tailieunhanh - Diseases of the Liver and Biliary System - part 8

Trong 30 năm qua đã có một sự thay đổi rõ rệt trong các nguyên nhân của áp xe gan mủ (hình 29,1). [7]. Áp xe thứ bệnh đường mật, đặc biệt là ác tính, đã tiếp tục gia tăng. Các trạng thái ức chế miễn dịch đã tăng số lượng do nhiễm trùng cơ hội. | Chapter 29 The Liver in Infections Pyogenic liver abscess Over the past 30 years there has been a marked change in the aetiology of pyogenic liver abscess fig. 7 . Abscesses secondary to biliary disease particularly malignant have continued to increase. The immunosuppressive states have increased the number due to opportunistic infections. Earlier diagnosis has followed increased use of scanning and cholangiographic techniques. Aetiology Underlying biliary disease is the most frequent cause. Septic cholangitis can complicate any form of biliary obstruction especially if partial. More cases are related to surgical or invasive non-surgical treatment of hepatobiliary disease despite the use of prophylactic antibiotics. Biliary stenting for malignant biliary and pancreatic disease is a particular association. Abscess may follow sclerosing cholangitis and congenital biliary anomalies especially Caroli s disease. Portal pyaemia may follow pelvic or gastrointestinal infection resulting in portal pylephlebitis or septic emboli. It can follow appendicitis empyema of the gallbladder diverticulitis regional enteritis 14 Yersinia ileitis 9 perforated gastric or colonic ulcers leaking anastomoses pancreatitis 1 or infected haemorrhoids. Neonatal umbilical sepsis may spread to the portal vein with subsequent liver abscesses. Injury to the hepatic arterial system may lead to liver abscesses. This can follow cholecystectomy. In liver transplant patients abscess may be diagnosed 2 weeks post-operatively associated with technical complications particularly hepatic arterial thrombosis. Abscesses may follow local treatment of liver tumours by trans-hepatic chemo-embolization or percutaneous tumour injections 5 . Abscess may follow therapeutic hepatic arterial catheterization to treat colonic cancer metastases 15 . Increase in liver abscesses may also be related to the numbers of severely immunosuppressed patients. These include those post-transplant with HIV infection or with .