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肝膿瘍の診断・治療のアルゴリズム

出典
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1: 著者提供

細菌性肝膿瘍のCT画像所見

出典
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1: Mark Feldman MD, Lawrence S. Friedman MD, Lawrence J. Brandt MD:Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 10th ed., CHAPTER84:Bacterial, Parasitic, and Fungal Infections of the Liver, Including Liver Abscesses, Elsevier, 2016, FIGURE 84-9.

アメーバ性肝膿瘍のCT画像所見

画像検査でアメーバ性肝膿瘍は典型的には膿瘍辺縁がくっきりした単包性の肝膿瘍となる。
出典
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1: 著者提供

肝膿瘍の症状

Presenting symptoms in cases of pyogenic liver abscess. RUQ, right upper quadrant.
出典
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1: Pyogenic liver abscess: recent trends in etiology and mortality.
著者: Rahimian J, Wilson T, Oram V, Holzman RS.
雑誌名: Clin Infect Dis. 2004 Dec 1;39(11):1654-9. doi: 10.1086/425616. Epub 2004 Nov 9.
Abstract/Text: BACKGROUND: Pyogenic liver abscess, a potentially life-threatening disease, has undergone significant changes in epidemiology, management, and mortality over the past several decades.
METHODS: We reviewed the data for patients admitted to Bellevue Hospital and New York University Downtown Hospital (New York, New York) over a 10-year period.
RESULTS: Of 79 cases reviewed, 43% occurred in patients with underlying biliary disease. The most common symptoms were fever, chills, and right upper quadrant pain or tenderness. The most common laboratory abnormalities were an elevated white blood cell count (in 68% of cases), temperature >or=38.1 degrees C (90%), a low albumin level (70.2%), and an elevated alkaline phosphatase level (67%). Seventy percent of the abscesses were in the right lobe, and 77% were solitary. Klebsiella pneumoniae was identified in 41% of cases in which a pathogen was recovered. Eighteen (50%) of 36 Asian patients had K. pneumoniae isolated, in contrast to 6 (27.3%) of 22 non-Asian patients (not statistically significant). Fifty-six percent of cases involved treatment with percutaneous drainage. Although prior reports noted mortality of 11%-31%, we observed only 2 deaths (mortality, 2.5%).
CONCLUSIONS: The data suggest that K. pneumoniae has become the predominant etiology of pyogenic liver abscess and that mortality from this disease has decreased substantially.
Clin Infect Dis. 2004 Dec 1;39(11):1654-9. doi: 10.1086/425616. Epub 2...

肝膿瘍の起因菌数

Number of bacterial isolates recovered per case in patients with pyogenic liver abscesses.
出典
imgimg
1: Pyogenic liver abscess: recent trends in etiology and mortality.
著者: Rahimian J, Wilson T, Oram V, Holzman RS.
雑誌名: Clin Infect Dis. 2004 Dec 1;39(11):1654-9. doi: 10.1086/425616. Epub 2004 Nov 9.
Abstract/Text: BACKGROUND: Pyogenic liver abscess, a potentially life-threatening disease, has undergone significant changes in epidemiology, management, and mortality over the past several decades.
METHODS: We reviewed the data for patients admitted to Bellevue Hospital and New York University Downtown Hospital (New York, New York) over a 10-year period.
RESULTS: Of 79 cases reviewed, 43% occurred in patients with underlying biliary disease. The most common symptoms were fever, chills, and right upper quadrant pain or tenderness. The most common laboratory abnormalities were an elevated white blood cell count (in 68% of cases), temperature >or=38.1 degrees C (90%), a low albumin level (70.2%), and an elevated alkaline phosphatase level (67%). Seventy percent of the abscesses were in the right lobe, and 77% were solitary. Klebsiella pneumoniae was identified in 41% of cases in which a pathogen was recovered. Eighteen (50%) of 36 Asian patients had K. pneumoniae isolated, in contrast to 6 (27.3%) of 22 non-Asian patients (not statistically significant). Fifty-six percent of cases involved treatment with percutaneous drainage. Although prior reports noted mortality of 11%-31%, we observed only 2 deaths (mortality, 2.5%).
CONCLUSIONS: The data suggest that K. pneumoniae has become the predominant etiology of pyogenic liver abscess and that mortality from this disease has decreased substantially.
Clin Infect Dis. 2004 Dec 1;39(11):1654-9. doi: 10.1086/425616. Epub 2...

