Amoebic abscess of a liver

Description:

Complication of an acute or recurrent intestinal amebiasis. Amoebic abscesses meet preferential in the middle age, is more often at men. Amoebic abscess usually single, large, is located more often in the right share. Abscess contents liquid, characteristic red-brown color (so-called paste of anchovies).

Symptoms of Amoebic abscess of a liver:

It is necessary to consider stay of the patient in the countries with tropical or subtropical climate or the diseases postponed in the same place. At patients with a hepatic amebiasis only in 10% of cases amoebic dysentery and in 15% — cysts in Calais comes to light. Dysentery occurs in the anamnesis seldom. Cases of emergence of a hepatic amebiasis through long (to 30 years) time proyomezhutok after primary intestinal infection are noted. Most often the disease is observed at young men aged from 28 up to 50 years. Mnoyozhestvenny abscesses are more often observed in such countries as Mexico and Taiwan.

As a rule, the disease begins subacutely, and such symptomatology can proceed up to 6 months. Less often the beginning can be acute, with a fever and perspiration within less than 10 days. Fever can be intermittent, remittiruyushchy or can be even absent until there is a secondary infection of abscess. In rare instances body temperature exceeds 40 °C. At a deep arrangement of abscesses at the patient only fever without signs of damage of a liver can be observed.

Jaundice is uncharacteristic and poorly expressed. As a result of a prelum of a bilious channel jaundice can be big and multiple abscesses the first display of a disease.

The general condition of patients is broken, the specific yellowish coloring of skin reminding the turned pale suntan is noted.

In a liver there can be dull ache. which becomes later acute and shooting. At an abscess arrangement about a diaphragm the patient can have synalgias in a shoulder amplifying at a deep breath or cough. Pain amplifies at alcohol intake and at change of position of a body. Patients hold forced position, bending to the left as at the same time intercostal spaces increase on the right and the liver capsule tension decreases. Pain amplifies at night.

At inspection of the patient tumorous education in epigastric area or protrusion of intercostal spaces can be visible. Almost in all cases morbidity at a palpation of a liver edge is noted or at percussion of the lower edges on the right. The spleen is not increased.

In lungs consolidation in the right lower share, pleurisy or an exudate in a pleural cavity can be found. Pleural liquid can be painted by blood.

At a research the calla of a cyst and vegetative forms of amoebas are found seldom.

Serological researches. Results of serological tests remain positive after clinical recovery for some time. If results of serological tests are negative, existence of amoebic abscess of a liver is improbable. At inspection of the population and valuable reaction of indirect hemagglutination is sensitive.

Biochemical researches. At the chronic course of a disease activity of ShchF is approximately twice higher than norm. Increase in activity of transaminases is observed only at patients with an acute disease or heavy complications. For amoebic abscess of a peyochena increase in level of bilirubin in serum, except for cases of superinfection or break of abscess in an abdominal cavity is uncharacteristic.

Visualization methods of a research. At a chest fluoroscopy it is possible to find high standing of the right dome of a diaphragm, an obliteration of costal and phrenic and cardiophrenic sine commissures, a pleural exudate or right-hand nizhnedolevy pneumonia. The perpendikuyolyarny commissures which are taking place from a diaphragm to the lung basis can be observed. The abscess located lateralno in the right hepatic lobe can lead to expansion of intercostal spaces. It is, as a rule, difficult to judge existence of the abscess which is in the center or in a front part of the right hepatic lobe. Increase in a shadow of a liver with high standing and reduction of mobility of the right dome of a diaphragm can be observed. Usually abscess causes formation of swelling in an anteromedial part of the right dome of a diaphragm.

Crescent deformation of small curvature of a stomach can testify to abscess of the left hepatic lobe.

Reasons of Amoebic abscess of a liver:

The activator - Entamoeba histolytica.
Entamoeba histolytica can exist in a vegetative form and in the form of cysts which provide survival of a microorganism in external environment and vysokoinfektsionna. Having got to an organism, the cyst passes unimpaired through a stomach and a small bowel, in a large intestine turns in trofozoit — a vegetative form of an amoeba. In a large intestine of a trofozoita are implemented into a mucous membrane, causing formation of characteristic kolbovidny ulcers. Through system of a portal vein of an amoeba get into a liver. Sometimes they get through hepatic sinusoids to a system blood stream that leads to formation of abscesses in lungs and a brain.

Treatment of Amoebic abscess of a liver:

Operational treatment is not shown, the intestinal phase of a disease will not be liquidated yet. Metronidazop on 30 mg/kg 3 times a day within 10 days, then 10 days give a half dose him. At the same time appoint Resochinum within 2 days on 2-3 g a day, then during 3 weeks 0,5 g once a day, in the subsequent carry out treatment by tetracycline. If, despite treatment by amebicides, the clinical or X-ray pattern of an asbtsess of a liver remains, its puncture is shown, and at insufficient drainage and emergence of signs of secondary infection — outside drainage. Forecast. The lethality at amoebic abscess makes 6-17%; it is caused by development of complications — break in free belly or in a pleural cavity, a pericardium, etc.