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The common causes of right abdominal pain in the elderly are gastrointestinal spasm, cholecystitis, appendicitis, and right ureteral calculi, intussuscences and other diseases need further differential diagnosis. The etiology should be determined as early as possible through detailed physical examination and auxiliary examination, and it is important to choose targeted treatment according to different etiology. For elderly people with diabetes, there is another disease that can not be ignored, that is, the formation of liver abscess, many people understand little about this disease liver abscess, the following details about the relevant medical knowledge of diabetic liver abscess:

First, why is diabetes in the elderly one of the causes of liver abscess formation

The decrease of insulin secretion level and insulin action caused by various reasons in diabetic patients leads to the increase of blood sugar level in the body, resulting in the disorder of sugar, fat and protein metabolism in the body; When the blood sugar rises, the tiny blood vessels in the liver are prone to circulation disorders. And the elderly's own anti-infection ability itself is reduced, and the immune function of diabetic patients is decreased, resulting in a decline in the ability of white blood cells to phagocytic bacteria. Therefore, if the blood sugar control is not good, it is easy to provide opportunities for bacteria to multiply, leading to various infectious diseases in elderly diabetic patients. Hepatic abscess is a relatively common infectious disease of the liver, but hepatic abscess is not a complication of diabetes. When blood sugar is poorly controlled or continuously elevated, elevated blood sugar will induce the formation of intrahepatic abscess. Hepatic abscess refers to infectious diseases occurring in the hepatic parenchyma, which can be divided into three categories: bacterial hepatic abscess, amebic hepatic abscess and fungal hepatic abscess. Bacterial hepatic abscess is the most common, and its bacterial source is intestinal source, biliary source, etc., or outside the liver

The infection routes of the wound include transbiliary system, portal vein system, arterial system, lymphatic system and direct entry. Therefore, active control of blood sugar, elimination of diabetes symptoms and prevention of related metabolic disorders in elderly patients with diabetes is the primary task to ensure life safety.

Second, what are the symptoms of liver abscess in elderly diabetic patients

Liver abscess is usually not easy to be found early because the symptoms are not obvious, some elderly people will have mild dull pain in the liver area discomfort, nausea, vomiting, fatigue, loss of appetite and other minor symptoms, often appear obvious right upper abdominal pain or high fever and other obvious infection symptoms before they were sent to the hospital. If it is not found in time, there may be jaundice symptoms such as yellow skin, itching, dark urine, etc., and even toxic shock caused by infection.

Third, elderly diabetic patients suspected liver abscess how to diagnose

Once patients with diabetes have mild symptoms such as dull pain and discomfort in the liver area, nausea, vomiting, fatigue, loss of appetite, etc., ultrasound or CT imaging examinations should be performed as soon as possible to rule out the possibility of liver abscess. Ultrasound has the advantages of non-invasive, convenient, inexpensive, visual and dynamic observation, and is the first choice for the examination of liver abscess. The early ultrasonographic manifestations of liver abscess are not specific, and 60% of patients need at least 3 weeks or more from infection to abscess formation. Therefore, liver abscess cannot be easily ruled out when the ultrasound results are negative, and it must be closely combined with clinical laboratory examination and ultrasonic dynamic follow-up examination, otherwise it is easy to miss diagnosis and misdiagnosis.

Ultrasound diagnosis of liver abscess mainly depends on the liver examination image features of patients. During the development of hepatic abscess, there is no neovascularization, only vascular reaction and destruction of vascular structure along with tissue destruction during lesion necrosis. According to the course of liver abscess, it can be divided into: the stage of intrahepatic inflammation, the stage of abscess formation and the stage of absorption and recovery. The pathological features of the stage of intrahepatic inflammation were local inflammatory congestion, edema and focal necrosis of liver cells. The ultrasound image showed an inflammatory mass with unclear boundary. The course of the disease was about 1 week, and the ultrasonography showed a heterogeneous low echo area with unclear boundary. The ultrasonographic manifestations are not specific, and must be closely combined with the clinical and dynamic observation to have diagnostic significance, otherwise it is easy to misdiagnose. The ultrasonographic manifestations of abscess in the formation stage were characteristic, and the images showed honeycomb echo in low echo or free dot echo in liver echo zone. Abscess has clear boundary, thick wall and pus cavity. In the recovery period of liver abscess, the echoless area within the abscess was significantly reduced or disappeared, and was replaced by patchy or stringy high or low echo.

