<prompt> A patient with 8 cm x 8 cm abscess in right lobe of liver was treated with aspiration multiple times 3 times and with systemic amebicide. Now cavity is remaining in right lobe of liver but there is nothing in the cavity. Seven days course of luminal amebicides is given. How will you follow up?Stool examination onlyUSG weekly for 1 month followed by monthly USG till 1 yearUSG weekly for 3 months followed by CT scan at 3 months.USG or CT scan monthly and stool examination weekly  <response>: Ans. b. USG weekly for 1 month followed by monthly USG till 1 year Ref: Sabiston 19e p1445-1447; Schwartz 9e p1115-1116; Bailey 25e p1095; Blumgart 5e p1016-1024; Shackelford 7e p1471-1478In uncomplicated cases of amebic liver abscess, follow-up is done with ultrasound.Role of ultrasound in the diagnosis and treatment follow-up of amoebic liver abscess, by K. Shamsi, A. De Schepper, F. Deckers, E. de Bergeyck, J. Van den EndSerological and clinical data in combination with these nonspecific sonographic features are sufficient for the management of ALA, obviating the need for expensive and invasive techniques in majority of the cases.- springer.comarticle10.10072FBF00221420?LltrueSabiston says The average time to radiologic resolution is 3 to 9 months and can take as long as years in some patients. Studies have shown that more than 90 of the visible lesions disappear radiologically, but a small percentage of patients are left with a clinically irrelevant residual lesion.Most individuals with amebic liver abscess do not have concurrent signs or symptoms of colitis, and most do not have E. histolytica trophozoites in their stools.Most individuals with amebic liver abscess do not have concurrent signs or symptoms of colitis, and most do not have E. histolytica trophozoites in their stools. - Harrison 18e p1683-1685Amoebic Liver AbscessCaused by Entamoeba histolytica whose cysts are acquired through the feco-oral routeQTrophozoites reach the liver through portal venous systemQ.Solitary aand more common in right lobe of liverQ.Low incidence of invasive amoebiasis in menstruating womenQMajority of patients are young men may be due to heavy alcohol consumptionPathogenesis:MC form of invasive disease is colitis, frequently affects the cecum and ascending colonQIn colon: Flask-shaped ulcersQ MC site: Cecum and ascending colonQSynchronous hepatic abscess is found in one third of patients with active amebic colitis.Clinical Features:MC symptom is abdominal painQTypical clinical picture: Patient of 20-40 years of age, with history of travel to endemic area, presents with fever, chills, anorexia, right upper quadrant painQ.Results from an obligatory colonic infection, a recent history of diarrhea are uncommonQ.Active colitis and amoebic liver abscess rarely occur simultaneously, as a rule colonic lesions are silentQJaundice is rareQRaised PT is MC LFT abnormalityQ.Diagnosis:USG and CT are the main diagnostic modalitiesQDiagnosis is confirmed by serological testsQ ELISA for antiamoebic antibodies.Cultures of amoebic abscess are usually sterile or negativeQ.CXR: Elevated hemi diaphragm, right sided pleural effusion or atelectasisALA: Reddish-brown anchovy pasteQ; more reliable characteristic than color is the odour of the fluid.Treatment:Metronidazole 750 mg orally TDS X 10-14 days is the mainstay of treatment and is curative in over 90 of patientsQ, clinical improvement is seen within 3 days.Luminal agents include iodoquinol, paromomycin and diloxanide furoateQ.The average time to radiologic resolution of abscess is 3-9 monthsQIndications of Aspiration in ALA Diagnostic uncertaintyQ Failure to respond to therapy in 3-5 daysQ Pyogenic superinfectionQ High risk of rupture size 5 cm. left lobe abscessQ PregnancyQ Therapeutic trial with high dose Metronidazole is deemed inappropriateComplications:Most frequent complications: Rupture into the peritoneum MCQ, pleural cavity, or pericardium.Size of abscess appears to be the most important risk factor for ruptureLaparotomy is indicated in cases of doubtful diagnosis, hollow viscus perforation, fistulization resulting in hemorrhage or sepsis, and failure of conservative therapy.Treatment of rupture into the pleural space: ThoracentesQRupture into bronchi is self-limited with postural drainage and bronchodilatorsQ. 