Clinical Pattern of Liver Abscess among the Patients Admitted in Rajshahi Medical College Hospital

Abstract

Introduction: Liver abscess is an important clinical problem in tropical regions of the world. Current assessment of liver abscesses should allow for better understanding of the aetiopathogenesis of the disease. This study was conducted to find the clinical pattern and aetiopathogenesis of liver abscess in patients admitted in Rajshahi Medical College Hospital. Methodology: The present cross-sectional study was carried out in the Department of Medicine, Rajshahi Medical College Hospital (RMCH) on consecutive 34 patients of liver abscess admitted between the period of July 2002 and June 2003. Detailed history and clinical examination were performed in all patients. All routine investigations were done. Liver abscess was confirmed by ultrasonography (USG). Aspiration of liver abscess was done under sonographic guidance in the Nuclear Medicine Department of RMCH to diagnose the cause of liver abscess. Aspirated materials were sent for microscopical examination and culture and sensitivity in the Department of Microbiology of the same Institute.Result: The findings showed that early middle-aged population were usually affected by liver abscess followed by middle aged (mean age around 40 years). The patients were predominantly male with males being 16 times more likely to suffer from the disease than the females. Most of the patients belong to low socioeconomic status (82.4%). All patients had fever and malaise. Other common manifestations were loss of appetite, lump in the abdomen, intercostal tenderness, nausea/ vomiting, loss of weight. Less common presentations were diarrhoea (29.4%), jaundice (23.5%), cough (11.8%), chest pain (11.8%) and breathlessness (2.9%). Liver span of the patients measured by ultra-sonogram showed hepatomegaly in all cases. All patients with pyogenic liver abscess and 75% of the patients with amoebic abscess had the history of prolonged intake of fermented palm juice (palm wine). Microscopic examination of the pus/aspirate drawn from the liver revealed trophozoite in 7(20.6%) cases. However, on culture of the specimen, 12(35.3%) were culture positive and 22(64.7%) were culture negative. Conclusion:Middle-aged male with low socioeconomic status with the history of prolonged palm wine intake are the most common characteristic of patients with liver abscess. Multi-center study with large sample size is recommended to verify the findings of the present study.

Safety and efficacy of ultrasound guided percutaneous needle aspiration of liver abscess

“…6,7 Similarly our study did not correlate with some other studies. 8,9 In our study we found male to female ratio 8:1 which was similar to others. 6,9 Most of the patient are economically poor and lives in rural area.…”

“…In our study pus culture were negative in 66% of patient, but previous study showed 70% was negative. 6,8 The major advantages of percutaneous needle aspiration are: 1) it is less invasive and less expensive; 2) avoids problems related to catheter care; and 3) multiple abscess cavities can be aspirated easier in the same setting. 14 The success rate of percutaneous needle aspiration in the literature varies from 77-100%.…”