INVESTIGATION

• Low Hb% in 50% cases.

• Liver function tests may show altered bilirubin and albumin
• level.
• Prothrombin time may be widened x Serum alkaline phosphatase,
SGPT, SGOT levels are altered.
• US abdomen shows altered echogenicity
(anechogenic,Hypoechogenic), size, location, number
• X-RAY FINDINGS
Raised fixed diaphragm
Pleural effusion
Soft tissue shadow
CT SCAN AND USG
• Sigmoidoscopy/colonoscopy are used to identify the active ulcers.
• Scrapings of the ulcer show trophozoites.
• Technetium 99 nuclear image liver scanning is helpful in
differentiating
amoebic from pyogenic abscess as amoebic abscess do not contain
WBCs. Amoebic abscess shows cold lesion with a hot rim or halo
• Indirect haemagglutination test Serological tests are reliable in non-
endemic areas than endemic areas
TREATMENT
• Drugs
• Tablet metronidazole 800 mg tid or injection metronidazole 500 mg IV tid
for 10–14 days (40 mg/kg/day).
• Tinidazole 600 mg BD dose for 5 days.
• IV or oral antibiotics are essential to control secondary infection
(cefotaxime, ciprofloxacin, amoxicillin)
• (Small abscesses < 3 cm respond to drugs).
• Other drugs:
• 1. Injection dihydroemetine.
• 2. Chloroquine
ASPIRATION
• Indications:
• In case of large abscess (> 10 cm),
• infected abscess
• failure of drug therapy
• large left lobe abscess,
• seronegative abscess
• Abscess in pregnancy where drug therapy cannot be used
• Ultrasound guided wide bore needle aspiration is done
• last part of the aspirant fluid is sent for trophozoite study; fluid .
• PT INR should be made normal by using injection vitamin K IV or FFP
transfusion (three units).
PERCUTANEOUS DRAINAGE
Under US guidance pigtail catheter is placed into the abscess cavity
percutaneously to drain the pus.
It may fail if there is thick pus, multiloculated abscess, and multiple
abscesses.
• INDICATION-when percutaneous drainage fails or in presence of
complications.
SURGERY
Procedure
1. Through transperitoneal
approach, abscess area is
opened
2. Pus is evacuated.
3. Malecot’s catheter is placed
and brought out through
separate stab incision.
4. Advice is given to avoid alcohol,
5. Chloroquine 250 mg BD for 10
days
Diloxanide furaote 500mg tid is
given for 10–14 days.
Complications of surgery—
Anaesthetic problems
Bleeding
liver failure (in cirrhotic patients)
intraperitoneal abscess formation
bile leak—bile peritonitis and fistula.
Follow-up
• At regular intervals is important.
• Proper counselling to avoid alcohol; repeat LFT; repeat ultrasound to
• Confirm the complete resolution of the abscess cavity.