Hepatic manifestations during amoebic dysentery

Significance of elevation of the right dome of the diaphragm

Elevation of the right dome of the diaphragm occurs in a small proportion of healthy young adults, and in a proportion of patients with cardiac disease, cirrhosis of the liver and gastroenteritis. Hence this radiological feature, although common in hepatic amoebiasis, should be considered in concurrence with the other clinical features in the diagnosis of hepatic disorders. The significance of an elevation in the right hemidiaphragm in diseases primarily non-hepatic in origin, although of no diagnostic importance, is of clinical interest and is discussed.

Syndromes in amoebic liver abscess

A series of 137 patients with amoebic liver abscess has been studied. Recognition of clearly defined but diverse clinical syndromes was found to be necessary not only in diagnosis but also in planned surgical management. The majority of patients had the classic syndrome of fever, right abdominal or chest pain, hepatomegaly, hepatic tenderness and radiological abnormalities. Other syndromes of presentation included the silent abscess, acute amoebic colitis, the acute abdomen, the intraabdominal lump, the external sinus, pyrexia of obscure origin, obstructive jaundice and renal, pleuro-pulmonary and cardiac symptoms. The syndromes due to an abscess in different parts of the right lobe and in the left lobe of the liver are to some extent distinct. In spite of the varied modes of presentation of amoebic liver abscess, the key to diagnosis is an understanding of the chronological sequence of the disease and its progression from one syndrome to another. Diagnostic methods of value and the mortality are discussed.