Amebic Hepatic Abscesses Clinical Presentation
- Author: Daniel Matei Brailita, MD; Chief Editor: BS Anand, MD more...
The signs and symptoms of amebic liver abscess often are nonspecific, resembling those of pyogenic liver abscess or other febrile diseases.[7, 8, 9, 10]
Time of onset
Patients with amebic liver abscess usually present acutely (duration of symptoms < 14 d), with the most frequent complaints being fever and abdominal pain. This presentation is characteristic of younger patients.
The subacute presentation is characterized by weight loss, and, in less than half the cases, abdominal pain and fever are present.
Abdominal pain is the most common element in the history and is present in 90-93% of patients. The pain is usually constant, dull, and aching, and it is most frequently located in the right upper quadrant (54-67%) and may radiate to the right shoulder or scapular area.
The pain increases with coughing, walking, and deep breathing, as well as when patients rest on their right side.
Fever is present in 87-100% of cases, and rigors are present in 36-69% of cases.
Nausea and vomiting are present in 32-85% of cases, and weight loss is present in 33-64% of cases.
Diarrhea is present in less than one third of patients at the time of diagnosis. Some patients describe a history of having had dysentery within the previous few months. Bloody diarrhea is present in 7% of cases.
Pulmonary symptoms are present in 18-26% of cases. The most frequent symptoms are cough and chest pain, which may represent a sign of secondary pulmonary involvement by abscess rupture in the pleural cavity.
When coughing produces an odorless brown substance similar to anchovy paste, a bronchopleural fistula has developed.
Recent travel to endemic areas
Onset of symptoms usually occurs within 8-12 weeks from the date of travel. In 95% of cases, onset occurs within 5 months of returning from travel to an endemic area. A remote travel history of as many as 12 years has been reported.
Fever is the most common sign and is found in as many as 99% of cases.
Hepatomegaly is present in some cases. The frequency varies widely in different series published, reporting as high as 63% in one series and as low as 18% in another.
Hepatomegaly with pain upon palpation is one of the most important signs of amebic liver abscess. Point tenderness over the liver, below the ribs, or in the intercostal spaces is a typical finding.
Right upper abdominal quadrant tenderness is present in 55-75% of cases. When the abscess is located in the left lobe (28% of cases), epigastric tenderness is noted.
Pulmonary abnormalities are present in 20-45% of cases, and they consist of dullness and rales at the right lung base and nonproductive cough. Breath sounds over the right lung base may be diminished. Pleural rub may be audible.
Jaundice (< 10% of cases) most often occurs in complicated cases with multiple abscesses or a large abscess compressing the biliary tract.
Signs of complications include the following:
Signs of peritoneal irritation, such as rebound tenderness, guarding, and absence of bowel sounds, are present when the abscess ruptures into the peritoneal cavity. Peritonitis occurs in 2-7% of cases.
Pericardial friction rub can be audible when the abscess extends into the pericardium. This sign is associated with a very high mortality.
Signs of pleural effusion are present when the abscess ruptures into the pleural cavity.
The following are the risk factors associated with amebic liver abscess:
Immigrants from endemic areas
Institutionalized persons, especially people with mental retardation
Crowding and poor hygiene
Men who have sex with men (secondary to sexually acquired amebic colitis)
Presence of immunosuppression (eg, HIV infection, malnutrition with hypoalbuminemia, alcohol abuse, chronic infections, posttraumatic splenectomy, steroid use)
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