Hepatic amebiasis
NORMAL
ABNORMAL* This is an Abscess (walled area of infection/pus) in the liver that is caused by the organism Entamoeba histolytica. It is common in tropical and subtropical areas (southeast Asia, Africa, India, Latin America). In the U.S., it is most common in young Hispanic adults. It is also seen in those with recent travels to tropical areas, homosexuals, and among the inhabitants of institutions for the mentally ill.
SYMPTOMS
* Right upper abdominal pain
* Right sided chest pain worse on a deep breath
* Diarrhea precedes infection in 20% of patients
* Weight loss, malaise, and jaundice may occur.
CAUSE
* Travel to endemic areas (as above), where the cysts of the parasite may be ingested by consuming water or food contaminated by fecal matter.
HOW THE DIAGNOSIS IS MADE
* Examination
1. Ill-appearance
2. Fever
3. Tender right upper abdomen
4. Palpable liver (liver can be felt) whereas the liver is not easily felt
5. Tenderness in chest wall of right chest
* Laboratory tests
1. Anemia
2. Elevated white blood cell count
3. Hemagglutination test
4. If needle aspiration is done, culture is sent to laboratory
* Imaging:
1. Chest X-Ray shows elevated right diaphragm
2. Ultrasound
3. CT scan 20 days after successful treatment to eradicate ameba cysts
4. MRI
TREATMENT
* Metronidazole (Flagyl) orally
* Percutaneous needle drainage of the Abscess in severely ill patients
* Iodoquinal is taken for ameba remaining in the intestines (treating the Abscess only would not clear infection in the intestines).
COMPLICATIONS
* Amebic Abscess may rupture and cause the infection to spread.
PREVENTION
* Amebic infection is caused by the ingestion of contaminated food or water. Therefore, use careful sanitation, avoid unpeeled fruits and vegetables, and use bottled water when traveling in areas known to have amebiasis.
SIMILAR CONDITIONS
* Hepatic vein obstruction
* Cholecystitis
* Choledocholithiasis/cholangitis
* Hepatocellular carcinoma
* Pyogenic Abscess
* Cancer of the biliary tract
* Pancreatic Cancer
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