AMCEBIC ABSCESS 53 



The pus may pass between the two la)'ers of the Hgamentum 

 puhnonis and here penetrate the bronchus, but it never passes from 

 the lung tissue into the bronchus (CantHe). The pus is then like 

 anchovy sauce. 



The mortality of Liver Abscess is always high, 50 — 80 per cent. 



In Algiers, 80 per cent. In the Indian Army, 57*7 per cent. 



TREATMENT. 



Liver abscess can often be prevented if, when there are signs and 

 symptoms of hepatitis, treatment is adopted as for amoebic dysentery. 



When the abscess has once formed operation is the only thing. 



The starvation diet before operation should not be observed in these 

 cases. From two to three hours before give a very nutritious and easily 

 digestible meal, well sweetened. It prevents some of the evil effects 

 of the chloroform poisoning dependent upon the state of ihe liver 

 (Cantlie). 



Always give a general anaesthetic. 



Insert the needle to diagnose correctly. If pus, then operate. 



When the pus is in the left half of the liver, which is verv rare, do 

 not explore with a needle, nor use a trocar and cannula, but cut down 

 and evacuate the pus in the ordinary Avay. 



In mapping out the liver before operating remember : — 



That the left margin of the liver does not coincide with the right 

 costal margin. In a tall man it is normally above, and in a short, 

 stout man below the costal margin, as the ribs pass out\\ards more 

 transversely. 



To get the lower border for that particular patient place the patient's 

 hand (right) with the upper border at the articulation of the sternum 

 with the ensiform cartilage and draw a line along its lower border; this 

 is the normal lower border line of his liver. Each inch below this line 

 means one pound of liver extra, and this is serious (Cantlie). 



Examine for an egg-shaped swelling along the upper border 

 between the right nipple and the sternum. 



Remember that the pleura comes to within three fingers breadth of 

 the lower costal margin and the lung to five fingers breadth. 



When needling, it does not matter if the pleura is penetrated. 



Even if the base of the lung is pierced it is not of importance, as 

 this is congested, doing no work, and the puncture will relieve the 

 tension. 



Bleeding from the hepatic veins is good; it relieves congestion and 

 affords comfort even if no abscess is found. 



The portal vein has never been entered. 



The vena cava is 4I inches away from any part of the surface of a 