Fourth, elderly diabetic patients got liver abscess how to do

If the liver abscess is not given timely and effective diagnosis and treatment, it often causes serious complications. At present, the surgical treatment includes ultrasonic or CT-guided liver abscess aspiration and drainage, laparoscopic abscess incision and drainage, partial liver resection, etc. With the widespread use of antibiotics and the interventional treatment of liver abscess, the prognosis of liver abscess has been greatly improved. Interventional ultrasound was officially recognized as a new discipline of ultrasound medicine at the World Conference on Interventional Ultrasound held in Copenhagen in 1983. Interventional ultrasound includes ultrasound-guided puncture biopsy and ultrasound-guided puncture therapy. Ultrasound-guided hepatic abscess aspiration and tube drainage is an interventional ultrasound that is both diagnostic and therapeutic. The infection type of hepatic abscess can be determined through drug sensitivity test and bacterial culture examination, so that appropriate antibiotics can be further used for treatment. Catheterization and drainage can not only reduce the liver pressure caused by liver abscess in patients, but also achieve the therapeutic purpose by injecting normal saline to repeatedly aspirate and dilute the pus. Under ultrasound-guided puncture aspiration and catheter drainage for liver abscess, the ultrasound doctor first evaluated the intrahepatic lesions in advance, observed the location, number and diameter of the liver abscess, understood the correlation between the abscess and the surrounding blood vessels and bile ducts, selected the direction of puncture needle entry, measured the distance between the puncture point and the center of liver abscess, and determined the best needle insertion route. Then, under the real-time guidance or supervision of the ultrasonic instrument, the direction of the puncture needle is adjusted at any time, the best Angle is selected, and the puncture needle is inserted into the designated location of the liver abscess according to the determined route, which can clearly show the location of the needle tip, the complete or not of the suction of the pus cavity, and the process of indwelling the drainage tube is completed.

The clinical application of interventional ultrasound is becoming more and more widespread, which enables patients to achieve the same therapeutic effect as surgical drainage with minimal trauma. The results showed that the operation of ultrasound-guided liver abscess was simple and relatively safe, while the operation of abdominal liver abscess incision and drainage was shorter in hospital, higher in cure rate and lower in recurrence rate. Both have their own advantages, so the choice of their indications is very important. Compared with surgical drainage, ultrasound-guided hepatic abscess aspiration and catheter drainage have the advantages of simple operation, minimally invasive, safety, reliable efficacy and short course of treatment, providing timely diagnosis and effective treatment for abdominal abscess. For liver abscess diameter >5cm, the elderly and weak can not tolerate the operation is more suitable for ultrasound guided liver abscess puncture catheter drainage. According to statistics, it can exempt 82-98% of liver abscesses from surgical operation, especially for postoperative and elderly, frail and critically ill patients with special application value, which not only reduces the pain of patients, but also avoids the risk caused by repeated surgery. However, in cases where the abscess is deep, located near the portal of liver and large blood vessels and is not easy to puncture, such as the roof of the diaphragm, the puncture effect is poor, the recurrence is easy, or the patient is affected by lung or gastrointestinal gas interference, or the patient is overweight, the abscess is unclear, there is no safe puncture path, the puncture drainage of liver abscess under ultrasound guidance will be limited, and improper puncture will cause bleeding and other complications. It is more suitable for conservative or surgical laparoscopic surgery and early surgical incision and drainage treatment. A large number of liquefaction areas formed in the abscess cavity during the formation period of liver abscess, so the formation period of abscess is the best period for ultrasound guided liver abscess puncture drainage tube placement. while The stage of intrahepatic inflammation and the stage of liver abscess absorption and recovery is not suitable for ultrasound guided puncture drainage because there is no liquefaction area formed.

Ultrasound-guided hepatic abscess puncture aspiration catheter drainage is simple, easy to operate, safe, less trauma, less pain, reliable efficacy, quick postoperative recovery, short hospital stay, low cost and economic advantages, easy to be accepted by patients. For most patients, especially the elderly and frail patients with cardiovascular and cerebrovascular diseases and dystrophic diseases, the risk caused by anesthesia and surgery is greatly reduced. Therefore, ultrasound-guided liver abscess aspiration and catheter drainage can be regarded as the first choice treatment for liver abscess in elderly diabetic patients.

 Finally, elderly patients with diabetes and related symptoms should go to the regular hospital in time, choose the appropriate auxiliary examination and diagnosis under the guidance of professional doctors, and choose the correct treatment method in time under the guidance of professional doctors, and timely ultrasound guided liver abscess aspiration and tube drainage for those with indications, so as to control the disease as soon as possible.

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