In this article, we will discuss the Clinical Features of Amoebic Liver Abscess. So, let’s get started.
Amoebic liver abscess can occur with colitis but more commonly presents without history of prior intestinal symptoms. Of traveller’s who develop amoebic liver abscess after leaving an endemic area, 95% do so within 4-5 months. Young patients with abscess are more likely to present in the acute phase with prominent symptoms of less than 10 days duration.
The presenting symptoms fever with right upper quadrant pain which may be dull or pleuritic in nature and radiates to the shoulders. Point tenderness over the liver and right sided pleural effusion (sympathetic effusion) is common. All the parasites reach the liver from the intestine, concomitant diarrhoea is common. In older patients, unexplained weight loss, anorexia without fever or pain may be seen as a presenting complaint.
Hepatomegaly with intercostal tenderness (thumping sign) is a characteristic finding but may be absent in deep or centrally located lesion. Jaundice is not a common finding but a large abscess can cause compression of bile ducts and produce obstructive jaundice at a later stage.
Abscess are most commonly single and in the right lobe of the liver and they are more common in men. Persistent or increase in local signs of inflammation on the skin suggest impending rupture.
Complications occur due to rupture of the abscess into subdiaphragmatic, pleural, pericardial, intraperitoneal or intra biliary space or into the lung. compression of inferior vena cava or hepatic veins may cause an outflow obstruction producing portal hypertension (Budd-Chiari syndrome).
Fever, tender hepatomegaly with intercostal tenderness of less than 10 days duration in a young person suggest and amoebic liver abscess.
Since 10-15% of patients present only with fever, therefore, amoebic liver abscess should be considered in the differential diagnosis of pyrexia of unknown origin (PUO).