XII, B, 3 Abriol: Amcebic Abscess of the Liver 137 



DIAGNOSIS 



There are certain cases of amcebic liver abscess whose symp- 

 toms are so prominent that one can readily make a correct 

 diagnosis. I have already stated that the symptoms of this 

 disease are varied and due to this we are not always in a posi- 

 tion to give a correct diagnosis in certain cases. . Manson(i) puts 

 it thus : 



Golden rules in tropical practice are to think of hepatic abscess in all 

 cases of progressive deterioration of health; and to suspect liver abscess 

 in all obscure abdominal cases associated with evening rise of temperature, 

 and this particularly if there be enlargement of or pain in the liver, leucocy- 

 tosis and a history of dysentery — not necessarily recent dysentery. If 

 doubt exist, there should be no hesitation in having early recourse to the 

 aspirator to clear up diagnosis. 



Chief among those diseases which may be confused with liver 

 abscess are syphilitic disease of the liver, cholecystitis and sup- 

 purative cholangitis, malarial hepatitis, carcinoma of the liver, 

 pyelonephrosis or hydronephrosis, hydatid cysts, and tubercu- 

 lous abscess of the abdominal wall. Syphilitic disease of the 

 liver may be excluded by the Wassermann test and thera- 

 peutic tests with salvarsan and other antisyphilitic agents. 

 Cholecystitis and suppurative cholangitis are distinguished by 

 high leucocytosis, and in the latter there is apt to be present a 

 distinct septic temperature. The liver, as a rule, is not changed 

 in size. In some of our cases the exclusion of these conditions 

 has not been made before laparatomy was performed. Malarial 

 hepatitis is easily ruled out by the presence of the malarial 

 parasites in the blood and the quick response of the disease to 

 quinine. Carcinoma of the liver has often led us to a mistaken 

 diagnosis. Careful examination shows an enlarged liver of a 

 firm consistency, and sometimes nodules are distinctly palpable, 

 Pyelonephrosis or hydronephrosis, especially when the colon has 

 become adherent to the liver, complicates the diagnosis. Catheter- 

 ization of the ureters will as a rule lead to their identification. 

 Hydatid cysts are slow in their grovii;h, painless, and devoid of 

 constitutional symptoms. Exploratory puncture may be resorted 

 to in order to observe the character of the fluid in the cavity. 

 Tuberculous abscess of the abdominal wall often leads to a 

 doubtful diagnosis. In some large abscesses of the lower part 

 of the right lobe, particularly when fluctuation is present and 

 when complicated by adhesions of the liver to the parietal 

 peritoneum in a subject with thin abdominal wall, the differen- 

 tiation is hard to make. Occasionally an abscess of this type 



