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×ȵǾî 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¿©