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Leverabscess

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Sakkunnig:

Definition:
Ett hålrum fyllt med pus i levern på grund av invasion och förökning av mikroorganismer.
Förekomst:
Sällsynt.
Symtom:
Ofta icke-specifika symtom, såsom buksmärtor och feber.
Kliniska fynd:
Dåligt allmäntillstånd med ofta hög feber. Ibland öm, palpabel lever.
Diagnostik:
Bekräftas med bilddiagnostik, i första hand ultraljud eller DT.
Behandling:
Består av dränage och antibiotikabehandling (eller annan mikrobiell behandling). 
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  2. Lardière-Deguelte S, Ragot E, Amroun K, et al. Hepatic abscess: Diagnosis and management. J Visc Surg 2015; 152(4): 231-43. pmid:25770745 PubMed  
  3. Jeong SW, Jang JY, Lee TH, et al. Cryptogenic pyogenic liver abscess as the herald of colon cancer. J Gastroenterol Hepatol 2012; 27:248. PubMed  
  4. Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: Recent trends in etiology and mortality. Clin Infect Dis 2004; 39: 1654. PubMed  
  5. Mølle I et al. Increased risk and case fatality rate of pyogenic liver abscess in patients with liver cirrhosis: A nationwide study in Denmark. Gut 2001; 48: 260-.
  6. Lin HF, Liao KF, Chang CM, et al. Correlation between proton pump inhibitors and risk of pyogenic liver abscess. Eur J Clin Pharmacol 2017; 73(8): 1019. pmid:28434021 PubMed  
  7. Chen YW, Che YS, Le SS, et al. A pilot study of oral fleroxacin once daily compared with conventional therapy in patients with pyogenic liver abscess. J Microbiol Immunol Infect 2002; 35: 179. PubMed  
  8. Yu SC, Ho SS, Lau WY, et al. Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Hepatology 2004; 39: 932. PubMed  
  9. Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. AJR Am J Roentgenol 2007; 189: 138. PubMed  
  10. Tan YM, Chung AY, Chow PK, et al. An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm. Ann Surg 2005; 241: 485. PubMed  
  11. Lam Y-h, Wong SK-h, Lee DW-h, et al. ERCP and pyogenic liver abscess. Gastrointest Endosc 1999; 50: 340. PubMed  
  12. Serste T, Bourgeois N, Vanden Eynden F, et al. Endoscopic drainage of pyogenic liver abscesses with suspected biliary origin. Am J Gastroenterol 2007; 102: 1209. PubMed  
  13. Kuo SH, Lee YT, Li CR, et al. Mortality in Emergency Department Sepsis score as a prognostic indicator in patients with pyogenic liver abscess. Am J Emerg Med 2013; 31(6): 916-21. pmid:23623237 PubMed  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

  • Hanns-Ulrich Marschall, professor och överläkare, Medicinkliniken gastrosektionen, Sahlgrenska universitetssjukhuset, Göteborg