A TYPICAL PRESENTATION OF AMOEBIC LIVER ABSCESS
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
In India a typical average case of amoebic liver abscess is one of the easiest cases which can he diagnosed at the bedside. The combination of fever with pain in right hypochondrium has hardly any differential diagnosis, specially when on examination the liver is tender.
While a typical case of liver abscess is so easy to diagnose, the atypical case is very easily missed. This is the tragedy of this disease. However, if practitioners realise, that since it is a common disease in our country, atypical presentations must be remembered in every ill patient specially if he presents with PUO or pain in the right half of the abdomen. Also when initially this illness is missed, the patient will present with symptoms of complications and not the original liver infection. Once the disease is thought of, a single sonography examination of the liver can confirm the diagnosis in most but not all, the cases.
Amoebic liver abscess must be excluded in the following cases-
1 . A patient of pyrexia having leucocytosis, with no signs and symptoms of pneumonia or pyelitis.
2. A male patient of pyrexia, whose blood count shows evidence of anaemia without leucopenia.
3. A case of jaundice (a) whose icterus was not preceded by loss of appetite and nausea for about a week (b) who complains of severe pain and tenderness (inability to lie down on right side) (c) who is an alcoholic (d) in whom there is marked hepatornegaly (e) whose white cell count is elevated (f) whose right dome of the diaphragm is elevated (g) whose SGPT or SGOT is less than 100 units while serum alkaline phosphatase is markedly elevated (h) whose routine blood count shows evidence of anaemia
4. Any or every case where diagnosis of "acute cholecystitis" has been made specially (a) in an alcoholic and (b) when there is no history of a typical "colic" with vomiting.
5. In every case diagnosed as "pericarditis with effusion", amoebic liver abscess of the superior surface of the left lobe must be excluded even if the liver is not enlarged.
6. In every patient having a basal lesion on the right side of chest, amoebic liver abscess must be excluded specially if the blood count shows evidence of aneamia, leucocytosis or both.
7. Any patient diagnosed as bloody amoebic dysentery, if he continues to have low fever or mild icterus.
8. Any patient who is diagnosed by a surgeon as acute abdomen (a) whose leucocyte count is high, (b) whose right dome of the diaphragm is elevated (by the second uncomplicated liver abscess), (c) who has jaundice, (d) who is an alcoholic.
9. Finally, think of amoebic liver abscess (silent) in any patient who is ill or wasted and has got hepatomegaly where the diagnosis of hepatoma or carcinomatous deposits has been made.
It is worthwhile remembering, that the final diagnosis of this condition is made not by imaging but by Positive serological tests of amoebiasis or demonstration of E. histolytica in the pus (not in the stools).
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