1. Mortality Conference F/89 Date of Admission : 2010.2.4 Date of Death : 2010.2.20 2010.3.25 발표자 : R2 강지훈

2. oral intake, poor - 5DA Chief complaint

3. Present Illness #1. rectal cancer 로 2005.4 LAR 시행. 이후 GS 허승철 선생님 외래 다니면서 NED. #2. 2008.1 bifrontal area HA, anemia 나타나 신경과 입원. 입원 기간 중에 찍은 Chest CT 에서 r/o IPF, PFT 에서 severe restrictive pattern 으로 판단 되어 r/o IPF 로 이창훈 선생님 외래 다니기 시 작.

4. #4. 2009.11.5 cough 심화되면서 ER 방문하였으 나, EGD 시행 후에 r/o cough d/t GERD 으로 sx care 하면서 호전. #5. 2010.1.21 호흡기 내과 외래 방문하여 IPF 에 대해서 reversible factor 찾아보기로 권유 하였으 나 환자분과 교수님과 상의하여 집에서 observation 하기로 함. Present Illness

5. #6. 내원 5 일 전부터 poor oral intake 보이고 general weakness 나타나 내원. 15 일전부 터 대변은 보지 못했다고 하며, 약 1 주일 전 부터 소변이 시원하게 나오지 않는다고함. 이에 2010/2/4 ER 방문함. Present Illness

6. Past Medical History DM/HTN/Tb/CLD (-/+/-/-) rectal cancer 로 2005.4 LAR Social History denial

7. Systemic review G/W(++), E/F(-), F/C(-/-) HA/Dizz(-/-) C/S/R(+-/+-/-), sore throat(-) dyspnea(+-), palpitation(-), chest discomfort(-) orthopnea (-) A/N/V/D/C(+/-/-/-/+), H/M/H(-/-/-), abdominal discomfort(-) Urinary sx(+) : dysuria

8. Physical examination G/A> acute so ill-looking not so alert and oriented: T/P/P(+/-/+) HEENT> L/R(++/++), isocoric prompt anemic conjunctivae, anicteric sclerae PI(-/-), PTH(-/-) oral cavity: clear sl. dehydrated tongue no palpable cervical LAP

9. Physical examination Chest> symmetric expansion without retraction coarse lung sound without rale and crackle regular HB without murmur Abdomen> soft, flat NABS T/RT(++/-) : RUQ L/S/K(-/-/-) Back and Extremities> CVAT(-/-) P/C/C(-/-/-)

10. Initial Lab Findings V/S > 122/66 - 82 - 20 - 35.2 ABGA : 7.473 - 43.4 - 90.3 - 31.1 - 97.4% CBC : 14040 - 8.6 - 219k, ANC 12551 electro : 128/4.03/83.5/29.2 B/Cr : 38/0.8 LFT : 89 – 5.8/3.0 – 1.0 – 149 – 127/126 CRP : 37.0 pro BNP : 1032 CK/CKMB/TnI : 25/<0.5/<0.04

11. Initial Imaging CAP>

12. Initial Imaging * Chest CT >

13. Initial Imaging * Abdomen CT >

14. Initial Imaging * Abdomen CT >

15. #1. multi - loculated fluid collection in liver - r/o liver abscess - r/o liver mets. #2. h/o rectal cancer - s/p LAR 2005.4 -> NED --> NED #3. known IPF #4. known HTN #5. known GERD Initial Problem list

16. Initial Plan #1. PCD for liver abscess Blood culture and empirical antibiotics #3. consult to IMP for further w/u #4.~ #5. continue medication

17. Hospital course HD #1-4 S> N/V, abd pain 지속적으로 호소함. Fever 지속적으로 남. O> PCD fluid : R/W/p/l/o : (>1000/>1000/37/49/14) t. pro : 4400mg/dl, LDH 53736 PCD culture : all S Klebsiella pneumoniae B/C : (-) CRP : 9.24 (2/7) <- 25.94 (2/5) A> giant liver abscess P> Antibiotics : ceftriaxone + MTNZ :2/4-2/8

18. Hospital course HD #5-8 S> abd discomfort 지속적으로 있음. Fever 는 조금 subside 2010/2/10 PCD drainage 양 급감하여 CT re evaluation and foley insertion O> 2010/2/9 B/C : (-) CRP : 6.88(2/11) <- 9.24 (2/7) <- 25.94 (2/5) A> giant liver abscess P> Antibiotics upgrade d/t sustained fever : imipenem : 2/9-2/12

19. CT Imaging * Abdomen CT >

20. Hospital course HD #8-11

21. Hospital course HD #11-14

22. Hospital course HD #14-16