Amoebic liver abscess differential diagnosis: Difference between revisions

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==Overview==
==Overview==
Amoebic liver abscess must be differentiated from other diseases that cause [[fever]], abdominal pain, [[cough]], [[jaundice]], [[hepatomegaly]], [[anorexia]], [[nausea]], [[vomiting]], and pale or dark stools such as [[pyogenic liver abscess]], [[liver abscess|fungal liver abscess]], necrotic hepatoma, [[echinococcal cyst]] and [[hepatocellular carcinoma]].
Amoebic liver abscess must be differentiated from other diseases that cause [[fever]], [[abdominal pain]], [[cough]], [[jaundice]], [[hepatomegaly]], [[anorexia]], [[nausea]], [[vomiting]], and [[stool|pale or dark stools]] such as [[pyogenic liver abscess]], [[liver abscess|fungal liver abscess]], [[echinococcal cyst]], and [[hepatocellular carcinoma]].
 
==Differential Diagnosis==
==Differential Diagnosis==
Amoebic liver abscess must be differentiated from:<ref name="pmid9834333">{{cite journal| author=Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA| title=Fungal hepatic abscesses: Characterization and management. | journal=J Gastrointest Surg | year= 1997 | volume= 1 | issue= 1 | pages= 78-84 | pmid=9834333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9834333  }} </ref>
<div style="width: 85%;">
<small>
<small>
Amoebic liver abscess must be differentiated from:<ref name="pmid15189463">{{cite journal| author=Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA| title=Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. | journal=Trop Med Int Health | year= 2004 | volume= 9 | issue= 6 | pages= 718-23 | pmid=15189463 | doi=10.1111/j.1365-3156.2004.01246.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15189463  }} </ref><ref name="pmid5054724">{{cite journal| author=Barbour GL, Juniper K| title=A clinical comparison of amebic and pyogenic abscess of the liver in sixty-six patients. | journal=Am J Med | year= 1972 | volume= 53 | issue= 3 | pages= 323-34 | pmid=5054724 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5054724  }} </ref><ref name="pmid3316923">{{cite journal| author=Barnes PF, De Cock KM, Reynolds TN, Ralls PW| title=A comparison of amebic and pyogenic abscess of the liver. | journal=Medicine (Baltimore) | year= 1987 | volume= 66 | issue= 6 | pages= 472-83 | pmid=3316923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3316923  }} </ref><ref name="pmid3945889">{{cite journal| author=Conter RL, Pitt HA, Tompkins RK, Longmire WP| title=Differentiation of pyogenic from amebic hepatic abscesses. | journal=Surg Gynecol Obstet | year= 1986 | volume= 162 | issue= 2 | pages= 114-20 | pmid=3945889 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3945889  }} </ref><ref name="pmid9834333">{{cite journal| author=Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA| title=Fungal hepatic abscesses: Characterization and management. | journal=J Gastrointest Surg | year= 1997 | volume= 1 | issue= 1 | pages= 78-84 | pmid=9834333 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9834333  }} </ref><ref name="pmid3275982">{{cite journal| author=Pastakia B, Shawker TH, Thaler M, O'Leary T, Pizzo PA| title=Hepatosplenic candidiasis: wheels within wheels. | journal=Radiology | year= 1988 | volume= 166 | issue= 2 | pages= 417-21 | pmid=3275982 | doi=10.1148/radiology.166.2.3275982 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3275982  }} </ref><ref name="pmid11452064">{{cite journal| author=Mortelé KJ, Ros PR| title=Cystic focal liver lesions in the adult: differential CT and MR imaging features. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 895-910 | pmid=11452064 | doi=10.1148/radiographics.21.4.g01jl16895 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452064  }} </ref><ref name="pmid7668917">{{cite journal| author=Suwan Z| title=Sonographic findings in hydatid disease of the liver: comparison with other imaging methods. | journal=Ann Trop Med Parasitol | year= 1995 | volume= 89 | issue= 3 | pages= 261-9 | pmid=7668917 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7668917  }} </ref><ref name="pmid3047423">{{cite journal| author=Esfahani F, Rooholamini SA, Vessal K| title=Ultrasonography of hepatic hydatid cysts: new diagnostic signs. | journal=J Ultrasound Med | year= 1988 | volume= 7 | issue= 8 | pages= 443-50 | pmid=3047423 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3047423  }} </ref><ref name="pmid7225721">{{cite journal| author=Niron EA, Ozer H| title=Ultrasound appearances of liver hydatid disease. | journal=Br J Radiol | year= 1981 | volume= 54 | issue= 640 | pages= 335-8 | pmid=7225721 | doi=10.1259/0007-1285-54-640-335 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7225721  }} </ref>
{| class="wikitable"
{| class="wikitable"
! rowspan="3" |Disease
! rowspan="3" |Disease
! rowspan="3" |Causes
! rowspan="3" |Causes
! colspan="12" |symptoms
! colspan="11"|Signs and Symptoms
! rowspan="3" |Lab Findings
! rowspan="3" |Laboratory Findings
! rowspan="3" |Imaging Findings
! rowspan="3" |Imaging Findings
! rowspan="3" |Other Findings
! rowspan="3" |Other Findings
|-
|-
! rowspan="2" | Fever
! rowspan="2" | [[Fever]]
! colspan="3" | Pain
! colspan="2" | Pain
! rowspan="2" | cough
! rowspan="2" | [[Cough (patient information)|cough]]
! rowspan="2" | Hepatomegaly
! rowspan="2" | [[Hepatomegaly]]
! rowspan="2" | Jaundice
! rowspan="2" | [[Jaundice]]
! rowspan="2" | Weight loss
! rowspan="2" | [[Weight loss]]
! rowspan="2" | Anorexia
! rowspan="2" | [[Anorexia]]
! rowspan="2" | Diarrhoea
! rowspan="2" | [[Diarrhoea]]
or
or [[Dysentry]]
Dysentry
! rowspan="2" | [[Nausea]] and  
! rowspan="2" | Nausea and  
[[vomiting]]
vomiting
! rowspan="2" | [[Stool]]
! rowspan="2" | Stool
|-
|-
! Abdominal pain
! [[Abdominal pain]]
! Pleuritic pain
([[right upper quadrant pain]])
! Aggravating/
! [[Pleuritic pain]]
relieving factors
|-
|-
|Amoebic  
|[[Amoebic liver abscess]]
liver abscess
|[[Entamoeba histolytica]]
|Entamoeba  
| +++
histolytica
| +++
|✔✔
| +/-
|✔
| +
|
| ++/-
|
| +
|
(late stages)
|✔/✘
| +
|✔
(late stages)
(late stages)
| +
| +
| +
|
|
|✔
|[[Hypoalbuminemia]]
|
 
