A 40 year patient is having high grade fever associated with abdominal pain in right upper quadrant, with hepatomegaly and liver dullness on percussion. There is history of recent travel. Clinical diagnosis is:
Ans. (b) Amoebic liver abscessRef: Sabistan 19th ed. 11443AMOEBIC LIVER ABSCESS* Caused by Entamoeba histolytica whose cysts are acquired through the feco-oral route* Usually Solitary and more common in right lobe of liver.* It most frequently affects the cecum and ascending colon* In colon: Flask-shaped ulcers (MC site: Cecum and ascending colon)Clinical features* Most common symptoms is abdominal pain* Typical clinical picture (as seen in the question): patient of 20-40 yrs of age, with history of travel to endemic area, presents with fever, chills, anorexia, right upper quadrant pain.* Results from an obligatory colonic infection, a recent history of diarrhea are uncommon.Investigation* USG guided aspiration: Shows anchovy sauce pusDifference between Amoebic liver abscess and Pyogenic liver abscessClinical FeaturesAmebic liver abscessPyogenic liver abscessAge (yr)20-40>50Male-to-female ratio>10:11.5:1Travel in endemicYesNoDiabetesUncommonMore commonAlcohol useCommonCommonJaundiceUncommonCommonElevated bilirubinUncommonCommonElevated alkaline phosphataseCommonCommonAlso Know* Most common symptom of pyogenic abscess: FEVER* MC sign of pyogenic abscess: RUQ tenderness* Most common symptom of amoebic abscess: Abdominal pain* Most common sign of amoebic abscess: HEPATOMEGALY* Hydatid cyst is mostly asymptomatic. If presents with symptom, most common presenting symptom is abdominal pain, vomiting, dyspepsia.
Pyogenic liver abscess
Amoebic liver abscess
Hydatid cyst
Neoplastic growth
Hepatic Tumors, Cysts, and Abscesses