7.2
Amoebic Liver Abscess
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 7, Gastrointestinal Conditions.
Clinical Description
Amoebic liver abscess is a collection of typically brownish coloured fluid in the liver, occurring often as a single mass in the right lobe and a complication of intestinal infection with Entamoeba histolytica. Lung, heart and brain infections are uncommon sequelae.
Occasionally, pyogenic abscesses may have a similar clinical presentation.
Signs and Symptoms
- Large tender liver.
- Tenderness and/or bulging at right intercostal spaces.
- Jaundice, dullness to percussion on the right lower chest zones with basal crepitation’s amoebic empyema following extension into the chest cavity.
- Peritonitis (uncommon)
Investigations
- Abdominal ultrasound
- Chest X-ray
- FBC
- ESR
- Stool examination
- Abdominal CT scan
- Serology (amoebic antibodies)
Treatment
- Give Metronidazole 800mg 8 hourly for 10 days
- Give oral (preferably after food) or IV (depending on the condition of the patient)
- If necessary, repeat treatment course after 2 weeks
Complications and Referral Criteria
- In cases of large abscesses or superficial abscesses, to the tertiary facility for aspiration under ultrasound guidance.
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