¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

Amebic liver abscess Harrison p1200(14ÆÇ)

1. ÀÓ»óƯ¡

- Entamoeba hystolyticaÀÇ Àå¿Ü °¨¿°Áß °¡Àå ÈçÇѰ÷ÀÌ liverÀÌ´Ù.

- ÀþÀºÀ̰¡ ³ëÀκ¸´Ù ´õ ±Þ¼º°æ°ú¸¦ º¸ÀδÙ.

- ´ëºÎºÐ ¹ß¿­°ú RUQ pain(dull or pleuritic), shoulder radiationÇÑ´Ù.

- °£ À§Ä¡¿¡ point tenderness¿Í right-sided pleural effusionÀÌ ÈçÇϳª jaundice´Â µå¹°´Ù.

- initial infection site°¡ colonÀ̶ó ÇÏ´õ¶óµµ 1/3¹Ì¸¸¿¡¼­¸¸ active diarrhea¸¦º¸ÀδÙ.

- endemic areaÀÇ ³ëÀÎÀº 6°³¿ùÀÌ»ó Áö¼ÓÇÏ´Â subacute course¸¦ º¸À̸ç weight loss¿Í

hepatomegaly¸¦ µ¿¹ÝÇÑ´Ù.

- amebic liver abscessÀÇ sx & signÀÌ ºñƯÀÌÀûÀ̹ǷΠÀÓ»óÁø´ÜÀ» ÇϱⰡ ¾î·Æ´Ù.

10-15%´Â ´ÜÁö ¹ß¿­¸¸ ÀÖÀ¸¹Ç·Î FUOÀÇ °¨º°Áø´Ü¿¡ amebic liver abscess¸¦ ¹Ýµå½Ã

Æ÷ÇÔ½ÃÄÑ¾ß ÇÑ´Ù.

2. Ä¡·á

- Metronidazole

- »ç¸Á·ü 1% ¹Ì¸¸

- ¸ðµç luminal agent¸¦ µ¿¿øÇÏ¿© Àå³» cyst¸¦ ¹Ú¸êÇÏ¿© further transmissionÀ» ¹æÁöÇÏ¿©¾ß

Çϸç Àç¹ßÀº µå¹°´Ù.

3) Aspiration of liver abscess

metronidazoleÅõ¿©·Î 90%À̻󿡼­ dramaticÇÏ°Ô ÁÁ¾ÆÁö¸ç 72½Ã°£³»¿¡ ¹ß¿­ ¹× ÅëÁõÀÌ

»ç¶óÁø´Ù.

* Aspiration indication

¨ç pyogenic liver abscess¸¦ ¹èÁ¦ÇÏÁö ¸øÇÒ ¶§, ƯÈ÷ multiple lesion

¨è 3-5ÀÏÈÄ¿¡µµ ¹ÝÀÀÀÌ ¾øÀ»¶§

¨é rupture°¡´É¼ºÀÌ ÀÖÀ»¶§

¨ê pericardiumÀ¸·ÎÀÇ rupture¸¦ ¹æÁöÇϱâ À§ÇØ(left lobe abscess)

Sherlock p501

°¡Àå ÈçÇÑ °÷Àº right lobe, supero-anterior(diaphragm¹Ù·Î ¾Æ·¡)ÀÌ´Ù.

abscess center´Â large necrotic area·Î µÇ¾î Àִµ¥ ¾×È­µÇ¾î thick, reddish-brown pus·Î

µÇ¾îÀÖ´Ù. À̰ÍÀº anchovy or chocolate sauce¿Í ºñ½ÁÇϸç liver cell lysis·Î ÀÎÇØ Çü¼ºµÈ

°ÍÀ̹ǷΠ¾ö°ÝÈ÷ ¸»Çؼ­´Â pus°¡ ¾Æ´Ï´Ù.

1) ¿ªÇÐ

colonic ameba´Â Àü¼¼°èÀûÀ¸·Î ºÐÆ÷ÇÏÁö¸¸ hepatic amebiasis´Â ¿­´ë ¹× ¾Æ¿­´ë Áö¹æÀÇ

º´ÀÌ´Ù.

À¯ÇàÁö¿ªÀº ¾ÆÇÁ¸®Ä«, ³²µ¿¾Æ½Ã¾Æ, ¸ß½ÃÄÚ, ¸Þ³×ÁÖ¿¤¶ó, ÄÝ·Òºñ¾ÆÀÌ´Ù.

2) ÀÓ»óƯ¡

¿­´ë ¹× ¾Æ¿­´ëÁö¹æ¿¡ °ÅÁÖÇÏ´Â »ç¶÷µéÁß¿¡¼­ 10%¸¸ÀÌ amebic dysentery¸¦ °¡Áö°í ÀÖ°í

hepatic amebiasisÀÇ 15%¿¡¼­¸¸ ´ëº¯¿¡ cyst°¡ °ËÃâµÈ´Ù.

dysenteryÀÇ °ú°Å·ÂÀº µå¹°´Ù.

ÀþÀº³²ÀÚ¿¡¼­ °¡Àå ÈçÈ÷ ¹ß»ýÇϸç Mexico¿Í Taiwan°°Àº °÷¿¡¼­´Â multiple abscess°¡

ÈçÇÏ´Ù.

¹ßÇöÀº º¸Åë 6°³¿ù ÀÌ»ó Áö¼ÓÇÏ´Â ¾Æ±Þ¼ºÀÇ °æ°ú·Î ³ªÅ¸³ª¸ç 10ÀϹ̸¸ÀÇ ±Þ¼º°æ°ú´Â

µå¹°´Ù.

40¡ÉÀÌ»óÀÇ °í¿­ ¹× Ȳ´ÞÀº µå¹°´Ù.

3) ¹æ»ç¼± Ư¡

CXR : Right pleural effusion or right basal pneumonia

USG : Áø´Ü°ú °æ°ú°üÂû¿¡ À¯¿ë

CT : small abscessÀÎ °æ¿ì USGº¸´Ù sensitive

4) ÇÕº´Áõ

¨ç Rupture : 2/3 - intraperitoneal 1/3 - intrathoracic

lung or pleura·ÎÀÇ rupture½Ã empyema, hepato-bronchial fistula or pulmonary

abscess¾ß±â.

±âħÀ» ÅëÇØ pus°¡ À§·Î ¿Ã¶ó°¡ pneumonitis or lung abscess or pleural effusionÀÏÀ¸Å´.

pericardiumÀ¸·ÎÀÇ rupture - left lobe abscessÀ϶§

intraperitoneal rupture½Ã acute perotonitisÀ¯¹ß

portal vein, bile duct or GIT·ÎÀÇ rupture´Â µå¹°´Ù.

¨è Secondary infection

5) Ä¡·á

¨ç TOC : Metronidazole 750 mg tid ¡¿ 5-10 days => 95% success rate

¨è Aspiration : very large abscess ȤÀº metronidazoleÀ» 5ÀÏÀÌ»ó Åõ¿©Çصµ ¹ÝÀÀÀÌ ¾øÀ» ¶§

left lobe abscess(pericardiumÀ¸·ÎÀÇ rupture°¡´É¼º)

¨é luminal amebocide

(diloxanide furoate 500mg tid ¡¿ 10 days or iodoquinol 650 mg tid ¡¿20 days)

Àå°ü¿¡ Áö¼ÓÇÏ´Â ameba¸¦ coverÇϱâ À§ÇØ Åõ¿©