|✔
(+)
|
|
* [[Ultrasound]] is the [[Gold standard (test)|gold standard]] technique for diagnosing [[amoebic liver abscess]]
|
|
|
* Responds well to [[chemotherapy]] and rarely require drainage
|More ill appearing than pyogenic abscess
* Marked male predominance
More fever than pyogenic
* More common in developing countries
 
* [[Seropositive|Sero-positive]]
Needle aspiration: Fluid from an ALA is odorless,reddish brown anchovy paste
* [[Right lobe of liver|Right lobe]] is more frequently involved
|-
|-
|Pyogenic liver abscess
|[[Pyogenic liver abscess]]
|Bacteria
|Bacteria
* Gram-positive aerobes
* [[Gram-positive]] [[aerobes]]
* Gram-negative enterics
* [[Gram-negative]] enterics
* Anaerobic organisms
* [[Anaerobic]] organisms
* Acid fast bacilli  
* [[Acid-fast bacilli]]
|✔
| +
|✔
| +
|
| ++
| ++
| +/-
| +++
| +
(acute loss)
| +
|
|
|✔
| +
|✔
|✔
|✔
(acute loss)
|✔
|✔
|✔
|Pale/dark
|Pale/dark
|✔
|[[Hypoalbuminemia]]
|
 
(+++)
|Cluster sign
* [[CT scan]] shows cluster sign
* Aggregation of multiple low attenuation [[liver]] lesions in a localized area to form a solitary larger [[abscess]] cavity
|
|
* Abnormal pulmonary findings
* [[Diabetes mellitus]] increases the risk
* Medical-surgical approach is indicated
* More common in developed countries
* Culture positive and [[seronegative]]
* Both lobes are commonly involved
|-
|-
|Fungal liver abscess
|Fungal liver abscess
|Candida species
|''[[Candida|Candida species]]''<br>[[Aspergillus|Aspergillus species]]
|
| +
|
| +
|
| +-
|
| +
|
| +
|
| +
|
| +
|
| +
|
| +
|
| +
|
|
|
|
|
|
|[[CT]] and [[Ultrasonogram|USG]] findings with four patterns of presentation:
* Wheel-within-a-wheel pattern
* Bull’s-eye configuration pattern
* Uniformly hypoechoic nodule
* Echogenic foci with variable degrees of posterior acoustic shadowing
|
|
* Less common
* Pure fungal abscess or associated with [[pyogenic abscess]]
* [[Candida]] and [[Aspergillus]] are commonly found in the culture of aspirated pus
* Associated with underlying [[malignancy]] or [[DM]]
|-
|-
|Necrotic hepatoma
|[[hydatid cyst|Echinococcal (hydatid) cyst]]
|
|[[Echinococcus granulosus]]
* Hepatits B virus infection
* Hepatitis C virus infection
* Alcohol
* Oral contraceptive pills
|
|
|
|
|
|
|
|
|
|
| +
|
|
| +
|
|
| +
([[Obstructive jaundice]])
| +
| +
|
|
|
|
|
|
|Histology: [[Hydatid cyst]] with three layers
a.The outer pericyst, which corresponds with compressed and fibrosed [[liver]] tissue
b.The endocyst, an inner germinal layer
c.The ectocyst, a thin, translucent interleaved membrane
|[[Ultrasound]]:
* [[Cystic]] to [[solid]]-appearing pseudotumors
* Water lily sign
* [[Calcification]]s seen peripherally
|
|
* Blood or liquid from the ruptured cyst may be coughed up
* [[Pruritis]]
|-
|-
|Echinococcal (hydatid) cyst
|[[Malignancy]]
|Echinococcus granulosus
([[Hepatocellular carcinoma]]/[[Metastasis]])
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|-
|Malignancy
(Hepatocellular carcinoma/Metastasis)
|
*Hepatitis B and C
*Aflatoxins
*Alcohol
*Heamochromatosis
*Alpha 1 antitrypsin deficiency
*Non alcoholic fatty liver disease
|
|
|
|
|
|
|
|
|
|
*[[Hepatitis B]] and [[hapatitis C|C]]
*[[Aflatoxins]]
*[[Alcohol]]
*[[Hemochromatosis]]
*[[Alpha 1 antitrypsin deficiency]]
*[[Nonalcoholic fatty liver disease]]
| +
| +
(uncommon)
|
|
|
|
| +
| +
| ++
|
|
|
|
| ++
|Pale/Chalky
|
|
* High levels of [[alpha-fetoprotein|AFP]] in [[serum]]
* Abnormal [[liver function tests]]
|
|
* [[Liver biopsy]]
|Other symptoms:
* [[Splenomegaly]]
* [[Variceal bleeding]]
* [[Ascites]]
* [[Spider nevi]]
* [[Asterixis]]
|}
|}
</small>
</small>
</div>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]
[[Category:Hepatology]]

Latest revision as of 20:23, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

Amoebic liver abscess must be differentiated from other diseases that cause fever, abdominal pain, cough, jaundice, hepatomegaly, anorexia, nausea, vomiting, and pale or dark stools such as pyogenic liver abscess, fungal liver abscess, echinococcal cyst, and hepatocellular carcinoma.

