GI conference 2011.0.26 경희대학교 의과대학 소화기내과.

Presentation on theme: "GI conference 2011.0.26 경희대학교 의과대학 소화기내과."— Presentation transcript:

1 GI conference 경희대학교 의과대학 소화기내과

2 GI Case 1 Chief complaint Yellowish skin color change Present Illness
Admission date : Chief complaint Yellowish skin color change Present Illness M/50, 특이병력 없는 자로 매일 소주 2~3병씩 마셔오다가 2011년 6월 21일 부터 시작된 Yellowish skin color change, Itching sensation 있어서 동네 병원에서 치료 받아 왔으나 증상 호전되지 않아 외래 경유하여 입원함. Onset 3 weeks ago

3 Smoking : none Alcohol : 소주 2-3 병 daily
Past-medical history DM / HTN / Tbc / Hepatitis (-/-/-/-) Operation Hx : none Medication Hx : none Family history None Personal history Smoking : none Alcohol : 소주 2-3 병 daily

4 Review of system Physical examination Icteric sclera Abdominal pain(-)
A/N/V/D/C(-/-/-/-/-) Melena(-) Hematochezia(-) Hematemesis(-) Physical examination Icteric sclera Soft and flat abdomen Normoactive bowel sound Td/RTd(-/-)

5 Initial Lab Findings CBC/DC
7840/mm3 (58.7%)-15.4g/dL – 48.2% – 300,000/mm PT/INR sec(1.00) aPTT 32.9sec Chemistry TB/DB /9.61mg/dL Prot/Alb 7.0/4.0g/dL AST/ALT 38/13 U/L BUN/Cr 13/0.6 mg/dL ALP/GGT 307/351 U/L Na/K/Cl 138/4.5/101 mmol/L LD/CK /33 U/L Ca/P/Mg 8.9/3.4/2.2 mg/dL CRP

6 Work up Image study 2011.07.18 Abdomen sono 2011.07.19 Abdomen CT
ERCP c EST & EPBD PET CT ERCP c Stent insertion ERCP c Metalic stent insertion

7 Ampulla of vater cancer stage Ib
Final diagnosis Ampulla of vater cancer stage Ib

8 GI Case 2 Chief Complaint Anorexia Present Illness
Admission date : Chief Complaint Anorexia Present Illness M/82, 1 년전 허리통증으로 1주일간 입원 당시 7 kg 의 체중감소 있었으며 위내시경에서 GIST 의심 소견 보였으나 경과 관찰 하던 자로 최근 한달전부터 식욕감소, 3 kg의 체중 감소 있어 보훈병원 방문하여 위내시경 시행하였고 병변 크기 증가하여 치료 원하며 내원함. Onset 4 weeks ago

9 Smoking : ex-smoker Alcohol : none
Past-medical history DM / HTN / Tbc / Hepatitis (-/+/-/-) : 10 years ago Operation Hx : 25 years ago, SDH Medication Hx Family history None Personal history Smoking : ex-smoker Alcohol : none HTN Aspirin 100mg QD Lasartan 100mg QD BPH Finasteride 5mg QD Tamsulosin 0.2mg QD Dyslipidemia Simvastatin 20mg QD

10 Review of system Physical examination Weight loss (+)
Abdominal pain(-) A/N/V/D/C(+/-/-/-/-) Melena(-) Hematochezia(-) Hematemesis(-) Physical examination Soft and flat abdomen Normoactive bowel sound Td/RTd(-/-)

11 Initial Lab Findings CBC/DC
5,780/mm³ – 11.7 g/dL – 34.4% - 289,000/mm³ Chemistry TB/DB /0.36 mg/dL AST/ALT /14 U/L ALP/GGT 76/7 U/L Prot/Alb /3.7 g/dL CK/LD /492 U/L BUN/Cr /1.1 mg/dL Na/K/Cl 135/4.6/98 mmol/L Ca/P/Mg /3.3/2.0 mg/dL

12 Work up Image study 2011.09.05 외부 EGD 2011.07.19 외부 Abdomen CT
PET CT

13 Large cell neuroendocrine carcinoma
Final diagnosis Large cell neuroendocrine carcinoma