Liver Surgery

Liver abscess

What is a liver abscess?

Liver abscess is a pus-filled cyst in the liver. The liver is an organ in the digestive system that assists the digestive process and carries out many other essential functions. These functions include producing bile to help break down food into energy; creating essential substances, such as hormones; cleaning toxins from the blood, including those from medication, alcohol and drugs; and controlling fat storage and cholesterol production and release.

Anyone can get a liver abscess. The condition can be caused by infections spread directly from nearby structures, such as the bile-draining tubes, from the appendix or intestines, or carried in the bloodstream from more distant parts of the body. A liver abscess can also develop as a result of surgery or other trauma to the liver.

The most common type of liver abscess is caused by bacterial or parasitic infection. Bacterial liver abscess is often called pyogenic liver abscess. Microscopic organisms called amebas, which cause the intestinal disorder amebic dysentery, can also cause amebic liver abscess.

When detected in time, liver abscess is usually treatable and often can be cured with a course of antibiotics or a combination of antibiotics and a surgical procedure to drain the abscess. Left untreated, however, a liver abscess can burst and spread the infection, leading to sepsis, a life-threatening bacterial blood infection.

What are the symptoms of a liver abscess?

Symptoms of liver abscess vary among individuals but most commonly include a combination of the symptoms listed below. In itself, a liver abscess is not life threatening, but it can become dangerous if it opens and spreads the infection. This can happen suddenly, so you should consult your health care provider if you have any of the following symptoms.

Common symptoms of a liver abscess

You may experience any combination of liver abscess symptoms. At times, any of these symptoms can be severe:

• Abdominal pain (especially in the upper right portion of the abdomen)
• Clay-colored stools
• Dark urine
• Diarrhea
• Fever or chills
• Joint pain
• Loss of appetite
• Malaise or lethargy
• Nausea with or without vomiting
• Sweating
• Unexplained weight loss
• Yellowing of the skin and whites of the eyes (jaundice)

Serious symptoms that might indicate a life-threatening condition

In some cases, liver abscess can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

• Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions
• High fever (higher than 101 degrees Fahrenheit)
• Jerky movements
• Malaise or lethargy
• Rapid heart rate (tachycardia)
• Respiratory or breathing problems, such as shortness of breath, difficulty breathing or inability to breathe, labored breathing, wheezing, or choking
• Severe pain
• Vomiting

Liver cyst

Liver cysts occur in approximately 5% of the population. However, only about 5% of these patients ever develop symptoms. In general, cysts are thin-walled structures that contain fluid. Most cysts are single, although some patients may have several. The symptoms associated with liver cysts include upper abdominal fullness, discomfort, or pain. A small number of patients bleed into the cyst, which causes sudden and severe right upper quadrant and shoulder pain. The bleeding stops on its own, and the pain then improves over the next several days. Liver cysts do not impair the liver’s ability to function. The cyst(s) are usually found by ultrasound (US) or computed tomography (CT scan). Simple liver cysts are always benign. The only patients who require treatment for a liver cyst(s) are those who develop symptoms. Simply removing the fluid from the cyst with a needle is not effective because the cyst fills up again within several days. The best treatment is to remove a large portion of the cyst wall. This surgical procedure can usually be done through the laparoscope, which requires only 2-3 small incisions and an overnight stay in the hospital. Most patients recover fully within 2 weeks. The risk of the cyst recurring is very low. A very small number of patients (0.6% of the general population) have polycystic liver (PLD) disease, which is characterized by the liver appearing like a cluster of very large grapes. Over the course of several years, patients with PLD may develop massive enlargement of the liver, which results in abdominal swelling and discomfort. In extreme cases, the patient may have a very poor quality of life because of the pain and fluid. Unlike the inevitable kidney failure associated with polycystic kidney disease, which can coexist with PLD, PLD does not cause liver failure. The only long-term solution for patients with severe PLD is liver transplantation.

Cystic Tumors

Unlike simple liver cysts, cystic tumors are actually growths that may become malignant over the course of many years. The benign cystic tumor seen most frequently is called a cystadenoma; its malignant counterpart is a cystadenocarcinoma. The symptoms caused by cystic tumors are the same as those seen with simple cysts; fullness, discomfort, and pain. The liver blood tests usually remain normal, unless a cancer has developed. US and CT scans are the best imaging studies to show the cystic tumors, which contain both liquid and solid areas. Because of the possibility of malignancy, cystic tumors must be completely removed surgically with an open (not laparoscopic) operation. The recurrence rate after surgery is very low and the long-term prognosis is excellent.

Liver cancer

Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.

The most common form of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of cells in the liver can develop cancer, but these are much less common.

Not all cancers that affect the liver are considered liver cancer. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer. And this type of cancer is named after the organ in which it began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver.

Symptoms

Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

• Losing weight without trying
• Loss of appetite
• Upper abdominal pain
• Nausea and vomiting
• General weakness and fatigue
• Abdominal swelling
• Yellow discoloration of your skin and the whites of your eyes (jaundice)
• White, chalky stools

Causes

It's not clear what causes most cases of liver cancer. But in some cases, the cause is known. For instance, chronic infection with certain hepatitis viruses can cause liver cancer.

Liver cancer occurs when liver cells develop changes (mutations) in their DNA — the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.

Hydatid cysts of the liver

Hydatid cyst is an infection caused by a parasite named Echinococcus. The infection commonly manifests as a cyst (fluid filled cavity) in the liver or elsewhere.

A hydatid cyst may produce no symptoms for upto 10 - 20 years until it is large enough to be felt. Some common symptoms include pain in the upper right part of the abdomen, fever, persistent itching, chest pain or cough.

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Complicated cysts may present with varied symptoms such as fever, jaundice or cough with blood in sputum.

Many patients can be treated with anti-parasitic medicines (albendazole or mebendazole) for upto 3 months. Another drug, praziquantel, may be helpful combined with albendazole or mebendazole.

The cysts may have to be removed surgically when they do not respond to medical therapy or complications develop in the cysts. There are various types of surgical procedures described for treatment of hydatid cysts, the most complete removal is achieved by cysto-peri-cystectomy, which offers the best chance of cure from the infection, with least chances of recurrent infection.

Liver injury

A person with a liver injury has damage to the liver, caused by an injury. The most common liver injury is a bruise to the liver. Severe liver injuries may involve a laceration to the liver.

Symptoms of a liver injury may include right upper abdominal pain, abdominal swelling, abdominal tenderness, blood in the stool, blood in the urine, vomiting, jaundice, brown urine, rapid pulse, faintness, and fainting.

The treatment for a liver injury depends on the severity of the injury. Small contusions or lacerations to the liver may heal without surgery. However, severe liver injuries require surgery to repair the liver or to control bleeding from the liver