Understanding Hepatic Amoebiasis: Symptoms, Diagnosis, and Management

Question. Write a short note on Hepatic Amoebiasis.
Answer.

It is the most common complication of amoebiasis.

• Pathophysiology of Hepatic Amoebiasis
• Amoeba after reaching the liver multiply and block small intrahepatic portal radicles, producing thrombosis and infarction resulting in necrosed areas surrounded by areas of congestion.
• The necrotic area consists of degenerated liver cells, leukocytes, connective tissue strands, and is enmeshed with Entamoeba histolytica.
• Cytolytic enzymes liberated from amoebae destroy the liver parenchyma and fusion of these small necrosed areas results in abscess formation.

Amoebiasis Symptoms 

• An abscess is generally single, but may be multiple. Its walls are lined by a shaggy necrotic zone in whose centre there is thick reddish brown pus containing fragments of liver tissue, necrotic material, and erythrocytes.
• The pus is typically called “Anchovy sauce” and is sterile on culture.

Clinical Features Hepatic Amoebiasis

• The onset of Amoebic hepatitis is insidious, and the patient may present with irregular or intermittent fever
• There is a stretching sensation in the liver area.
• Gradually, with the progression of the disease, anorexia,a hepatic pain and epigastric discomfort appear
• Examination shows a uniform tender hepatomegaly
• There are signs of toxemia

Hepatic Amoebiasis: Symptoms, Diagnosis, and Management

Amoebiasis Treatment

• Jaundice is not very common
• When hepatitis progresses to a liver abscess, pain in the liver area becomes a constant feature
• Intermittent fever, loss of weight, lassitude, peculiar sallowness of skin, irritability, and sleeplessness are common features.

Investigations of Hepatic Amoebiasis

• TLC and DLC show leukocytosis with an increase in polymorphs.
• A stool examination is done, and cysts and trophozoites of
• The amoebic fluorescent antibody titer is positive.

Hepatic Amoebiasis Symptoms and Treatment

Management of amoebic liver abscess/Hepatic Amoebiasis

• Early cases are responding well with metronidazole 800 mg TID for 5 days or tinidazole 2 gm daily for three days.
• Luminal amoebicide: Diloxamide furoate 500 mg 8 hourly for 10 days should be given to determine the luminal cyst.
• If the abscess is large and does not respond to chemotherapy, repeated aspiration under ultrasonic guidance is required.
• Rupture of an abscess into the peritoneal cavity requires immediate aspiration or surgical drainage.