels rubbery to touch. Normally the liver cannot be felt, as it is protected by the ribs on the right side of our body.

The liver has two large sections known as the right and the left lobes. An organ named the gallbladder sits under the liver. Also present nearby is another organ called the pancreas and the intestines which are the main channels through which food passes. The liver and these organs work together to absorb and digest food.

The liver’s main work is to filter the blood coming from the digestive tract, before passing it to the rest of the body. Other functions include:

  • Breaks down impure substances and metabolizes drugs.
  • Helps in digestion of carbohydrates, proteins and fats.
  • Makes proteins important for blood clotting.
  • It produces and excretes a yellowish liquid called the bile required for digestion of fats and helps the absorption of vitamin K from the food we eat. Some of the bile drains directly into the intestines and some is stored in the gallbladder.
  • Many Vitamins are stored in this organ.

Liver Injury

The liver is positioned in our body in such a manner that it is easily injured. In fact it is the most common organ to be injured followed by the spleen because of these three reasons,

  • Its position in the body.
  • Is a very delicate organ even a small force can injure the organ.
  • The protective covering around the organ named the capsule is very thin.

Injuries may result from

  • Penetrating injuries like gunshot wounds, stab with a sharp objects such as a knife
  • Road Traffic Accidents

Liver injuries present a serious risk because the liver tissue is delicate and has a large blood supply. Majority of people who sustain this injury also have other accompanying injuries to the adjacent organs like the spleen and ribs.

Symptoms

Large amounts of blood are lost leading to shock. The affected person,

  • Becomes white in color, sweats profusely, his heart beats fast and there is fall in blood pressure
  • There is a fall in his urine output.
  • Blood leaks may collect in an area and can become infected
  • Experiences difficulty in breathing

Treatment

Small injuries where the patient is not very sick can be managed by the following ways,

  • First the patient has to be admitted in a hospital for a few days. He is kept on close watch because complications are likely to develop during the first few days.
  • Any blood lost is replaced.
  • His temperature, pulse, heart rate will be monitored regularly.
  • Antibiotics are given to prevent infections.

If the injuries are very serious, immediate measures have to be taken to manage shock and the patient is taken up to surgery.

If there is a small tear in the organ it can be closed carefully.

In the areas of bleeding, direct pressure is given to stop or an instrument called the Clamp can be used to stop bleeding from the injured blood vessel.

In very serious cases, a portion of your liver might require removal.

Liver Abscess

An abscess is a mass which contains infected fluid called ‘pus’. It can collect up within any tissue of our body. In the skin it is called superficial abscess and if it occurs in an organ inside the body it is called deep abscess.

Abscess can cause a lot of pain and feels warm upon touch. Unlike other infections, antibiotics alone will not usually cure an abscess. It must open and drain in order for it to improve. Draining occurs on its own, but generally it must be opened by a doctor by a procedure called incision and drainage.

If adequate care is not given an abscess can grow worse and spreads to the surrounding area. The infection can also spread to your blood.

The liver is an organ where an abscess develops commonly because it not only receives a large amount of blood but also most of the infection causing organisms after being filtered stays back in the organ.

There are three major forms of liver abscess classified by the infections caused by

  • Bacteria (Pyogenic Liver Abscess-PLA)
  • A parasite called amoeba (Amoebic liver abscess-ALA)
  • Fungus

Important Features

  • Many bacteria can join and produce an abscess at the same time.
  • More common in people with Diabetes.
  • More than one abscess can be present.
  • An infection in the biliary tract through which the bile passes is an important cause of bacterial liver abscess.

Symptoms Of An Abscess

  • In amoebic abscess patients may give history of a dysentery one to many months ago.
  • High fever, chillness and shivering.
  • The patient starts losing weight and eats less than normal.
  • He feels pain to the right of his stomach. Pain can also be felt in the right shoulder.
  • Sometimes dry cough, chest pain may also be complained of(common in amoebic liver abscess)
  • dark-colored urine and whitish or clay-colored stool

Diagnosis of Pyogenic Liver Abscess

A doctor may order a combination of blood cultures and imaging tests to confirm PLA.

The following tests may be used:

  • Blood tests—elevated white blood count and high neutrophil level indicate infection
  • Blood cultures for bacteria—to identify the bacteria so your doctor knows what antibiotic to prescribe
  • Computed tomography (CT) scan—to locate the abscess
  • CT with intravenous contrast—to pinpoint and measure the abscess (very useful when planning a surgery)
  • Ultrasound of the abdomen

Treatment of Pyogenic Liver Abscess

Some people can be successfully treated for PLA with systemic antibiotics alone.

Most, however, will require drainage of the abscess. This involves inserting a drainage tube/catheter into the abscess and removing the pus. Your doctor may perform a liver biopsy at the same time to determine the overall health of your liver. This procedure is performed with the aid of a CT scan or an ultrasound.

