Amoebic liver abscess pathophysiology: Difference between revisions
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===Pathogenesis=== | ===Pathogenesis=== | ||
'''Variants of amoebic liver abscesses''' | * '''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. | * Solitary lesions (30%-70%) are more common amoebic liver abscesses and most commonly seen in right lobe of the liver. | ||
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* Compression lesions include posteriorly located right lobe abscess which compresses inferior venacava or hepatic vein | |||
* Presenting features include: | |||
Bilateral pedal edema | |||
Ascites | |||
Visible veins on anterior and posterior abdominal wall | |||
Symptoms disappear after aspiration of abscess | |||
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Revision as of 21:02, 3 February 2017
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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.[1] They are
- 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.[2]
- 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 strictureExtra intestinal amoebiasis
*Amoebic Liver abscess
*Perforation and peritonitis
*Pleuropulmonary amoebiasis
*Amoebic pericarditis
*Cutaneous AmoebiasisPathogenesis
- 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 Klebsiella
- Multiple liver abscesses may cause right hepatic vein occlusion, pylophlebitis, and occlusion of portal vein radicals resulting in acute hepatic failure and encephalopathy.
- 35% of patients with amoebic liver abscess present with left lobe abscess
- Presenting features include:
- Longer duration of symptoms (3-4 weeks)
- Fever
- Large epigastric mass (minimal movement with respiration)
- weight loss
- Complications include:
- Peritonitis
- Toxaemia
- Management includes:
Aspiration + anti-amoebic drugs
- Compression lesions include posteriorly located right lobe abscess which compresses inferior venacava or hepatic vein
- Presenting features include:
Bilateral pedal edema
Ascites
Visible veins on anterior and posterior abdominal wall
Symptoms disappear after aspiration of abscess
References
- ↑ Gonin P, Trudel L (2003). "Detection and differentiation of Entamoeba histolytica and Entamoeba dispar isolates in clinical samples by PCR and enzyme-linked immunosorbent assay". J Clin Microbiol. 41 (1): 237–41. PMC 149615. PMID 12517854.
- ↑ Aikat BK, Bhusnurmath SR, Pal AK, Chhuttani PN, Datta DV (1979). "The pathology and pathogenesis of fatal hepatic amoebiasis--A study based on 79 autopsy cases". Trans. R. Soc. Trop. Med. Hyg. 73 (2): 188–92. PMID 473308.