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Arief Zamir
030.06.034
INTRODUCTION
Liver involvement occurs following invasion of the protozoa into mesenteric venules. Amoebae than enter the portal circulation and travel to the liver where they typically form large abscess.
LITERATURE STUDY
Amoebic dysentery usually occurs gradually, with symptoms : abdominal pain and tenderness, painful sudden bowel evacuation (tenesmus) and diarrhoea
that develop over a period of one to several weeks, often followed by weight loss
When the mucosal involvement becomes extensive, diarrhea is replaced by dysentery, with the passage of exudates, blood and
mucus.
Diagnosis is by doing direct fecal smear and staining. The others such as Enzyme Immuno Assay (EIA), Antigen detection, Polymerase Chain Reaction (PCR) is for species identification.
Metronidazole, or related drug such as Tinidazole and Ornidazole is the treatment for the trophozoite that have invaded tissue, and followed by luminal amebicide, such as Paramomycine, Diloxanide
DISCUSSION
The cysts of Entamoeba histolytica are transmitted primarily by food and water contamination. While it can cause dysentery when living in the intestinal, it can also manifested to liver abscess by entering mesenteric venule then go to portal vein and last remain in the liver,
The right lobe of the liver is more commonly affected than the left lobe. This has been attributed to the fact that the right lobe is supplied predominantly by the superior mesenteric vein, whereas the left lobe is supplied by the splenic vein
Abdominal pain, and may radiate to the right shoulder or scapular Fever
Diarrhea
cough and chest pain Hepatomegaly Jaundice Nausea and vomiting Weight loss
Diagnose can be confirmed by lab studies include stool examination, which finding the cyst of the parasite,or other test such as stool antigen detection, stool culture, and serologic test.
Imaging test, for example Ultrasonography (USG), can be an option to see the condition of the liver .
Tissue amebicides are used to eradicate the invasive trophozoite forms in the liver : - Metronidazole - Emetine, - Tinidazole, - Dehydroemetin
Additional drug may be given; Chloroquine that active only in the liver; Tetracycline acts on the bowel wall
to eradicate the intestinal carriage after the amebic liver abscess has been treated with one of the above tissue amebicides
Surgical care such therapeutic aspiration must be considered in amebic liver abscess in the following situations:
(1) high risk of abscess rupture, as defined by cavity size greater than 5 cm;
(2) left lobe liver abscess, which is associated with higher mortality and frequency of peritoneal leak or rupture into the pericardium;
(3) failure to observe a clinical medical response to therapy within 5-7 days
CONCLUSION
Amebic liver abscess, as the most frequent extraintestinal manifestation of Entamoeba histolytica (amebiasis), can affect all people from all races, and mostly in developing countries in the tropics. The risk factors for infection include travel or residence in
endemic areas.
The best way is to prevent it from affecting us. It can be done by avoiding contaminated food or drinks that may contain the cyst of Entamoeba histolytica by keeping the hygiene and sanitary of environment.
BIBLIOGRAPHY
1. Amebic Hepatic Abscesses. Available at: http://www.emedicine.com/med
http://en.wikipedia.org/wiki/Amoebic_dysentery
7. Amoebic Liver disease. Available at: http://en.wikipedia.org/wiki/ Amoebic_liver_abscess
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