Pyogenic liver abscess
1. ¿øÀÎ
°ú°Å¿¡´Â Ãæ¼ö¿° ÆÄ¿°ú ÀÌÀÇ ÀüÆÄ°¡ ÈçÇÑ °¨¿°°æ·Î¿´À¸³ª ÇöÀç´Â biliary tract disease°¡
°¡Àå ÈçÇÑ ¿øÀÎÀÌ´Ù.
È³ó¼º ¹®¸Æ¿°(suppurative pyelophlebitis = suppurative thrombosis of the portal vein)Àº
ÈçÈ÷ °ñ¹ÝÀÇ °¨¿°À¸·Î »ý±âÁö¸¸ ¶§·Î´Â º¹°³»¿¡¼µµ »ý±ä´Ù.
ÀÌ·± suppurative pyelophlebitis°¡ °£³ó¾çÀ» ÀÏÀ¸Å°´Â ÁÖ¿ä sourceÀÌ´Ù.
*¿øÀαÕ
1) biliary tree¿¡¼ ±â¿øÇÑ °æ¿ì : enteric aerobic GNB, enterococci°¡ °¡Àå ÈçÇÔ.
2) °ú°Å ¼ö¼úº´·ÂÀÌ ¾ø´Ù¸é anaerobe´Â µå¹°´Ù.
3) pelvic & other intraabdominal source¿¡¼ ±â¿øÇÑ °æ¿ì¿¡´Â mixed flora°¡ ÈçÇÏ´Ù.
: aerobe + anaerobe(ƯÈ÷ B. fragilis)
4) hematogenous spread¶§´Â ÈçÈ÷ ´ÜÀÏ ±ÕÁ¾ÀÌ´Ù.
: S. aureus, Streptococcus(S. milleri)
2. Áõ»ó
fever°¡ °¡Àå ÈçÇÑ ¹ßÇö ¡ÈÄÀÌ´Ù.
50%¿¡¼¸¸ hepatomegaly, RUQ tenderness, jaundice¸¦ º¸ÀÌ°í ³ª¸ÓÁö ¹ÝÀº Áõ»óÀÌ ¾ø´Ù.
3. Lab
*ALP¡è : single most reliable lab finding(70%)
´Ù¸¥ °Ë»ç¼Ò°ßÀº ÈçÈ÷ Á¤»óÀ̳ª ÀÌ»ó¼Ò°ßÀ» º¸Àϼöµµ ÀÖ´Ù.
Bil¡è(50%), AST/ALT¡è(48%), leukocytosis(77%), anemia(50%), hypoalbuminemia(33%)
4. ¹æ»ç¼± ¼Ò°ß
USG, CT, scanµî imaging study°¡ most reliable diagnostic methodÀÌ´Ù.
CXR»ó Rt pleural effusion, Rt hemidiaphragm, Rt basilar infiltrationÀ» º¸Àϼöµµ ÀÖ´Ù.
5. Ä¡·á
drainage + broad spectrum antibiotics
-> Gram stain, culture°á°ú³ª¿À¸é Á¶Á¤.
mortality = 15%