GI conference 경희대학교 의과대학 소화기내과

Case 1 Chief Complaint Abdominal discomfort onset > 내원 1년 전 Admission date : 2012.11.09 Chief Complaint Abdominal discomfort onset > 내원 1년 전 Present Illness 60/M, 특이병력 없는 환자 1년 전부터 abdominal distension, abdmonial discomfort 소견 있어 local clinic 방문하여 복부초음파 시행한 결과 복강내 종양 및 복수 있다는 이야기 듣고 추가적인 검사 위해 외래 통해 입원함.

Smoking (-) Alcohol (-) Past-medical history DM / HTN / Tbc / Hepatitis (-/-/-/-) Operation Hx (-) Medication Hx (-) Family history None Personal history Smoking (-) Alcohol (-)

Review of system Physical examination Weight loss(+): -2kg (60 -> 58kg)/1년 Fever(-) Chilling(-) Headache(-) Abdominal distension(+) Abdominal discomfort(+) Abdominal pain(-) A/N/V/D/C(-/-/-/-/-) Melena(-) Hematochezia(-) Hematemesis(-) Physical examination V/S: 130/70 mmHg – 60/min – 20/min – 36.0°C Alert mentality chronic-ill looking Clear breathing sound without rale Regular heart beat without murmur Soft & Distended abdomen without Td, Normoactive bowel sound

Initial Lab Findings CBC/DC 4.300/mm3 (53.2 %) – 14.1 g/dL – 42.2 % – 216,000 /mm3 PT(INR) 14.4 sec (1.13) aPTT 36.9 sec Chemistry TB/DB 1.49/0.33 mg/dL Prot/Alb 7.2/4.3 g/dL AST/ALT 25/14 U/L BUN/Cr 18/0.8 mg/dL ALP/GGT 55/11 U/L Na/K/Cl 141/4.4/105 mmol/L LD/CK 515/62 U/L Ca/P/Mg 8.8/3.5/2.4 mg/dL CRP <0.3 CA 19-9/CEA 8.79/1.49

Work Up 2012.11.09 Abdomen CT 2012.11.10 Chest CT 2012.11.12 PET CT 2012.11.20 f/u Abdomen CT

Operation 2012.11.14 Mass excision

Well differentiated liposarcoma, grade 1 Diagnosis : Soft tissue, “intra-abdominal mass”, biopsy: Well differentiated liposarcoma, grade 1 Soft tissue, peritoneum, excision: Fibrosis

Intra-abdominal liposarcoma Final Diagnosis Intra-abdominal liposarcoma

Case 2 Chief Complaint Present Illness 이O현 (F/51) 12307235 Admission date : 2012.10.25 Chief Complaint melena o/s) 내원 전날 Present Illness F/51. 특이병력 없는 자로 약 3개월 전에 GI bleeding으로 보훈병원 입원하여 치료받았으며 당시 검사상 (EGD, CFS) 이상소견은 없다고 얘기 들음. 내원 전날 부터 melena, vomiting, nausea 호소 있어 소화기내과 외래 경유하여 입원함.

Past-medical history Family history None Personal history DM / HTN / Tbc / Hepatitis (-/-/-/-) Operation Hx (+) : 2007년 hysterectomy Family history None Personal history Smoking (-) Alcohol (+) : 와인 2잔/2회/주

Review of system Physical examination Fever(-) Chilling(-) dizziness(+) General weakness(+) Itching(-) Jaundice(-) Epigastric discomfort(+) A/N/V/D/C(-/+/+/-/-) Abdominal distension(-) Abdominal pain(-) Melena(+) Hematochezia(-) Hematemesis(-) Physical examination V/S: 120/80 mmHg – 77/min – 18/min – 36.0 Alert mentality acute-ill looking Clear breathing sound without rale Regular heart beat without murmur Soft & flat abdomen :Td(-) & rTd(-)

