The patient is irritable and often complains of insomnia.
The right rectus tends to be somewhat rigid and decubitus is dorsal or toward the right side.
The Liver and Spleen.—The liver is tender and as the abscess in nine-tenths of the cases is located in the right lobe and generally toward the upper convex surface we have an enlargement upward. There is very rarely any jaundice.
The urine shows an excess of urobilin and of nitrogen eliminated as ammonia. When the abscess is in the left lobe the condition is apt to be considered as some gastric disturbance. The spleen, as a rule, shows no enlargement.
Examination of the Blood.—There is usually a moderate leucocytosis with normal polymorphonuclear percentage and increase in the large mononuclears.
Fig. 62.—Liver abscess. X-ray photograph taken from the side and showing upward enlargement of liver. (Ruge and zur Verth after Béclére.)
Diagnosis
Clinical Diagnosis.—Of greatest importance is a history of a previous dysentery although it must be remembered that liver abscess may appear in one who has never had dysenteric symptoms. Fever of a hectic type with crepitation at right base, pain and upward enlargement of the liver are most significant.