Chapter 51: Amebic Liver Abscess

Question 1

What is the etiology?

Answer 1

Entamoeba histolytica (typically reaches liver via portal vein from intestinal amebiasis)

Question 2

How does it spread?

Answer 2

Fecal–oral transmission

Question 3

What are the risk factors?

Answer 3

1. Patients from countries south of the U.S.–Mexican border
2. institutionalized patients
3. homosexual men
4. alcoholic patients

Question 4

What are the signs/symptoms?

Answer 4

1. RUQ pain
2. fever
3. hepatomegaly
4. diarrhea

Note: chills are much less common with amebic abscesses than with pyogenic abscesses

Question 5

Classic description of abscess contents?

Answer 5

“Anchovy paste” pus

Question 6

How is the diagnosis made?

Answer 6

Lab tests, ultrasound, CT scan

Question 7

What lab tests should be performed?

Answer 7

1. Indirect hemagglutination titers for Entamoeba antibodies elevated in >95% of cases
2. elevated LFTs

Question 8

What is the treatment?

Answer 8

Metronidazole IV

Question 9

What are the indications for percutaneous surgical drainage?

Answer 9

1. Refractory to metronidazole OR
2. bacterial coinfection OR
3. peritoneal rupture