Liver abscess- Ayurvedic Treatment, Diet, Exercises, Research Papers, Yoga & Pranayama

Introduction

Bacterial abscess of the liver is relatively rare; however, it has been described since the time of Hippocrates (400 BCE), with the first published review by Bright appearing in 1936. In 1938, Ochsner’s classic review heralded surgical drainage as the definitive therapy; however, despite the more aggressive approach to treatment, the mortality remained at 60-80%.

The development of new radiologic techniques, the improvement in microbiologic identification, and the advancement of drainage techniques, as well as improved supportive care, have reduced mortality to 5-30%; yet, the prevalence of liver abscess has remained relatively unchanged. Untreated, this infection remains uniformly fatal.

The three major forms of liver abscess, classified by etiology, are as follows:

·       Pyogenic abscess, which is most often polymicrobial.

·       Amoebic abscess due to Entamoeba histolytica

·       Fungal abscess, most often due to Candida species

Signs & symptoms

Fever with chills

Vomiting

Pain in the right side of upper abdomen

Sudden weight loss

Dark colour of urine

Pale or grey coloured stool

Diarrhoea

Causes

1)Infections in the liver

Bacterial liver abscess

            Escherichia coli 

Klebsiella pneumoniae

Staphylococcus aureus 

Staphylococcus milleri 

Amoebic liver abscess

  Entamoeba histolytica

Fungal abscesses

Candida albicans

Aspergillus 

Actinomyces 

Eikenella corrodens,

Yersinia enterocolitica,

Salmonella typhi,

Brucella melitensis.

2)As secondary to infections like appendicitis, peritonitis, endocarditis etc

3)Associated with diseases like pancreatic cancer, colon cancer, inflammatory bowel disease, septicaemia, etc.

4) Trauma to the liver by injury/accident

Pathophysiology

Enterobacteriaceae are especially prominent when the infection is of biliary origin. Abscesses involving K pneumoniae have been associated with multiple cases of endophthalmitis.

The most frequently encountered anaerobes are Bacteroides species, Fusobacterium species, and microaerophilic and anaerobic streptococci. A colony is found is usually as the initial source of infection.

Staphylococcus aureus abscesses usually result from hematogenous spread of organisms involved with distant infections, such as endocarditis.

Staphylococcus milleri is neither anaerobic nor microaerophilic. It has been associated with both monomicrobial and polymicrobial abscesses in patients with Crohn disease, as well as with other patients with pyogenic liver abscess.

Candida albicans occur in individuals with prolonged exposure to antimicrobials, hematologic malignancies, solid-organ transplants, and congenital and acquired immunodeficiency.

Pyogenic liver abscess is observed as the initial manifestation of underlying hepatocellular carcinoma in rare cases.

The liver receives blood from both systemic and portal circulations. Increased susceptibility to infections would be expected given the increased exposure to bacteria. However, Kupffer cells lining the hepatic sinusoids clear bacteria so efficiently that infection rarely occurs. Multiple processes have been associated with the development of hepatic abscesses.

Biliary tract disease is now the most common source of pyogenic liver abscess (PLA). Obstruction of bile flow allows for bacterial proliferation. Biliary stone disease, obstructive malignancy affecting the biliary tree, stricture, and congenital diseases are common inciting conditions. With a biliary source, abscesses usually are multiple, unless they are associated with surgical interventions or indwelling biliary stents. In these instances, solitary lesions can be seen.

Infections in organs in the portal bed can result in a localized septic thrombophlebitis, which can lead to liver abscess. Septic emboli are released into the portal circulation, trapped by the hepatic sinusoids, and become the nidus for micro abscess formation. These micro abscesses initially are multiple but usually coalesce into a solitary lesion.

Penetrating hepatic trauma can inoculate organisms directly into the liver parenchyma, resulting in pyogenic liver abscess. Nonpenetrating trauma can also be the precursor to pyogenic liver abscess by causing localized hepatic necrosis, intrahepatic hemorrhage, and bile leakage. The resulting tissue environment permits bacterial growth, which may lead to pyogenic liver abscess. These lesions are typically solitary.

The right hepatic lobe is affected more often than the left hepatic lobe. Bilateral involvement is seen in 5% of cases. The predilection for the right hepatic lobe can be attributed to anatomic considerations. The right hepatic lobe receives blood from both the superior mesenteric and portal veins, whereas the left hepatic lobe receives inferior mesenteric and splenic drainage. It also contains a denser network of biliary canaliculi and, overall, accounts for more hepatic mass.

Diagnosis

USG – abdomen

CT scan

MRI

Blood tests like TC, DC etc to check infection

ESR

Blood cultures

Treatments

Antibiotics

Anti-pyretic pills

NSAID’s

Drainage therapy with insertion of a needle & a drainage catheter into the abscess to remove the pus.

