Pathology of liver amoebic abscess

2021-01-27 12:00 AM

Amoeba cocoons in the stool outward can last 10-15 days. The cocoon is not destroyed by potassium permanganate and chlorine, in formol 0, 5% after 30 minutes the cocoon dies.

Outline

Protozeaire of the family Entamoeba. In humans, there are 4 types: Entamoeba, Endolima, Pseudolima and Dientamoeba. Only the E.histolytica known as the active E. was pathogenic. The E.minuta form does not cause symbiosis in the colon and the cocoon causes the disease to spread.

Pathogenesis and pathogenesis

Amoeba cocoons in the stool outward can last 10-15 days. The cocoon is not destroyed by potassium permanganate and chlorine, in formol 0, 5% after 30 minutes the cocoon dies.

Invasion is related to their phagocytic capacity, to produce the enzyme collagènase and a cytotoxic protein.

Vascular damage helps amoeba flow intravenously into the portal or lymphatic circulation to the liver. Rarely on the general circulation to form lung, brain, spleen abscess by amoeba.

Clinical symptoms

Clinical manifestations suggest when a history of intestinal amoeba is present or has only occurred a few weeks.

The first stage (for the first few days) is hepatitis amoeba (Amebia hepatitis).

Stage of liver abscess: Usually occurs quite suddenly with high fever, possibly accompanied by chills 39 - 40 0 C, infected expression, possibly with nausea or vomiting, pain in many lower right ribs. Pain is increased with deep breathing, coughing, but usually, there is no obstructive syndrome, the largest liver is found in the right liver. The liver is usually tender or tight,

Atypical forms:

Be with acute abdominal pain.

Exhausted anaemia form.

Suppose u.

Complications form.

Subclinical

Tests are nonspecific

CTM.

VS.

Men Transaminase.

Bilirubin blood.

Stool test for amibe.

Serological test for amibe markers.

Video recording methods.

Ultrasound of the liver.

Density tomography.

Resonance imaging.

Movie shooting.

Projection.

Pus suction.

Liver scintigraphy with technetium 99 .

Direct amibe test .

Diagnose

Based on the history and history of amibe dysentery. Diagnosis suggestive of Fontan triad: Fever, enlarged liver and pain.

Diagnosis is set when on ultrasound or CT images for Abcès. Based on serum amibe score.

Differential diagnosis

Distinguishing hepatic amibe abcès and biliary abcès.

Liver cancer.

Acute cholecystitis.

Treatment

Amoeba liver abscess treatment is surgical treatment or in combination with an ultrasound-guided aspiration procedure or CT scanner. The outcome of treatment depends on many factors such as the general condition of the patient, the stage of development and diagnosis of the disease, the status of inflammatory liver damage, early-stage abscess, the small size (<6 cm ), not purulent, number, size and location of the abscess drives.

Internally medical treatment

The general measure: Rest, eat and drink enough energy and nutrients, relieve pain and reduce fever if needed. such as paracetamol 500mg x 3 tablets / day or Efferalgan (paracetamol + codeine) 530mg x 3vs / day, Diantalvic (paracetamol + dextroprofan 530mg x 3 tablets / day.

Medicine:

Émétin: Is an organic amoebic agent (active amoeba) that has been used for a long time and has very good tissue diffusion properties, extracted from Ipéca tree. The drug is characterized by high concentration in liver, lung, spleen, kidney, and slowly excreted by the kidneys, it remains in the urine 1-2 months after treatment. The mechanism of action is irreversibly blocking protein synthesis due to inhibition of ribosome migration on messenger RNA.

Side effects: Nausea, diarrhea, muscle pain, but the most important side effect is cardiovascular toxicity due to oedema and necrosis of myocardial fibres, causing heart failure, dangerous arrhythmias. Symptoms of cardiotoxicity were irregular heartbeat, arrhythmias, pre-cardiac pain, and acute heart failure; Therefore, it should not be used in patients with cardiovascular disease, need to check the electrocardiogram before, during and after treatment. Cardiac abnormalities in emetin poisoning are: tachycardia, prolonged PR, long QT interval, QRS dilated, T reversed. There are two types:

Émetin Chlohyarate: Tube 30, 60, 40 mg. Dosage 1 mg / kg used 7- 10 days. The second course must follow the first dose 4 weeks later. Good response reduces fever after 2-3 days

Déhydroémetine is a synthetic type with lower toxicity than émétine. Dosage 1, 5 mg / kg for 10-15 days. The second treatment should be 3 weeks after the first.

The nitro-imidazole group is usually: Métronidazole (Flagyl, Klion) also kills tissue amoeba, also kills intestinal amoeba, the mechanism of action is due to reduction of ferredoxin, which reacts with large molecules of bacteria to kill them. The drug is rapidly absorbed through the intestine after 1 hour, half-life after 8 hours. High concentration in the blood after 5-7 hours.

Side effects: headache, vomiting, anorexia, dry mouth, metallic taste, fatigue, dizziness. In laboratory animals, it can cause genetic mutations, so it should not be used in pregnant women. Dose 25-30 mg / kg for 10-15 days. The drug is presented in the form of tablets of 0, 25mg x 4-6v / day or vials of 0.5g in 100ml, a dose of 1g / day; IV circuit split 2 times within 1 hour.

Another imidazole: Tinidazole, Nimorazole, Secnidazole (Flagentyl) and Ornidazole. These drugs have a long half-life, so they only need to be used 2 times a day for 5-7 days. Of these types, only Tinidazole (Fasigyne) is good at killing amoebas, while others are less than mronidazole in amoeba treatment. Tablets 0, 5 g dose of 3 tablets / day for 5 days.

Chloroquine has a high concentration in the lung 200 times/serum and in the liver 400 times/serum. Inhibits synthesis of DNA and RNA, slows down RNA replication and replication. It can be used to prevent liver amoeba when intestinal amoeba is active, or in combination with Émetine and Métronidazole in the treatment of abscess because it can be used for a long time. Dosage is 1 g for the first 2 days and 0.5 g for 3 to 4 weeks.

Antibiotics:

Paromomycin (Humatin) belongs to the Aminoglycoside group. Dose 25-30 mg / kg of weight for 5-10 days.

Cyclines group: Tetracycline 0, 25g x 4-6 tablets / day; Doxycyclines, 100mg tablets, x 2 sticks / day for 2 weeks.

Erythromycin, tablet 0, 25g or 0, 5g; Dosage 1, 5g / day x 2 weeks. These antibiotics have a weak effect on amoebas, so they should only be used in combination.

Intestinal amoebic drugs:

Diloxanide furoate is a derivative of dichloroacetate, the mechanism of action is not well known. Dose 500 mg twice daily for 10 days.

Lodoquinol (Direxiode, Enterovioform). Dosage 650 mg x 2 times / day for 3 weeks.

Tips:

Pus under the guidance of ultrasound, thanks to ultrasound and CT scanner can detect small abscess or after treatment with drugs abscess completely liquefied and not cleaned. Locate the abscess drive and then poke under the guidance of ultrasound or CT scanner, wash the pus then can inject amoebic directly into the abscess drive such as déhydroemetin, Flagentyl. And repeat aspiration if the test is still pus, very good results reduce pain and fever very quickly shorten treatment time.

Surgery:

Now tapering is only available for those that are too large, abscesses close to the liver that threaten to rupture, liver abscess rupture or located in an unattractive position.