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Liver

Hepatic abscess has protean clinical manifestations and is the most frequent extracolonic complication of amebic infection, occurring in up to one-third of all patients with colonic amebiasis. It may present at any age, but is 10 times more common in adults aged 20 to 60 years. It is three to four times more frequent in men. It is important to emphasize that, although the colon is the portal of entry of amebae, liver abscesses are often found in patients who have no dysentery or other colonic symptoms; in 59% of patients, there is no preceding history of diarrhea. Moreover, repeated stool examinations, and even culture and biopsy, may not demonstrate either cysts or trophozoites in every patient. Liver function tests are unreliable, but serological tests can be very helpful. In as many as 80% of such patients, the radiological and sonographic findings are highly significant, although not necessarily diagnostic. An abscess may sometimes persist within the liver for months before becoming clinically apparent. It frequently manifests itself by involvement of the chest. The clinical manifestations vary according to the stage and extent of the disease; however, there are some characteristic features. The onset is abrupt, beginning with sudden pain in the hepatic region, radiating towards the shoulder or subscapular area. Pain is exacerbated with deep inspiration, cough, and the right lateral decubitus position. In the minority of patients, where the abscess is located in the left lobe, the pain may be perceived to be in the epigastrium, radiating to the retrosternal area and occasionally to the precordium. There is an associated febrile course, reaching 38 to 40C, which can be accompanied by chills and profuse sweating. Other systemic symptoms include anorexia, nausea, vomiting, diarrhea, and weight loss.

The cardinal physical sign is a tender hepatomegaly, painful on digital pressure or percussion. However, if the abscess is subdiaphragmatic and the diaphragm is elevated, abdominal palpation may not reveal hepatomegaly. The patients are often anemic and have an elevated white blood cell count. Jaundice is noticeable in 8% of patients, of whom 70% will exhibit hepatic abscesses, heralding a poor prognosis. In isolated cases, jaundice is caused by porta-hepatic compression by a hepatic abscess.

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