Amoebic Liver Abscess

AMOEBIC LIVER ABSCESS


AMOEBIC LIVER ABSCESS

  • Amoebic liver abscess is also called tropical abscess (dysenteric abscess)
  • It is a complication of amoebic dysentry.
  • Amoebic liver abscess is usually solitary and located in right lobe in psoterosuperior portion.

ETIOLOGY-

  • Entamoeba histolytica causes amoebic liver abscess.

PATHOLOGY-

  • Amoebic cyst ingestion → Trophozoite form in colon → Bowel wall → Liver
  • Infective stage is quadrinucleate cyst.
  • Trophozoites destroy hepatocytes & necrosis of WBC → collection of reddish brown fluid → Anchovy- sauce appearance. (chocolate appearance)
  • Organism in liver destroys hepatocytes resulting in liquefaction necrosis.

  

CLINICAL FEATURES-

  • Male alcoholics are most common affected of 20- 40 years.
  • Common in developing countries.
  • Dysentry (most common)
  • Severe pain in right hypochondrium is due to enlarged liver is called as stage of amoebic hepatitis.
  • High grade fever, chills, rigour, coughs.
  • It is spread by Faecal- oral route.
  • Hepatomegaly

INVESTIGATIONS-

  • Stool examination for ova ad cyst of entamooeba histolytica.
  • Indirect hemagglutination test positive
  • Sigmoidoscopy – slows amoebic ulcer (flask shape)
  • Abdominal USG- investigation of choice
  • CT scan- shows abscess cavity
  • LFT abnormality (most common)- increase prothrombin time
  • PAS staining is done to confirm trophozoites of E. haemolytica

  

TREATMENT-

  1. DOC- oral metronidazole (750mg TDS 10- 14days), chloroquinone
  2. If condition is not improved- injection emetine
  3. US- guided needle aspiration/ pigtail catheter drainage- treatment of choice if metronidazole is contraindicated
  4. Open drainage and laparoscopic

COMPLICATIONS-

  • Rupture of abscess into-
  1. Peritoneal cavity- acute peritonitis (most common)
  2. Pleural cavity- emphysema
  3. Lung (bronchus)- coughing- bronchopleural fistula
  4. Pericardial space- pericardial effusion

Exam Important

  • Amoebic liver abscess is usually solitary and located in right lobe in psoterosuperior portion.

 ETIOLOGY-

  • Entamoeba histolytica causes amoebic liver abscess.

CLINICAL FEATURES-

  • Male alcoholics are most common affected of 20- 40 years.
  • Common in developing countries.
  • Dysentry (most common)
  • Severe pain in right hypochondrium is due to enlarged liver is called as stage of amoebic hepatitis.
  • High grade fever, chills, rigour, coughs.
  • It is spread by Faecal- oral route.
  • Hepatomegaly

INVESTIGATIONS-

  • Stool examination for ova ad cyst of entamooeba histolytica.
  • Indirect hemagglutination test positive
  • Sigmoidoscopy – slows amoebic ulcer (flask shape)
  • Abdominal USG- investigation of choice
  • CT scan- shows abscess cavity
  • LFT abnormality (most common)- increase prothrombin time
  • PAS staining is done to confirm trophozoites of E. haemolytica

TREATMENT-

  1. DOC- oral metronidazole (750mg TDS 10- 14days), chloroquinone
  2. II) If condition is not improved- injection emetine
  3. III) US- guided needle aspiration/ pigtail catheter drainage- treatment of choice if metronidazole is contraindicated
  4. IV)  Open drainage and laparoscopic

 

COMPLICATIONS-

  • Rupture of abscess into-
  1. Peritoneal cavity- acute peritonitis (most common)
  2. Pleural cavity- emphysema
  3. Lung (bronchus)- coughing- bronchopleural fistula
  4. Pericardial space- pericardial effusion

 

 

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