Amebic Hepatic Abscesses Clinical Presentation

  • Author: Daniel Matei Brailita, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Nov 22, 2011
 

History

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
    • Abdominal pain is the most common element in the history and is present in 90-93% of patients.
    • The pain most frequently is located in the right upper quadrant (54-67%) and may radiate to the right shoulder or scapular area.
    • Pain increases with coughing, walking, and deep breathing, and it increases when patients rest on their right side.
    • The pain usually is constant, dull, and aching.
  • Constitutional symptoms
    • Fever is present in 87-100% of cases.
    • Rigors are present in 36-69% of cases.
    • Nausea and vomiting are present in 32-85% of cases.
    • Weight loss is present in 33-64% of cases.
  • Diarrhea
    • 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
    • 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.[11]
  • 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.
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Physical

  • 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.
  • Abdominal tenderness
    • In 55-75% of cases, abdominal tenderness is located in the right upper abdominal quadrant.
    • When the abscess is located in the left lobe (28% of cases), epigastric tenderness is noted.
  • Pulmonary abnormalities
    • Pulmonary abnormalities are present in 20-45% of cases and 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) mostly occurs in complicated cases with multiple abscesses or a large abscess compressing the biliary tract.
  • Signs of complications
    • Signs of peritoneal irritation, such as rebound tenderness, guarding, and absence of bowel sounds, are present when the abscess ruptures in 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 very high mortality.
    • Signs of pleural effusion are present when the abscess ruptures in the pleural cavity.
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Causes

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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Contributor Information and Disclosures
Author

Daniel Matei Brailita, MD  Chief of Infectious Diseases, Mary Lanning Memorial Hospital

Daniel Matei Brailita, MD is a member of the following medical societies: HIV Medicine Association of America and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Ildiko Lingvay, MD, MPH  Assistant Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Texas Southwestern Medical Center at Dallas

Ildiko Lingvay, MD, MPH is a member of the following medical societies: Endocrine Society and Texas Medical Association

Disclosure: Nothing to disclose.

KoKo Aung, MD, MPH, FACP  Associate Professor, Department of Medicine, University of Texas Health Science Center at San Antonio; Adjunct Associate Professor of Public Health, University of Texas School of Public Health

KoKo Aung, MD, MPH, FACP is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Ambrish Ojha, MD  Staff Physician, Department of Internal Medicine, Texas Tech University Health Sciences Center

Ambrish Ojha, MD is a member of the following medical societies: American College of Physicians and American Medical Association

Disclosure: Nothing to disclose.

Harvey Kantor, MD  Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Texas Tech University Health Science Center

Harvey Kantor, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Illinois State Medical Society, Infectious Diseases Society of America, New York Academy of Sciences, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert J Fingerote, MD, MSc, FRCPC  Consultant, Clinical Evaluation Division, Biologic and Gene Therapies, Directorate Health Canada; Consulting Staff, Department of Medicine, Division of Gastroenterology, York Central Hospital, Ontario

Robert J Fingerote, MD, MSc, FRCPC is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Oscar S Brann, MD, FACP  Associate Clinical Professor, Department of Medicine, University of California at San Diego; Consulting Staff, Mecklenburg Medical Group

Oscar S Brann, MD, FACP is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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CT scan of the abdomen with IV and oral contrast is shown. Note the thick-walled cavity with low attenuation center and contrast-enhanced periphery.
CT scan of the abdomen with contrast showing large amebic abscess with multiloculated appearance and atypical left liver lobe location. CT scan cannot differentiate amebic liver abscess from pyogenic liver abscess.
 
 
 
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