영남대학교 의과대학 소화기내과학교실
증례 1
62 / F Chief complaint RUQ and periumbilical area pain for a day Present illness 내원 2주전부터 간헐적인 복통 있던 환자로 내원 전날 돼지고기 먹은 후 시작된 복통, 오심, 구토증세로 본원 응급실 내원
PMHx & FHx : Non specific ROS Fever/chill (+/+) Pain nature -RUQ and periumbilical area -continuous, stabbing -back radiation (+)
P/E V/S – 130/80 mmHg, HR 80 /min, RR 20 /min, BT 36.7 ℃ Anicteric sclera RUQ and periumbilical area DT/RT (+/-) Decreased bowel sound No palpable mass No ascites
Laboratory findings CBC : 21000/12.3/188000 (poly 62%, band 29%) ESR 14 mm/H AST/ALT 499/593 U/L, T/D-bilirubin 1.4/0.6 mg/dL ALP/GGT 243/180 U/L, Alb 3.5 g/dL, LDH 882 U/L amylase/lipase 687/764 IU/L Viral marker : Negative
Final Diagnosis Choledochocele Acute pancreatitis
증례 2
75 / F Chief complaint RUQ pain and fever for a day Present illness 평소 건강하게 지내던 환자로 내원 10일 전 부터 간헐적인 우상복부 통증 있어 오다가 내원 전날부터 시작된 sudden onset RUQ pain과 fever를 주소로 응급실 내원
PMHx 9년전 TA로 Rt nephrectomy (?) ROS fever/chill (+/+), nausea/vomiting(+/-) Reddish urine color change (+) Pain nature - epigastric and RUQ area - dull & squeezing nature, continuous - radiation (-)
P/E V/S – 120/70 mmHg, HR 120 /min RR 36 /min, BT 39.8 ℃ Icteric sclera Decreased bowel sound RUQ and epigastric DT/RT (+/-)
Laboratory findings CBC : 18700/11.3/341000 (poly 91.5%) ESR 98 mm/H AST/ALT 149/59 U/L, T/D-bilirubin : 4.2/2.8 mg/dL ALP/GGT 1145/1235 U/L amylase/lipase 166/37.5 IU/L PT/aPTT 15.0/50.1 sec (INR 1.18) Viral marker : Negative
Final diagnosis Acute cholangitis due to Choledochocele with impacted stone