Doctors try to treat PLA without surgery if possible to prevent the risk of bacteria spreading through the body. However, in more severe cases, surgery may be required to fully remove the abscess.

After surgery you will be treated with antibiotics for several weeks to avoid recurring infection.

Complications of Pyogenic Liver Abscess

The main complication of PLA is body-wide bacterial infection that causes inflammation and a dangerous fall in blood pressure. If not treated promptly with antibiotics, sepsis can be Life threatening.

Bacteria released and spread throughout the body can cause:

  • eptic pulmonary embolism (a clot in one or more arteries in the lungs)
  • Brain abscess, causing permanent neurological damage
  • Liver failure
  • Infection by a specific bacterium namely, ‘Klebsiella’ can cause dangerous endophthalmitis which is an infection in the inner part of the eye which may lead to vision loss commonly in diabetic patients.

Amoebic Liver Abscess

Amoebiasis is the infection of the human digestive tract by Entamoeba histolytica, a parasite that is capable of invading the intestinal mucosa and may spread to other organs, mainly the liver.

  • Multiple abscesses are seen.
  • Some patients can present with a lone abscess in the left lobe of the liver.

Extension of the abscess can occur into these regions

  • It can rupture into the lungs leading to coughing up of chocolate colored sputum.
  • Leakage of the abscess may occur into the pleural cavity (space between the surface of your lungs and the inner lining of your chest wall) with empyema thoracis (a collection of pus)
  • Intra abdominal extension following perforation into the peritoneal cavity (a potential space between the two membranes that separate the organs in the abdominal cavity from the abdominal wall) is usually associated with shock and generalized peritonitis
  • Rupture into the cavity around the heart causing cardiac tamponade (pressure caused by fluid in the pericardial cavity). It’s a highly dangerous condition requiring immediate intervention

Treatment Of An Amoebic Liver Abscess

Medical therapy may be instituted using either a single agent or a combination of antibiotics.

Single-agent therapy with a drug called metronidazole yields excellent results and the alternative drugs are indicated rarely and used mostly in seriously ill patients.

The response to anti-amoebic drugs is usually evident within 48-72 hours.

Aspiration or drainage of abscess.

Aspiration has been indicated in the following situations: lack of clinical improvement in 48-72 hours, left lobe abscess, when the abscess is very large.

Drainage is done using a catheter under ultrasound guidance.

Very rarely surgery is done in case of,

  • The abscess cavity fills again after repeated aspirations
  • Very thick pus
  • Abscess in left lobe
  • Ruptured abscess
  • Multiple abscess

Liver Cancer

Cancer of liver is rising in incidence due to various factors.

  • Chronic hepatitis B and C infection. Hepatitis C has no vaccine so contact your doctor to know more about Hepatitis B and Hepatitis C infection,
  • Cirrhosis of the liver , mainly due to alcohol.
  • Diabetes mellitus.
  • Exposure to toxins, such as certain types of fungi (aflatoxin), vinyl chloride, anabolic steroids, and arsenic.
  • Smoking. The link is not exactly clear but smokers are more prone to develop Liver Cancer.

Types of Liver Cancer

Hepatocellular carcinoma (HCC)

The most common type of liver cancer is hepatocellular carcinoma and it is the result of a tumor formed by the abnormal growth of the liver-specific cells called hepatocytes (‘hepat’ and ‘hepato’ are derived from the Greek word for liver). Most patients with this type of cancer are over 50 and it is more common in males than in females.

Hepatocellular carcinoma can metastasize, and when it does, it frequently goes to nearby lymph nodes and to the lungs.

Cholangiocarcinoma

This kind of carcinoma, also known as bile duct cancer, arises from the connective tissues of the tubes that connect the liver to the gallbladder and the gallbladder to the small intestine (hepatic bile ducts) as well as the ducts, located inside the liver (intrahepatic ducts). Most cholangiocarcinomas are adenocarcinomas (they form in glandular tissue)but they frequently grow slowly and don’t metastasize for long periods of time. Because the cancer has few specific symptoms and can be confused with other liver conditions (hepatitis or cirrhosis), it is difficult to detect early and is usually in advanced form when discovered. The average age of patients at diagnosis with cholangio carcinoma is 65.

Hepatoblastoma

Hepatoblastoma characteristically develops in children; it is most frequently diagnosed in infants between 14 and 24 months and almost all patients are diagnosed by the age of 5. Older children and adults can develop this carcinoma, but it is very rare. This malignancy is the result of an uncontrolled proliferation of undeveloped liver cells (hepatocytes). Hepatoblastoma is usually found in only one place (unifocal), it’s uncommon for it to metastasize.

Symptoms

  • Yellowish color of the skin (Jaundice)
  • Inability to eat (Anorexia)
  • Weight Loss
  • Abdominal pain and/or swelling

Treatment

Treatment of liver cancer is diverse. It involves a combination of Surgery, Radiotherapy and Chemotherapy.