肝膿瘍の臨床像

Clinical characteristic and initial laboratory values for patients with pyogenic liver abscesses.
出典
imgimg
1: Pyogenic liver abscess: recent trends in etiology and mortality.
著者: Rahimian J, Wilson T, Oram V, Holzman RS.
雑誌名: Clin Infect Dis. 2004 Dec 1;39(11):1654-9. doi: 10.1086/425616. Epub 2004 Nov 9.
Abstract/Text: BACKGROUND: Pyogenic liver abscess, a potentially life-threatening disease, has undergone significant changes in epidemiology, management, and mortality over the past several decades.
METHODS: We reviewed the data for patients admitted to Bellevue Hospital and New York University Downtown Hospital (New York, New York) over a 10-year period.
RESULTS: Of 79 cases reviewed, 43% occurred in patients with underlying biliary disease. The most common symptoms were fever, chills, and right upper quadrant pain or tenderness. The most common laboratory abnormalities were an elevated white blood cell count (in 68% of cases), temperature >or=38.1 degrees C (90%), a low albumin level (70.2%), and an elevated alkaline phosphatase level (67%). Seventy percent of the abscesses were in the right lobe, and 77% were solitary. Klebsiella pneumoniae was identified in 41% of cases in which a pathogen was recovered. Eighteen (50%) of 36 Asian patients had K. pneumoniae isolated, in contrast to 6 (27.3%) of 22 non-Asian patients (not statistically significant). Fifty-six percent of cases involved treatment with percutaneous drainage. Although prior reports noted mortality of 11%-31%, we observed only 2 deaths (mortality, 2.5%).
CONCLUSIONS: The data suggest that K. pneumoniae has become the predominant etiology of pyogenic liver abscess and that mortality from this disease has decreased substantially.
Clin Infect Dis. 2004 Dec 1;39(11):1654-9. doi: 10.1086/425616. Epub 2...

肝膿瘍の起因菌

Identity of organisms recovered from patients with pyogenic liver abscesses.
出典
imgimg
1: Pyogenic liver abscess: recent trends in etiology and mortality.
著者: Rahimian J, Wilson T, Oram V, Holzman RS.
雑誌名: Clin Infect Dis. 2004 Dec 1;39(11):1654-9. doi: 10.1086/425616. Epub 2004 Nov 9.
Abstract/Text: BACKGROUND: Pyogenic liver abscess, a potentially life-threatening disease, has undergone significant changes in epidemiology, management, and mortality over the past several decades.
METHODS: We reviewed the data for patients admitted to Bellevue Hospital and New York University Downtown Hospital (New York, New York) over a 10-year period.
RESULTS: Of 79 cases reviewed, 43% occurred in patients with underlying biliary disease. The most common symptoms were fever, chills, and right upper quadrant pain or tenderness. The most common laboratory abnormalities were an elevated white blood cell count (in 68% of cases), temperature >or=38.1 degrees C (90%), a low albumin level (70.2%), and an elevated alkaline phosphatase level (67%). Seventy percent of the abscesses were in the right lobe, and 77% were solitary. Klebsiella pneumoniae was identified in 41% of cases in which a pathogen was recovered. Eighteen (50%) of 36 Asian patients had K. pneumoniae isolated, in contrast to 6 (27.3%) of 22 non-Asian patients (not statistically significant). Fifty-six percent of cases involved treatment with percutaneous drainage. Although prior reports noted mortality of 11%-31%, we observed only 2 deaths (mortality, 2.5%).
CONCLUSIONS: The data suggest that K. pneumoniae has become the predominant etiology of pyogenic liver abscess and that mortality from this disease has decreased substantially.
Clin Infect Dis. 2004 Dec 1;39(11):1654-9. doi: 10.1086/425616. Epub 2...

肝膿瘍の診断・治療のアルゴリズム

出典
img
1: 著者提供

細菌性肝膿瘍のCT画像所見

出典
img
1: Mark Feldman MD, Lawrence S. Friedman MD, Lawrence J. Brandt MD:Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 10th ed., CHAPTER84:Bacterial, Parasitic, and Fungal Infections of the Liver, Including Liver Abscesses, Elsevier, 2016, FIGURE 84-9.