Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily...Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.展开更多
Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,...Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.展开更多
文摘Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.
文摘Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.
