Liver Abscess Nursing Management

 

LIVER ABSCESS

 Liver abscess occurs when bacteria or protozoa destroy hepatic tissue.

Incidence: Affects both sexes and all age-groups, more prevalent in hospitalized children (because of a high rate of immunosuppression) and in women (between 40-60 years).

Causes

Results from infection [with protozoa Entamoeba histolytica. In pyogenic liver abscesses, the common infecting organisms are Escherichia coli, Klebsiella, Salmonella,

Staphylococcus and Enterococcus(Such organisms may invade the liver] directly after a liver wound or they may spread junes skin or other loans he the henatic artery, portal vein or biliary tract. Certain illnesses or conditions (may lead to abscess development). Cholecystitis, colon Ca, divertifulitis, peritonitis, regional enteritis, infective endocarditis, pelvic inflammatory disease, [pneuma], traumi and septicemia.

Pathophysiology:

Infection in the GI trach, lung, skin or other organs/direct trauma to liver.

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Biliary system, portal venous system or Hepatic arteria lymphatic systems

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Enter liver

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Liver destroys bacteria

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Bacterial toxens destroys the neighbouring liver cells.

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Production of necrotic tissue

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Protective wall for organisms

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Leukcocytes migrate into affected area.

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Abscess cavity is fillof a liquid containing living and dead leukocytes, liquefied liver cells and bacteria.

Clinical Manifestation:

Increased temperature may be accompanied by chills. Dull abdominal pain and tenderness in the right upper quadrant of abdominal Hepatomegaly, jaundice and anemia may develop.

Diagnostic Investigations

1.  Liver scan-shows filling defects at the abscess area
2. Hepatic U/S - indicate defects caused by abscess but is less definitive than a liver scan.
3. CT scan verifies diagnosis
4. Chest x-ray - The diaphragm on the right side is raised and fixed.
5. Blood Test Elevated levels of SGOT, SGPT, alkaline phosphatase and bilirubbin (serum albumin level is decreased) WBC is elevated.
6. Blood C/S and percutaneous liver aspiration identifies causative bacteria in pyogenia abscess.

Management

• Intravenous antibiotic therapy [aninoglycosides, cephalosporins, clindamycin or chloramphenicol] 2-4 months surgery usually avoided, but require when it fails to respond to antibiotics
• CT guided Abscess Drainage

Nursing Management

1. Monitor vital signs
2. Maintain fluid and nutritional intake
3. Assess pain and administer analgesics as ordered.
4. Monitor and document drug adverse effects.
5. Apply cold/heat as ordered to minimize/relieve pain.
6. Help patient in a comfortable position, using pillows to splint/support painful areas.
7. Administration of antibiotics as ordered.
8. Wash hands before and after providing care. Wear gloves to maintain asepsis when providing direct, care, such as dressing changes.
9. Obtain and record patient's weight at the same time everyday.
10. Document skin condition and report any changes
11. Watch carefully for complication of abdominal surgery such as hemorrhage and infection