Surgery and parenteral antibiotics in more severe cases.

Prognosis

Liver abscesses usually have a bad prognosis in general due to chance of multi-organ failure and delay in diagnosis & treatment. Pyogenic liver abscess is fatal, when left untreated. With timely administration of antibiotics and drainage procedures, mortality currently occurs in 5-30% of cases. The most common causes of death include sepsis, multiorgan failure, including hepatic failure.

Bilirubin level greater than 3.5 mg/dL, encephalopathy, hypoalbuminemia, and multiple abscesses; all are independent factors that predict poor outcome in amoebic abscess

An underlying malignant aetiology and an Acute Physiology and Chronic Health Evaluation (APACHE II) score greater than 9 increases the relative mortality by 6.3-fold and 6.8-fold, respectively.

Complications

Sepsis

Pulmonary complications especially in amoebic abscess

Empyema resulting from contiguous spread or intrapleural rupture of abscess

Rupture of abscess with peritonitis afterwards

Endophthalmitis when an abscess is associated with K. pneumoniae bacteraemia

Disease & Ayurveda

Aabhyantaravidradhi

Nidana

Diet which is Heavy, Unsuitable, unwholesome, dry, and mixed with all other food items with opposite potency.

Excess physical exercise & sexual intercourse

Holding natural urges like urine, faeces, vomiting, cough etc.

Diet which causes & aids infection & inflammation

Purvaaroopa

Not mentioned

Samprapti

Due to the causative factors, the doshas get vitiated individually or together and generates aabhyantaravidradhi or abscess inside the abdomen. In this, all the three doshas are involved in most cases. The vitiated doshas vitiate all dhatus and supportive tissues like Twak, rakta, mamsa, medas, asth, snayu, kandara etc. The vitiated doshas can get lodged in any of the following 10 sites in abdomen to produce aabhyantara vidradhi.

Naabhi – navel

Vasti    – Urinary bladder

Yakrit  – Liver

Pleeha -Spleen

Kloma – Pancreas

Hrdaya – Heart

Kukshi – Abdomen

Vankshana      – Groin

Vrkka  – Kidney

Guda   – Rectum

After the sthaanasamsraya, these doshas produce a heavy swelling or cyst which is painful and inflammatory in nature.

Lakshana

There is general and specific lakshanas of aabhyantaravidradi depending upon its site of development.

General lakshanas are:

        Cyst/bulged up tissue

            Pain (Severe and unbearable)

Pus discharge

Specific lakshana of aabhyantaravidradhi in

yakrit

swaasa difficulty in breathing

 kukshi

maarutakopanam (abnormal movement of Vaayu/gas formation)

kukshiparswaamsaarti(pain in abdomen, sides and shoulder)

aatopajanma(abnormal sounds from abdomen with gas trouble)

Divisions

  • Baahyam

Aabhyantaram

  • Vaatikam

Paittikam

Kaphajam

Thridoshajam

Raktajam

Kshatajam

Prognosis

Kashtasadhyam

Chikithsa

Samana

Soolaharalepanam

Sodhana

Virechanam

Bhedanam and drainage of pus

Commonly used medicines

        Guggulupanchapalachoornam

            Punarnavadi kashayam

            Dasamoolapanchakoladi kashayam

            Avipathichoornam

Brands available

AVS Kottakal

AVP Coimbatore

SNA oushadhasala

Vaidyaratnam oushadhasala

Home remedies

No home remedy is suggested for liver abscess as it is a condition of medical emergency

Diet

  • To be avoided

Minimise the intake of Salt and oil as a part of diet.

Heavy meals and difficult to digest foods – cause indigestion.

Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine

Carbonated drinks – makes the stomach more acidic and disturbed digestion

Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)

Milk and milk products – increase kapha and cause respiratory problems

Curd – causes vidaaha and thereby many other diseases

  • To be added

Light meals and easily digestible foods

Green gram, soups.

Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc

Behaviour:

Quit alcohol/smoking/narcotics.

Avoid sedentary lifestyle. Be active.

Better to avoid exposure to excessive sunlight wind rain or dust.

Maintain a regular food and sleep schedule.

Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.

Avoid day sleep.

Yoga

Vigorous exercises are not allowed in inflammatory liver abscess conditions.

Only stretching, moderate walking, and mild cardio exercises are advised. Also, specific yogacharya including Ardhamathsyentrasana, Dhanurasana, Gomukhasna and naukasana is recommended. Pain, the strength of the patient, range of movement and flexibility must be considered while doing every exercise. 

Sookshma sandhi vyayama (warming up small joints) is advised.

Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.

 Yoga can maintain harmony within the body and with the surrounding system.

Ardhamathsyentrasana

Dhanurasana

gomukasana

Naukasana

All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.

Research articles

https://pubmed.ncbi.nlm.nih.gov/2648615/

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s