Incidence
Age
Sex
Geography	- occurs worldwide; consider in patients travelling from endemic areas
Aetiology	- Entamoeba histolytica carried from bowel to liver in the portal venous system - portal inflammation -> multiple microabscesses -> single or multiple large abscesses
Presentation	- onset is usually gradual - fever, anorexia, weight loss, malaise - often no history of dysentery - patient ill with tender hepatomegaly + effusion or consolidation in lower R chest
Investigations	LFTs - raised ALP - raised bilirubin in 25% FBC - normochromic normocytic anaemia - PMN leukocytosis ESR raised Serum vitamin B12 - very high - stored in and released from liver Blood cultures - positive in only 30% USS / CT CXR - elevation of right hemidiaphragm with pleural effusion in severe cases Serological tests for amoeba - haemagglutination inhibition, amoebic complement fixation test, ELISA - remain positive after a clinical cure; do not indicate current disease Diagnostic aspiration of fluid - resembles anchovy sauce
Macro
Micro
Staging
Serum markers
Management	- metronidazole 800 mg tds for 10 days - aspiration in patients failing to respond, and those with multiple or large abscesses, or abscesses in the left lobe of the liver
Prognosis
Complications	- rupture - 2º infection - septicaemia

Hepatobiliary medicine

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