Amoebic liver abscess
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Entamoeba histolytica is a protozoal parasite that infests the large intestine. Trophozoites released by the cyst in the intestine may penetrate the mucosa to gain access to the portal venous system and so spread to the liver to cause amoebic liver abscess.
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The abscess is large and thin-walled, is usually solitary, and in the right lobe, and contains brown sterile pus resembling “anchovy sauce“.
Clinical features
Symptoms
- Right upper quadrant abdominal pain is the commonest symptom
- Anorexia, nausea, weight loss and night sweating
Signs
- Tender hepatomegaly
- Jaundice (uncommon)
- Other signs includes basal pulmonary collapse, pleural effusion.
Investigation
Lab tests: Leukocytosis, direct and indirect serological tests are extremely useful for diagnosis
Imaging: Ultrasound and CT scan are used to demonstrate the site and size of the abscess
COMPLICATIONS OF AMEBIC ABSCESS
Amoebic abscess if untreated it may rupture into:
- Peritoneal cavity causing peritonitis
- Pleural space causing pleural effusion
- Bronchus with anchovy sauce expectoration
- Pericardial cavity causing cardiac tamponade and failure
Treatment
- Treatment consist of administration of metronidazole 800mg 8hourly, for 7 – 10 days
- The abscess should be aspirated under imaging guidance if no response to medical treatment within 72 hours