What is Quality and Quality Assurance?
John Fry, Nat Yuen in Principles and Practice of Primary Care and Family Medicine: Asia-Pacific Perspectives, 2018
This refers to the delivery of the maximum number of comparable units of health care for a given unit of health resources used. This means choosing the most effective plan for patient care possible within given cost constraints. An example is a comparison of two methods of treating patients who have suffered an uncomplicated solitary amoebic liver abscess. The established method is surgical drainage, although another method— drainage of the abscess by percutaneous needle aspiration combined with chlororquine treatment—is also available. The effectiveness of the two methods is the same, but the cost of the surgical method is much higher than the medical method. Therefore the latter can be considered to be more efficient in treating an uncomplicated solitary amoebic liver abscess.
Hepatic cysts and abscesses
Prem Puri in Newborn Surgery, 2017
Plain films may suggest the diagnosis of hepatic abscess by the presence of an elevated right hemidiaphragm and right pleural effusion. Sometimes, a gas shadow can be visualized in the liver itself corresponding to the abscess cavity. Improvements in abdominal ultrasound and CT scanning now allow for a more rapid and accurate diagnosis in neonates.33 Ultrasound has the advantage of lower cost, no radiation exposure, relative convenience, and ease of repeating the exam (no sedation, portable).34,35 A hepatic abscess typically shows low or variable echogenicity by ultrasound, and cystic lesions as small as 1 cm can be identified separate from liver parenchyma. A pyogenic abscess may have more irregular margins on ultrasound compared with an amoebic liver abscess, which may be round and well-defined.36 CT scanning has demonstrated increased sensitivity compared with ultrasound, and it gives a clearer definition of the abscess.20 The abscess margins are variably enhanced with the use of intravenous (IV) contrast. Figure 77.2 demonstrates the appearance on CT scan of a large hepatic abscess in a 5-day-old full-term baby. This neonate had an umbilical venous catheter in place with progressive hepatomegaly on physical examination. Included in the differential diagnosis of this cystic mass were hepatoblastoma, infantile hemangioendothelioma, MH, and other rare liver tumors. Any neonate with persistent fever and suggestion of upper abdominal tenderness or an enlarged liver should undergo radiographic examination, especially if risk factors are present. If the ultrasound appears normal but clinical suspicion remains high, CT scanning should be performed. Specific diagnosis requires aspiration of the lesion with Gram stain and culture, leading to subsequent identification of the infecting organism.
Tropical infections and infestations
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The typical patient with amoebic liver abscess is a young adult male with a history of insidious onset of non-specific symptoms, such as abdominal pain, anorexia, fever, night sweats, malaise, cough and weight loss. These symptoms gradually progress to more specific symptoms of pain in the right upper abdomen and right shoulder tip, hiccoughs and a non-productive cough. A past history of bloody diarrhoea or travel to an endemic area raises the index of suspicion.
Infections caused by hypervirulent Klebsiella pneumoniae in non-endemic countries: three case reports and review of the literature
Published in Acta Clinica Belgica, 2023
Wannes Van Hooste, Marthe Vanrentergem, Eric Nulens, Christophe Snauwaert, Deborah De Geyter, Rembert Mertens, Jens T. Van Praet
A 54-year-old Belarusian male truck driver presented at the emergency ward because of diarrhoea in the last 3 days, cough, dyspnoea and fever. He had no relevant medical history and took no medication. Upon clinical examination, he looked severely ill and had fever up to 39°C, but other vital signs were stable. Deep palpation of the abdominal right upper quadrant was painful without muscular rigidity. Further clinical examination was unremarkable. Blood results showed mild neutrophilic leucocytosis (14,900/µl), normal kidney function, significantly raised C-reactive protein (CRP) (378 mg/dl), hyperbilirubinemia (3.30 mg/dL [reference value 0.30–1.20 mg/dl], with a direct bilirubin of 1.1 mg/dl) and minimally elevated AST (58 U/l) and ALT levels (91 U/l). Cholestatic parameters were normal on admission. As screening test for Covid-19, a chest CT without intravenous contrast was performed which visualised an atypical lesion in segment 6 of the partially displayed liver. After taking blood cultures, empiric antibiotic treatment (amoxicillin/clavulanic acid 1000 mg/200 mg every 6 hours IV) was initiated. Additional investigation with triple-phase CT of the liver showed an ill-defined, thin-walled and heterogeneous lesion with a diameter of 9 cm in the right liver lobe (see Figure 1, panel A-D). There was some heterogeneous enhancement after intravenous contrast administration, mostly sparing the outer rim. The differential diagnosis at this point included a pyogenic liver abscess, amoebic liver abscess or multilocular liver tumour.
When IBD is not IBD
Published in Scandinavian Journal of Gastroenterology, 2018
Bram Verstockt, Séverine Vermeire, Gert Van Assche, Marc Ferrante
Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), develop in genetically susceptible hosts, who’s immune system reacts inappropriately to the enteric microbiome [1,2]. Although intestinal microbiome dysbiosis has been observed in patients with CD [3], no single causative microorganism has yet been revealed. Studies suggested the importance of adherent-invasive Escherichia coli in CD pathogenesis, but its exact role remains debated [4]. Nevertheless, some gastro-intestinal infections can mimic CD, making the differential diagnosis of IBD challenging [5]. We report a patient diagnosed with Crohn’s colitis, who developed an amoebic liver abscess under anti-TNF. Based on further investigations the initial diagnosis of CD was finally changed to an amoebic colitis.
Antigenic membrane proteins of virulent variant of Entamoeba histolytica HM-1:IMSS
Published in Pathogens and Global Health, 2020
Gaayathri Kumarasamy, Asmahani Azira Abdus Sani, Alfonso Olivos-García, Rahmah Noordin, Nurulhasanah Othman
The disease is commonly transmitted via ingestion of water and food contaminated with feces containing E. histolytica cysts. People in high-risk groups include returning travelers and immigrants from highly endemic areas such as South East Asian countries (6). Besides, atypical means of transmission are via oral and anal sex [7]. Furthermore, this infection also occurs in first-world countries with insufficient barriers between water and human feces [7]. After ingestion, the amoebic cysts enter the stomach and excyst in the terminal ileum, develop into trophozoites and then inhabit the colon. Almost 90% of the infections remain asymptomatic and 10% exhibit a range of diseases which include acute diarrhea, amoebic colitis, amoebic liver abscess (ALA) and dysentery [5]. The prevalence of E. histolytica diseases is apparently deceptive since over 90% of the infections are caused by E. dispar. In a study conducted by [8], the asymptomatic infections of E. histolytica/E. dispar is mostly attributed to E. dispar infections rather than E. histolytica.
Related Knowledge Centers
- Ceruloplasmin
- Entamoeba Histolytica
- Fever
- Hypochondrium
- Pallor
- Hemoglobin
- Colitis
- Liver Abscess
- Amoebiasis
- Feces