내시경 집담회 증례 서울아산병원 소화기내과 이태윤.

Presentation on theme: "내시경 집담회 증례 서울아산병원 소화기내과 이태윤."— Presentation transcript:

1 내시경 집담회 증례 서울아산병원 소화기내과 이태윤

2 F/57 Chief Complaint Postprandial vomiting onset: 1month ago

3 Present Illness 상기 환자는 내원 3개월 전 복통이 있어 본원 내원하
였고 prepyloric antrum greater curvature side의 AGC 와 peritoneal carcinomatosis, multiple bone metastasis로 진단받고 tegafur-cisplatin chemo- therapy를 2회 시행받고 RT를 시행받음. 내원 1개월 전부터 식사 후 vomiting 발생하여 시행한 CT상 gastric outlet obstruction이 의심되어 further evaluation 및 treatment 위해 입원함

4 Review of System Past medical history
; No history of HTN, DM, tuberculosis, hepatitis Social History ; Smoking (-) Alcohol (-) Family History; NS Review of System G-I: A/N/V (+/+/+)

5 Physical Examination V/S: 36.0℃ - 105/min - 18/min – 105/82mmHg
General: chronically ill-looking appearance Abdomen: soft and flat normoactive bowel sound no direct or rebound tenderness not palpable liver / spleen / kidney

6 Initial Laboratory Data
CBC 11,000/mm g/dl – 246 X 103/mm3 BUN/Cr 44 / 1.7 mg/dL glucose 81 mg/dL AST / ALT 69 / 44 IU/L ALP / r-GT 698 / 146 IU/L total / direct bilirubin 2.5 / 0.7 mg/dL protein / albumin 5.3 / 3.1 g/dL Na/K/Cl/CO2 126/1.8/49/65.7 mmol/L PT 81.6%

7 Initial Assessment & Plan
#1 AGC with peritoneal carcinomatosis, multiple bone metastasis #2 Gastric outlet obstruction due to #1 Assessment 1. gastric outlet obstruction due to disease progression 2. Jaundice due to metastatic lymphadenopathy Plan 1. Imaging study (CT, UGI) 2. duodenal stent

8 Abdomen CT (before admission)

9 Gastroscopy on HD#1

10 UGI on HD #2

11 Duodenal stent on HD #3

12 HD#10 환자가 epigastric distension을 호소함

13 Simple abdomen on HD#10

14 Second Duodenal Stent Insertion

15 UGI after Stent Insertion