The final proof is the obtaining of the chocolate-coloured or anchovy sauce-like pus by exploratory puncture.
Fig. 61.—Temperature chart of liver abscess.
This pus does not contain pus cells but only granular débris, cholesterin crystals and is often bacteriologically sterile. The amoebae, being in the abscess wall, are not apt to be found when pus is at first withdrawn. Owing to the tendency of liver abscess to rupture into the lungs the first indication of the true nature of a prolonged hectic fever may be obtained when the characteristic pus is expectorated by the patient.
Attended with progressive emaciation and exhaustion the patient, as a rule, after a prolonged illness, dies, unless operative procedures cure him or some intercurrent disease brings about his death.
Symptoms in Detail
Onset and the Fever Chart.—The onset is at times so insidious that there may be no symptoms and yet a liver abscess be found at autopsy. Usually following convalescence after amoebic dysentery an irregular fever sets in which becomes hectic in character. Profuse sweats accompany the evening rise. The morning temperature is frequently normal and there may be frequent apyretic intervals.
The Respiratory System.—Crepitation at the right base, a dry cough (tussis hepatica) and shallow respirations are features of the disease.
The Nervous System.—Pains in the right shoulder are connected with irritation of the branches of the phrenic nerve.