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