Cholestasis in amoebic liver abscess.

Abstract

SUMMARY Two hundred and thirty six patients with amoebic liver abscess were investigated for cholestasis, its mechanism and the natural course of the disease. Cholestasis was seen in 29% of cases and it presented with some unusual features: it was frequently seen in young men (mean age 38-6±6-3 years) (87%) with acute onset (69%) and was associated with signs of peritonism, or peritonitis (28%), splenomegaly (12%) and hepatic encephalopathy (coma 13%). Raised diaphragm was seen only in 37% of cases. Alcoholism may have contributed to the cholestasis in 37% of cases. Multiple (43%) and single (32%) large liver abscesses, especially on the inferior surface of the liver (25%), were common in jaundiced patients with amoebic liver abscess, while size and number of abscesses were directly related to the raised serum bilirubin concentrations. Bromsulphalein excretion (BSP) was found to be significantly reduced (p<001) in patients with jaundice (60%). Retrograde injection of contrast media into the common bile duct during six necropsies showed compression by amoebic liver abscess on the hepatic ducts. The mortality (43%) and the complications were significantly higher (p<0.001) in patients with jaundice. The aspiration/surgical drainage of amoebic liver abscess together with a combination of metronidazole and di-iodohydroxyquinoline was more effective than either metronidazole alone, or dehydroemetine with chloroquine.

Hyperbilirubinemia in Patients with Amoebic Liver Abscess: A Study of 75 Cases

“…The incidence of jaundice in patients with ALA varies between 6% and 29% [1][2][3][4]. Ramachandran et al [7] reported 137 cases of ALA in which jaundice was seen in 11 patients only (8%), out of which 9 patients had serum bilirubin 2-5mg/ dl and two patients had Serum bilirubin >5 mg/dl.…”

“…The mechanism of hyperbilirubinemia in ALA has been studied previously in many studies [2,6]. Various mechanisms were suggested like pressure on biliary ducts at the porta hepatis especially by large abscess [2,7].…”

“…Various mechanisms were suggested like pressure on biliary ducts at the porta hepatis especially by large abscess [2,7]. Sharma et at observed that jaundice occurs because of intrahepatic obstruction or associated hepatitis and is usually seen in large or multiple abscesses; abscess situated at porta hepatis is more likely to produce jaundice because of extra-hepatic obstruction [8].…”

“…Jaundice in patients with amoebic liver abscess is a frequent occurrence. Its incidence varies between 6% and 29% [1][2][3][4]. During the course of illness, one-third of the patients may develop clinical jaundice.…”

“…The cause of jaundice in patient with amoebic liver abscess has not yet been established. It is thought to be either due to secondary infection of ALA, or pressure of the abscess on hepatic ducts, while other views are that it is due to parenchymal destruction or cholestatic in nature [1,2,5,6]. This study was designed to study the incidence and the actual cause of hyperbilirubinemia in patients with amoebic liver abscess.…”