GI conference 2011.0.26 경희대학교 의과대학 소화기내과

GI Case 1 Chief complaint Yellowish skin color change Present Illness Admission date : 2011.7.18 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

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

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(-/-)

Initial Lab Findings CBC/DC 7840/mm3 (58.7%)-15.4g/dL – 48.2% – 300,000/mm PT/INR 12.6 sec(1.00) aPTT 32.9sec Chemistry TB/DB 12.75/9.61mg/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 426/33 U/L Ca/P/Mg 8.9/3.4/2.2 mg/dL CRP 1.41

Work up Image study 2011.07.18 Abdomen sono 2011.07.19 Abdomen CT 2011.07.20 ERCP c EST & EPBD 2011.07.22 PET CT 2011.07.22 ERCP c Stent insertion 2011.07.29 ERCP c Metalic stent insertion

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

GI Case 2 Chief Complaint Anorexia Present Illness Admission date : 2011.7.18 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

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

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(-/-)

Initial Lab Findings CBC/DC 5,780/mm³ – 11.7 g/dL – 34.4% - 289,000/mm³ Chemistry TB/DB 1.01/0.36 mg/dL AST/ALT 22/14 U/L ALP/GGT 76/7 U/L Prot/Alb 6.3/3.7 g/dL CK/LD 37/492 U/L BUN/Cr 11/1.1 mg/dL Na/K/Cl 135/4.6/98 mmol/L Ca/P/Mg 8.6/3.3/2.0 mg/dL

Work up Image study 2011.09.05 외부 EGD 2011.07.19 외부 Abdomen CT 2011.09.26 PET CT

Large cell neuroendocrine carcinoma Final diagnosis Large cell neuroendocrine carcinoma