Pyogenic Liver Abscess 소화기내과 R4 신아리 MGR Disease Review

Pyogenic Liver Abscess - Pus-filled cavity within the liver 2 Introduction Harrison 18th Ch127, page

Epidemiology – Annual incidence 3 Emerg Infect Dis (2008) 14, 1592~-1600 Am J Gastroenterol (2010) 105, 117~124

Liver Abscess In KMC Patients diagnosed with liver abscess in KMC - From to Mean age : 59.7 yrs, Sex : M(150) / F(154) - Incidence per years

Pathogenesis 5 1. 임상우, et al. 대한소화기학회지 2003;42: 나병규, et al. 대한간학회지 2003;9: 서태진, et al. 대한내과학회지 2005;68:26-38 Route of hepatic invasion StudyBiliaryPortal veiin Hepatic artery Direct extension TraumaCryptogenic 2003 대구 1 45 %-3 %4 %2 %46 % 2003 대전 %0 %3 %1 %-74.5 % 2005 광주 %5.2 %4 %0.5 %1.5 %45.5 % * Associated with DM : 14.9 ~ 31.7%

Microbiology 6 Journal of infection, (2007) 54, 대한소화기학회지, (2010) 56, 90-96

Microbiology 7 Journal of infection, (2007) 54, Metastatic infection at Distant sites septic pneumonia (m/c) meningitis endophthalmitis skin and subcut. tissue infection renal or prostatic abscess cerebral abscess septic arthritis lung abscess

8 Clinical Manifestations 대한 소화기학회지, (2010) 56, 90-96

9 Diagnosis Symptoms - fever, jaundice, abdominal pain or discomfort Non-specific symptoms Laboratory finding - Leukocytosis : 84~88% - Alkaline phosphatase : about 2/3 - Bilirubin, AST/ALT Radiographic imaging : Abdomen CT or Sono Microbial cultures - Blood and CT or US-guided aspiration or drainage Harrison 18th Ch127, page

Abdomen Ultrasonography Diagnosis 대한방사선의학회지, (2001) 44, AB C D

Contrast-enhanced Abdomen CT Diagnosis J Korean Radiol Soc, (2005) 53, AB C D

Cholangiocarcinoma Differential Diagnosis J Korean Radiol Soc, (2005) 53, AB C D

13 Differential Diagnosis Amebic Liver abscess - Classically single large abscess in the right lobe - Near-complete overlap in symptomatology - Serology test sensitivity : about 95% highly specific for E. histolytica infection thus, a negative result helps to exclude this diagnosis Harrison 18th Ch129, page

Treatment Antibiotics therapy - Empirical broad-spectrum antibiotics - Consider results of culture study Drainage - Radiographically guided percutaneous drainage - Surgical drainage Harrison 18th Ch127, page ) Multiple or Loculated abscesses 2) Abscesses with viscous contents obstructing drainage catheter 3) Inadequate response to percutaneous drainage within 7 days 3 rd Cephalosporin + Metronidazole or Fluoroquinolone + Metronidazole

Follow Up Duration of therapy - Antibiotics : 4~6 weeks - Drainage cath : remain in place until drainage is minimal Indicators to follow up - Clinical & chemical markers : temperature, WBC count, CRP - Follow up image study Ix - persistent clinical symptoms - drainage is not proceeding as expected Harrison 18th Ch127, page