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Amebic Hepatic Abscesses Clinical Presentation

  • Author: Daniel Matei Brailita, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Apr 15, 2015
 

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 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.

Constitutional symptoms

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

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.

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.
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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 Infectious Disease Specialist, Mary Lanning Healthcare and Central Nebraska Infectious Diseases

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

Disclosure: Nothing to disclose.

Coauthor(s)

KoKo Aung, MD, MPH, FACP Chief, Division of General Internal Medicine, O Roger Hollan Professor of Internal Medicine, Director, Office of Educational Programs, Department of Medicine, University of Texas Health Science Center at San Antonio

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

Disclosure: Nothing to disclose.

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

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

Disclosure: Received consulting fee from GI Dynamics for consulting; Received honoraria from NovoNordisk, Inc for board membership.

Ambrish Ojha, MBBS 

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

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, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

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.

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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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