Amoebic liver abscess pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

Ameoebic liver abscess is caused by a protozoan Entamoeba histolytica. It is the most common extraintestinal manifestation of amoebiasis.

Pathophysiology

• Amoebic liver abscess is the most common extraintestinal manifestation of amoebiasis.
• There are two genetically different species of entamoeba. They are

• Entamoeba histolytica (the pathogen)
• Entamoeba dispar (a commensal)

• Mode of transmission of Entamoeba histolytica include

• Fecal-oral route (ingestion of food and water contaminated with feces containing cysts)

• Hepatocyte programmed cell death induced by Entamoeba histolytica causes amoebic liver abscess.
• The infection is transmitted to liver by portal venous system.
• Clinical syndromes associated with Entamoeba histolytica infection

• Entamoeba histolytica

  Intestinal amoebiasis •Asymptomatic cyst passers •Acute amoebic colitis - Mucosal disease - Transmural disease - Ulcerative postdysentric colitis *Appendicitis *Amoeboma *Amoebic stricture

  Extra intestinal amoebiasis *Amoebic Liver abscess *Perforation and peritonitis *Pleuropulmonary amoebiasis *Amoebic pericarditis *Cutaneous Amoebiasis

  Pathogenesis

  Variants of amoebic liver abscesses

  • Solitary lesions (30%-70%) are more common amoebic liver abscesses and most commonly seen in right lobe of the liver.

  Multiple liver abscesses	Left lobe abscess	Compression lesions	Extension of the abscess
  15% of patients have multiple liver abscesses Presenting features include: Fever Toxaemia Encephalopathy Jaundice The most common organisms that cause multiple liver abscesses are E.coli and Klebsilella

  1. Multiple liver abscesses

  • 15% of patients have multiple liver abscesses
  • Presenting features include:

  • Fever
  • Toxaemia
  • Encephalopathy
  • Jaundice

  • The most common organisms that cause multiple liver abscesses are E.coli and Klebsilella