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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%