Initial Lab Findings CBC/DC 8,390/mm3 (66.7%) – 8.9g/dL – 31.1% - 418,000 /mm3 PT(INR) 12.6 sec (0.96) aPTT 28.2 sec Chemistry TB/DB 0.6/0.1 mg/dL Prot/Alb 6.8/4.1 g/dL AST/ALT 33/16U/L BUN/Cr 23/0.6 mg/dL ALP/GGT 72/26 U/L Na/K/Cl 136/4.4/102 mmol/L LD/CK 572/48 U/L Ca/P/Mg 8.4/3.6/2.0 mg/dL CRP <0.3 mg/dL

Work Up 2012.10.25 Abdominal CT, EGD, sigmoidoscopy 2012.10.26 Small bowel enteroscopy

2012.10.29 Laparoscopic segmental resection Operation 2012.10.29 Laparoscopic segmental resection

Gastrointestinal stromal tumor Diagnosis : Small intestine, segmental resection: Gastrointestinal stromal tumor

GI bleeding d/t small bowel GIST Final Diagnosis GI bleeding d/t small bowel GIST

Case 3 Chief Complaint Present Illness 이O영 (F/54) 12306607 Admission date : 2012.11.05 Chief Complaint RUQ pain o/s) 내원 1달 전 Present Illness F/54, DM, dyslipidemia 과거력 있는 자로 약1달 전부터 RLQ pain있어 local clinic에서 내시경 시행 받고 (당시 건강검진으로 chest CT, 복부초음파 시행: 이상소견 없다고 했다고 함) 이후에도 pain지속되어 본원 소화기내과 방문, 2012.10.30 시행한 abd. CT상에서 Suggestive of peritoneal seeded metastases 소견으로 further evaluation위해 입원함.

Past-medical history Family history None Personal history DM / HTN / Tbc / Hepatitis (+/-/-/-) Operation Hx (-) : none 28년 전 IUD insertion Family history None Personal history Smoking (-) Alcohol (-)

Review of system Physical examination Fever(-) Chilling(-) Weight loss(+) : -7kg/1mo Fatigue(+) Epigastric discomfort(-) A/N/V/D/C(-/-/-/-/-) Abdominal distension(-) Abdominal pain(+) :RLQ pain Melena(-) Hematochezia(-) Hematemesis(-) Physical examination V/S: 120/90 mmHg – 98/min – 20/min – 36.2 Alert mentality acutely-ill looking Clear breathing sound without rale Regular heart beat without murmur Soft & flat abdomen :Td(+) & rTd(-)

Initial Lab Findings CBC/DC 9,340 /mm3 (76.3%) – 10.2g/dL – 30.1% - 447,000 /mm3 PT(INR) 13.9 sec (1.08) aPTT 40.9 sec ESR 76 mm/hr Chemistry TB/DB 0.47/0.17 mg/dL Prot/Alb 7.2/3.5 g/dL AST/ALT 14/14 U/L BUN/Cr 13/0.4 mg/dL ALP/GGT 107/24 U/L Na/K/Cl 139/4.2/99 mmol/L LD/CK 249/20 U/L Ca/P/Mg 8.7/3.4/2.0 mg/dL CRP 7.50 mg/dL CA125/CA19-9/CEA 19.5/2.0/1.18

Work Up 2012.11.05 Chest CT 2012.11.06 AP sono 2012.11.07 PET CT 2012.11.08 Pelvis MRI 2012.11.19 f/u AP sono

Sono-guided biopsy & pus aspiration 2012.11.09 Sono-guided biopsy & pus aspiration

Fibrosis with acute and chronic inflammation Diagnosis : Soft tissue, abdomen, US-guided biopsy: Fibrosis with acute and chronic inflammation

A pure of Porphyromonas gingivalis 2012.11.21 Abscess culture : A pure of Porphyromonas gingivalis

Pelvic abscess by P. gingivalis Final Diagnosis Pelvic abscess by P. gingivalis