AMOEBIC LIVER ABSCESS

Question 1

What is amoebic liver abscess

Answer 1

collection of typically brownish coloured fluid in the liver, occurring often as a single mass in the right lobe

Question 2

Amoebic liver abscess is a complication of intestinal infection with ………………..

Answer 2

Entamoeba histolytica

Question 3

Symptoms of amoebic liver abscess

Answer 3

Right upper abdominal pain
Fever
Malaise
Sweats
Cough
Hiccups
Anorexia
Weight loss
Jaundice (uncommon)
Concurrent diarrhoea

Question 4

Nature of abdominal pain in amoebic liver abscess

Answer 4

Right upper abdominal pain referable to the epigastrium, right chest or right shoulder

Question 5

Signs of amoebic liver abscess

Answer 5

Tenderness and/or bulging at right intercostal spaces
Jaundice
Dullness to percussion on the right lower chest zones with basal crepitations
Amoebic empyema following extension into the chest cavity
Peritonitis (uncommon)

Question 6

Investigations in amoebic liver abscess

Answer 6

Abdominal ultrasound
Chest X-ray
FBC
ESR
Stool examination
Abdominal CT scan
Serology (amoebic antibodies)

Question 7

Treatment objectives in amoebic liver abscess

Answer 7

To eradicate Entamoeba histolytica infection
To prevent further destruction of liver tissue
To prevent further complications

Question 8

Non-pharmacological interventions in amoebic liver abscess

Answer 8

Therapeutic aspiration may be required in patients with poor response to therapy

Question 9

Treatment of amoebic liver abscess should be initiated with a …………… and continued with a ……………

Answer 9

Tissue agent
Luminal agent

Question 10

First line treatment of amoebic liver abscess

Answer 10

Metronidazole, oral,
Adults
800 mg 8 hourly for 10 days
Children
15 mg/kg 8 hourly for 10 days

Then

Diloxanide furoate, oral,
Adults
500 mg 8 hourly for 10 days
Children
6-8 mg/kg 8 hourly for 10 days

Question 11

Tissue agents for amoebic liver abscess

Answer 11

Metronidazole
Tinidazole

Question 12

Luminal agents for amoebic liver abscesss

Answer 12

Diloxanide furoate
Paromomycin

Question 13

Tissue agents target ………

Answer 13

Trophozoite form

Question 14

Luminal agents target………..

Answer 14

Intra-luminal cysts

Question 15

Second line treatment of amoebic liver abscess

Answer 15

Tinidazole, oral,
Adults
2 g once daily for 5 days
Children
> 3 years; 50 mg/kg (max. 2 g) once daily for 5 days

Then

Paromomycin, oral,
Adults
8-10 mg/kg 8 hourly for 7 days
Children
8-10 mg/kg 8 hourly for 7 days