A patient with 8 cm x 8 cm abscess in right lobe of liver was treated with aspiration multiple times (3 times) and with systemic amebicide. Now cavity is remaining in right lobe of liver but there is nothing in the cavity. Seven days course of luminal amebicides is given. How will you follow up?
Ans. b. USG weekly for 1 month followed by monthly USG till 1 year (Ref: Sabiston 19/e p1445-1447; Schwartz 9/e p1115-1116; Bailey 25/e p1095; Blumgart 5/e p1016-1024; Shackelford 7/e p1471-1478)In uncomplicated cases of amebic liver abscess, follow-up is done with ultrasound.Role of ultrasound in the diagnosis and treatment follow-up of amoebic liver abscess, by K. Shamsi, A. De Schepper, F. Deckers, E. de Bergeyck, J. Van den End"Serological and clinical data in combination with these nonspecific sonographic features are sufficient for the management of ALA, obviating the need for expensive and invasive techniques in majority of the cases."- http://link. springer.com/article/10.1007%2FBF00221420?Ll=trueSabiston says "The average time to radiologic resolution is 3 to 9 months and can take as long as years in some patients. Studies have shown that more than 90% of the visible lesions disappear radiologically, but a small percentage of patients are left with a clinically irrelevant residual lesion."Most individuals with amebic liver abscess do not have concurrent signs or symptoms of colitis, and most do not have E. histolytica trophozoites in their stools.'Most individuals with amebic liver abscess do not have concurrent signs or symptoms of colitis, and most do not have E. histolytica trophozoites in their stools.' - Harrison 18/e p1683-1685Amoebic Liver AbscessCaused by Entamoeba histolytica whose cysts are acquired through the feco-oral routeQTrophozoites reach the liver through portal venous systemQ.Solitary aand more common in right lobe of liverQ.Low incidence of invasive amoebiasis in menstruating womenQMajority of patients are young men (may be due to heavy alcohol consumption)Pathogenesis:MC form of invasive disease is colitis, frequently affects the cecum and ascending colonQIn colon: Flask-shaped ulcersQ (MC site: Cecum and ascending colon)QSynchronous hepatic abscess is found in one third of patients with active amebic colitis.Clinical Features:MC symptom is abdominal painQTypical clinical picture: Patient of 20-40 years of age, with history of travel to endemic area, presents with fever, chills, anorexia, right upper quadrant painQ.Results from an obligatory colonic infection, a recent history of diarrhea are uncommonQ.\Active colitis and amoebic liver abscess rarely occur simultaneously, as a rule colonic lesions are silentQJaundice is rareQRaised PT is MC LFT abnormalityQ.Diagnosis:USG and CT are the main diagnostic modalitiesQDiagnosis is confirmed by serological testsQ (ELISA) for antiamoebic antibodies.Cultures of amoebic abscess are usually sterile or negativeQ.CXR: Elevated hemi diaphragm, right sided pleural effusion or atelectasisALA: Reddish-brown anchovy pasteQ; more reliable characteristic than color is the odour of the fluid.Treatment:Metronidazole (750 mg orally TDS X 10-14 days) is the mainstay of treatment and is curative in over 90% of patientsQ, clinical improvement is seen within 3 days.Luminal agents include iodoquinol, paromomycin and diloxanide furoateQ.The average time to radiologic resolution of abscess is 3-9 monthsQIndications of Aspiration in ALA* Diagnostic uncertaintyQ* Failure to respond to therapy in 3-5 daysQ* Pyogenic superinfectionQ* High risk of rupture (size > 5 cm. left lobe abscess)Q* PregnancyQ (Therapeutic trial with high dose Metronidazole is deemed inappropriate)Complications:Most frequent complications: Rupture into the peritoneum (MC)Q, pleural cavity, or pericardium.Size of abscess appears to be the most important risk factor for ruptureLaparotomy is indicated in cases of doubtful diagnosis, hollow viscus perforation, fistulization resulting in hemorrhage or sepsis, and failure of conservative therapy.Treatment of rupture into the pleural space: Thoracentes'QRupture into bronchi is self-limited with postural drainage and bronchodilatorsQ.
Stool examination only
USG weekly for 1 month followed by monthly USG till 1 year
USG weekly for 3 months followed by CT scan at 3 months.
USG or CT scan monthly and stool examination weekly
Parasitology