대한소화기내시경학회 집담회 증례발표 2008년 4월 15일 장재영, 동석호, 김효종, 김병호, 장영운, 장 린 Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
F/79 C.C: Melena onset: 내원 전날(07-05-20) P.I: 2004년도에 특발성혈소판감소자색반병 진단받고, 약물치료를 받았으나 반응이 없었던 환자로 내원 전날 3차례의 흑색변을 보아 응급실 통해 입원함.
PMHx Personal Hx Alcohol (-) DM / HTN / Hepatitis / Tb (-/-/-/-) Gastric adenoma: 2003년 11월 Gastric ulcer bleeding: 2004년 4월, 2007년 2월 Idiopathic thrombocytopenic purpura: 2004년 4월 Steroid, immunoglubulin, danazol Personal Hx Alcohol (-) Smoking (-)
2007-02-07
2007-04-03
Review of Systems & Physical Examinations Vital sign 90/50 mmHg – 100/min – 28/min – 36.4°C Eye & ENT pale conjunctiva Abdomen melena (+) jaundice (-) epigastric discomfort (-) A/N/V/D/C (-/-/-/-/-) soft & flat normoactive bowel sound
Initial Lab Findings (2007-05-21) CBC 11,900/mm3 – 7.9 g/dL – 26.2% - 33K aPTT 37.2/34 sec PT(INR) 14.1S82C13.3 (1.15) Chemistry TB/DB 1.36/0.44 mg/dL AST/ALT 28/17 U/L ALP/GGT 49/17 U/L Protein/Alb 5.3/2.7 g/dL LD/CK 1086/16 U/L BUN/Cr 42/0.9 mg/dL Na/K/Cl 135/4.1/102 mmol/L Ca/P 8.2/3.7 mg/dL
2007-05-21 Epinephrine inj and APC
2007-05-23 Epinephrine injection and hemoclip x 10
2007-05-24 Hemoclip x 14
2007-05-25 Right gastric a. embolization
2007-06-09
Clinical Courses PR: pack RBC x 11 PC: platelet x 96 FFP x 6 PR x 2 PC x 8 PR x 1 PC x 16 PR x 3 PC x 8 PC x 8 PR x 1 PC x 3 PC x 8 PR x 2 PC x 8 PC x 8 PC x 8 PC x 16 PC x 5 PR x 1
Final Diagnosis Recurrent gastric ulcer bleeding Refractory idiopathic thrombocytopenic purpura Gastric adenoma