Amoebic liver abscess

Amoebic liver abscess

Q. 1 All of the following are TRUE about amoebic liver abscess, EXCEPT:

 A Metronidazole is the mainstay of treatment

 B

Shows male preponderance of 4:1

 C

More common on right liver

 D

Multifocal abscess cannot be treated with aspiration

Q. 1

All of the following are TRUE about amoebic liver abscess, EXCEPT:

 A

Metronidazole is the mainstay of treatment

 B

Shows male preponderance of 4:1

 C

More common on right liver

 D

Multifocal abscess cannot be treated with aspiration

Ans. B

Explanation:

“Male preponderance of greater than 10:1 has been reported in all studies”

“A recent retrospective study comparing surgical with percutaneous drainage for large (>5 cm) abscess showed a better success rate with surgical drainage”

“Percutaneous drainage of multiple abscess is usually met with a higher failure rate”

“Like pyogenic liver abscess, amoebic liver abscess also tend to occur mainly in right liver”

The mainstay of treatment of amoebic liver abscess is metronidazole (750 mg orally three times per day for 10 days), which is curative in more than 90% of patients. In general, aspiration is recommended for diagnostic uncertainty, failure to respond to metronidazole therapy in 3-5 days, or in abscess felt to be at high risk for rupture.

Abscess larger than 5cm in diameter and in the left liver are thought to be a risk for rupture, and aspiration need to be considered.

Ref: CSDT 11/e, page 593-94 ; Sabiston 18/e, page 1489 ; Maingot’s Abdominal Operation 10/e, page 178, 1524


Q. 2

Amoebic liver abscess can be diagnosed by demonstrating-

 A

Cysts in the sterile pus

 B

Trophozoites in the pus

 C

Cysts in the intestine

 D

Trophozoites in the feces

Ans. B

Explanation:

Ans. is ‘b’ i.e., Trophozoites in the pus


Q. 3

All are true about amoebic liver abscess except:

 A

More common in females

 B

More common in left lobe of liver 

 C

Metronidazole is mainstay of treatment

 D

a and b

Ans. D

Explanation:

Ans is D

a i.e. More common in females & b i.e. More common in left lobe of liver 

“Male preponderance of greater than 10:1 has been reported in all studies”

The right lobe of the liver is more commonly affected than the left lobe.
amebic liver abscess is 7-12 times more common in men than in women, with a predominance among men aged 18-50 years.
Metronidazole 800 mg TDS for 5–10 days
Aspiration
Repeated imaging of liver


Q. 4

Which one of the following is not correct with regard to amoebic liver abscess-

 A

Its usual occurrence is in the right lobe

 B

Patient is toxic

 C

Surgical drainage is always indicated

 D

c and b

Ans. D

Explanation:

Ans. is ‘c>b’ i.e., Surgical drainage is always indicated > Patient is toxic. 


Q. 5

All are used in treatment of amoebic liver abscess except –

 A

Diloxanide furoate

 B

Chloroquine

 C

Metronidazole

 D

Emetine

Ans. A

Explanation:

Ans. is ‘a’ i.e., Diloxanide furoate 

Diloxanide furoate is a highly effective luminal amoebicide but has no systemic antiamoebic activity. This is because the furoate ester is hydrolysed in the intestine and the released diloxanide is absorbed. Diloxanide is a weaker amoebicide then its furoate ester and no systemic antiamoebic activity is seen despite its absorption.


Q. 6 Amoebic liver abscess ruptures most commonly into which cavity:        

 A

Peritoneal cavity

 B

Pleural cavity

 C

Pericardial cavity

 D

None of the above

Ans. B

Explanation:

Ans. B: Pleural cavity

Pleuropulmonary infection is the most common complication.

Mechanisms of infection include development of a sympathetic serous effusion; rupture of a liver abscess into the chest cavity, leading to empyema; or hematogenous spread, resulting in parenchymal infection.

Cardiac involvement results following the rupture of an abscess involving the left lobe of the liver. It usually is associated with very high mortality.

Intraperitoneal rupture occurs in 2-7% of patients. Left lobe abscesses are more likely to progress to rupture because of their later clinical presentation


Q. 7 Investigation of choice for amoebic liver abscess:

March 2012

 A Demonstration of parasites in stool

 B

Serum Entamoeba antibodies

 C

Aspiration of cyst fluid

 D

X-ray abdomen

Ans. B

Explanation:

Ans: B i.e. Serum Entamoeba antibodies

Diagnosis of amoebic liver disease
  • Analysis of serum for Entamoeba antibodies by immunoassay carries 99% sensitivity and more than 90% specificity, and is more accurate than stool analysis in amoebic liver disease
  • Diagnosis may depend on cyst aspiration revealing the classic anchovy sauce appearance of the cyst fluid

Q. 8 All are true about Amoebic liver abscess except:

March 2007

 A

Common site is right posterosuperior part of liver

 B

Alcoholics are susceptible to develop amoebic liver abscess

 C

Anchovy sauce pus

 D

Fever is the most common sign

Ans. B

Explanation:

Ans. B: Alcoholics are susceptible to develop amoebic liver abscess

Amebic liver abscess is the most frequent extraintestinal manifestation of Entamoeba histolytica infection. This infection is caused by the protozoa Ehistolytica, which ascends the portal venous system.

The right lobe (posterior superior quadrant) of the liver is more commonly affected than the left lobe. This has been attributed to the fact that the right lobe is supplied predominantly by the superior mesenteric vein, whereas the left lobe is supplied by the splenic vein.

Histologic Findings of abscess

The abscess contains acellular proteinaceous debris and is surrounded by a rim of amebic trophozoites invading tissue. The abscess contains a chocolate-colored fluid that resembles anchovy paste and consists predominantly of necrotic hepatocytes.

Complications

  • Pleuropulmonary infection is the most common complication.
  • Cardiac involvement results following the rupture of an abscess involving the left lobe of the liver. It usually is associated with very high mortality.
  • Intraperitoneal rupture occurs in 2-7% of patients. Left lobe abscesses are more likely to progress to rupture because of their later clinical presentation.
  • Bacterial superinfection can occur.

Q. 9 True about Amoebic liver abscess:

 A More common in right lobe

 B

Patients usually present with fever, chills & upper quadrant abdominal pain

 C

Usually multiple

 D

Abscess cavity contains anchovy sauce -like fluid

Ans. A:B:D

Explanation:

Answer- A,More common in right lobe B,Patients usually present with fever, chills & upper quadrant abdominal pain D,Abscess cavity contains anchovy sauce -like fluid

Amebic liver abscess is the most frequent extraintestinal manifestation of Entamoeba histolytica infection.

The right lobe (posterior superior quadrant) of the liver is more commonly affected than the left lobe.

The abscess contains a chocolate-colored fluid that resembles anchovy paste and consists predominantly of necrotic hepatocytes.

Anorexia, fever night sweats, malaise, cough and weight loss.



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