Chronic Involvement of the Liver in Intestinal Amoebiasis. (Chronic Amoebic Hepatitis)

Summary

Of the various stages of hepatic antoebiasis generally only abscess formation is described, much more seldom acute hepatitis, mostly as precursor of abscess formation. Chronic amoebic hepatitis is mentioned very seldom although it is the most frequent complication of chronic intestinal amoebiasis. Payne found it in 50% of his cases of chronic amoebiasis, in this series 26% suffered from chronic liver involvement. The pathology of this condition is not yet well understood. The question is whether the presence of amoebae in the liver is essential or whether some toxic influence suffices to induce the pathologic changes. Some investigations on the histologic changes in the absence of abscess or outside the immediate sphere of abscess, have been made by Palmer (1938) and much earlier by Councilman & Lafleur (1891). They found an increase in portal connective tissue with infiltration of lymphocytes and monocytes, with no involvement of the parenchyma, besides some congestion. Numerous patches of these fibrotic areas were found at the same time as active amoebic lesions in the intestines. It seems probable that by constant invasion of amoebae from an active intestinal process the above described reaction on the side of the liver is carried on, the invading amoebae soon being destroyed (Rogers). This conception is strengthened by the great percentage (72%) of Entamoeba histolytica found in the stools in this series, and the presence, at the same time, of clinical symptoms of an active intestinal process, the liver condition improving together with the intestinal symptoms after treatment of the latter.

The symptomatology is characterized by the chronicity of the process. Therefore, many features of the acute phase of hepatitis, such as fever, severe pains, enlargement of the liver, are not present, or only in a minor degree. The main feature is the tenderness of the liver. Constitutional symptoms are much more outstanding than in chronic amoebiasis, presenting the picture of early liver disease. The x-ray is mostly negative.