True about amoebic liver abscess -a) Frequently associated with diarrhea at presentationb) Most common in right lobe liverc) Can rupture into pleural cavityd) Almost never respond to metronidazole
Correct Answer: bc
Description: Amoebic Liver abscess
Caused by Entamoeba histolytica whose cysts are acquired through the feco-oral route and their trophozoites reach the liver through portal venous system.
Like pyogenic abscess they are also common in rt. lobe of liver.
Clinical Picture
the typical clinical picture is of a patient 20-40 yrs of age who has travelled to an endemic area, presents with fever, chills, anorexia, rt. upper quadrant pain.
although liver abscess results from an obligatory colonic infection, a recent history of diarrhoea is uncommon.
jaundice is rare. (c.f. in pyogenic abscess jaundice is seen in -.25% of pts.)
Liver function tests may show mild abnormalities, hyperbilirubinemia is uncommon.
CT > U/S are the mainstay of investigation.
Diagnosis is confirmed by serological tests (enzyme immuno assay) for antiamoebic antibodies.
Cultures of amoebic abscess are usually negative.
Treatment
Metronidazole is the mainstay of t/t and is curative in over 90% of patients.(other nitroimidazoles i.e. secnidazole, tinidazole, are also effective)
Therapeutic needle aspiration is avoided. Done only when
pt. fails to respond to metronidazole
high risk of rupture
abscess secondarily infected with pyogenic organism.
Complications may occur uncommonly; these are
rupture into the peritoneum, pleural cavity or pericardium.
Category:
Surgery
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