Differential Diagnosis

Amoebic liver abscess must be differentiated from:[1][2][3][4][5][6][7][8][9][10]

Disease Causes Signs and Symptoms Laboratory Findings Imaging Findings Other Findings
Fever Pain cough Hepatomegaly Jaundice Weight loss Anorexia Diarrhoea

or Dysentry

Nausea and

vomiting

Stool
Abdominal pain

(right upper quadrant pain)

Pleuritic pain
Amoebic liver abscess Entamoeba histolytica +++ +++ +/- + ++/- +

(late stages)

+

(late stages)

+ + + Hypoalbuminemia

(+)

Pyogenic liver abscess Bacteria + + ++ ++ +/- +++ +

(acute loss)

+ + Pale/dark Hypoalbuminemia

(+++)

Cluster sign
  • CT scan shows cluster sign
  • Aggregation of multiple low attenuation liver lesions in a localized area to form a solitary larger abscess cavity
  • Abnormal pulmonary findings
  • Diabetes mellitus increases the risk
  • Medical-surgical approach is indicated
  • More common in developed countries
  • Culture positive and seronegative
  • Both lobes are commonly involved
Fungal liver abscess Candida species
Aspergillus species 		+ + +- + + + + + + + CT and USG findings with four patterns of presentation:
  • Wheel-within-a-wheel pattern
  • Bull’s-eye configuration pattern
  • Uniformly hypoechoic nodule
  • Echogenic foci with variable degrees of posterior acoustic shadowing
Echinococcal (hydatid) cyst Echinococcus granulosus + + +

(Obstructive jaundice)

+ + Histology: Hydatid cyst with three layers

a.The outer pericyst, which corresponds with compressed and fibrosed liver tissue

b.The endocyst, an inner germinal layer

c.The ectocyst, a thin, translucent interleaved membrane

Ultrasound:
  • Blood or liquid from the ruptured cyst may be coughed up
  • Pruritis
Malignancy

(Hepatocellular carcinoma/Metastasis)

+ +

(uncommon)

+ + ++ ++ Pale/Chalky Other symptoms:

References

  1. ↑ Lodhi S, Sarwari AR, Muzammil M, Salam A, Smego RA (2004). "Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases". Trop Med Int Health. 9 (6): 718–23. doi:10.1111/j.1365-3156.2004.01246.x. PMID 15189463.
  2. ↑ Barbour GL, Juniper K (1972). "A clinical comparison of amebic and pyogenic abscess of the liver in sixty-six patients". Am J Med. 53 (3): 323–34. PMID 5054724.
  3. ↑ Barnes PF, De Cock KM, Reynolds TN, Ralls PW (1987). "A comparison of amebic and pyogenic abscess of the liver". Medicine (Baltimore). 66 (6): 472–83. PMID 3316923.
  4. ↑ Conter RL, Pitt HA, Tompkins RK, Longmire WP (1986). "Differentiation of pyogenic from amebic hepatic abscesses". Surg Gynecol Obstet. 162 (2): 114–20. PMID 3945889.
  5. ↑ Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA (1997). "Fungal hepatic abscesses: Characterization and management". J Gastrointest Surg. 1 (1): 78–84. PMID 9834333.
  6. ↑ Pastakia B, Shawker TH, Thaler M, O'Leary T, Pizzo PA (1988). "Hepatosplenic candidiasis: wheels within wheels". Radiology. 166 (2): 417–21. doi:10.1148/radiology.166.2.3275982. PMID 3275982.
  7. ↑ Mortelé KJ, Ros PR (2001). "Cystic focal liver lesions in the adult: differential CT and MR imaging features". Radiographics. 21 (4): 895–910. doi:10.1148/radiographics.21.4.g01jl16895. PMID 11452064.
  8. ↑ Suwan Z (1995). "Sonographic findings in hydatid disease of the liver: comparison with other imaging methods". Ann Trop Med Parasitol. 89 (3): 261–9. PMID 7668917.
  9. ↑ Esfahani F, Rooholamini SA, Vessal K (1988). "Ultrasonography of hepatic hydatid cysts: new diagnostic signs". J Ultrasound Med. 7 (8): 443–50. PMID 3047423.
  10. ↑ Niron EA, Ozer H (1981). "Ultrasound appearances of liver hydatid disease". Br J Radiol. 54 (640): 335–8. doi:10.1259/0007-1285-54-640-335. PMID 7225721.
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