CWM Hospital Fiji School of Medicine Depts' of Medicine

1
CWM Hospital / Fiji School of Medicine Depts. of
Medicine Pathology
CPC Meeting 23/8/2001

• Amoebic Liver Abscess

2
Case 1

3
Clinical details

• 25 Year Fijian Male
• Anorexia, Abdominal swelling
• Liver enlargement
• Liver Abscess
• Surgical drainage and biopsy from the wall of the
  abscess.
• Biopsy no 1826B Dt. 20/8/01

4
Liver Biopsy Abscess wall
Granulation tissue
Dilated vascular channels.
5
Liver Biopsy Amoebic Abscess
Necrotic hepatocytes
Entamoeba histolytica trophozoits
6
Liver Biopsy Amoebic Abscess
Necrotic hepatocytes
Entamoeba histolytica trophozoits
7
Liver Biopsy Amoebic Abscess
Necrotic hepatocytes
Entamoeba histolytica trophozoits
8
Liver Biopsy Amoebic Abscess
Necrotic hepatocytes
Entamoeba histolytica trophozoits
9
Case 2

10
Clinical details

• A 44 year old farmer presented with right
  pleuritic chest pain.
• The pain commenced three weeks before admission.
  He was seen at a health centre and was treated
  with antibiotics.
• The pain improved briefly but then got worse
  again
• Two nights ago he began spitting up blood. (see
  slide)

11
Appearance of Sputum
Blood in sputum
12
Examination

• On examination he was mildly febrile and looked
  unwell.
• On the right side he had decreased persussion
  note, decreased breath sounds and decreased vocal
  fremitus at the base.
• He had a tender right upper quadrant.

13
Right sided effusion(ruptured liver abscess
into thorax)
14
Investigations

• An ultrasound revealed a mixed density lesion in
  the right lobe of the liver.
• He had a presumptive diagnosis of liver abscess
  rupturing into the right hemithorax.
• He rapidly improved on oral metronidazole.

15
Pathology

• Etiology Protozoan Entamoeba histolytica
• Mainly infest colon
• Anaerobic No Kreb cycle, ferment glucose to
  ethanol
• Metronidazole blocks oxidoreductases necessary
  for anaerobic fermentation. Not present in
  humans.
• in 10 of cases, tissue invasion occurs causing
  dysentery.

16
Pathology

• In 40 of amoebic dysentery cases, parasites
  enter liver through portal veins to produce
  solitary abscess.
• Mild inflammation, marked necrosis, Shaggy
  margin, fibrin lining usually with hemorrhage.
• Chocolate colored thick pus Anchovy sauce pus
• Trophozoites with ingested RBC can be seen in the
  wall of the abscess.