Tropical Infections And Infestations- Amoebiasis

Entamoeba histolytica is the cause of amoebiasis, and the majority of patients have no symptoms. The Feco-oral route is the mode of infection.  Not every patient with amoebiasis will develop an amoebic liver abscess. Merely 10% of the patients experience distress.

The following are risk factors for amoebic liver abscess:
• People with weakened immune systems.
• Patients with alcoholism.

There is a polluted faecal-oral pathway in an amoebic liver abscess, and the cysts enter the small intestine. The trophozoites enter the big intestine and cause ulcers that resemble flasks to form. They cause cysts to form once more. The cyst may either enter the portal circulation or be expelled in the feces. The interlobular vein may be affected if the cysts enter the portal circulation. where they cause hepatocytes to infarct and necrotize, which in turn causes an amoebic liver abscess.

The right lobe of the liver is more affected by the amoebic liver abscess than the left lobe is. Twenty percent of patients have involvement of the left liver lobe, while eighty percent of patients have involvement of the right hepatic lobe.
The diaphragm may be affected by this abscess. Pulmonary symptoms will manifest in the patient if it reaches the diaphragm. Because it contains both blood and necrotic hepatocytes, the abscess is also known as anchovy sauce pus.

Ameboma 

The caecum is most frequently affected when there is a long-term big-bowel infection, which eventually results in the development of granulomas in the large bowel.

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Clinical Features Of Amoebic Liver Abscess

The patient with a liver abscess will present with the following features.

• M>F
• The patients will have abdomen pain related to the right hypochondrium.
• Anorexia
• Fever 
• Night Sweats
• Malaise
• Cough 
• Weight loss.

Examination

• The patient will have a toxic look.
• Patient will be anaemic.
• When the abdomen is palpated, abdomen rigidity is seen.
• There is going to be an oedema of the abdominal wall.
• The X-ray will show Pleural effusion and Basal pneumonitis.

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Investigation Of Amoebic Liver Abscess Shows

• Anaemia 
• Leukocytosis.
• Raised ESR and CRP.
• Hypoalbuminemia.
• There can be a deranged liver test which is not common, but it might be present in some cases also.

Investigation of choice

A serological test is used to diagnose amoebic liver abscesses; ulcerative colitis is the differential diagnosis. Making a distinction can be achieved by doing a biopsy or scopy on the ulcer.  An ultrasound can be performed to detect hypoechoic or anechoic lesions in the liver that have ill-defined borders and internal echoes. Additionally, the biopsy of the ulcer will reveal the trophocytes. A CT scan (preferably radiologically) can be useful.

Because diagnostic aspiration cannot identify trophozoites, its usefulness is severely limited. The aspirate will be sterile, colorless like anchovy sauce, and odorless.when an abscess raises the diaphragm. Pneumonia and pleural effusion are possible.

Treatment

Tinidazole is the second line therapy in the case of an amoebic liver abscess, while metronidazole is the primary treatment in oral medication cases. It lasts for around three weeks. Diloxanide furoate, which eradicates intestinal amoebiasis, comes next.

Therapeutic aspiration may be performed if there is an imminent rupture (size > 5 cm), involvement of the left lobe, or secondary infections.

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Hope you found this blog helpful for your NEET SS General Surgery preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.