1. GS – GI – RAD - PATH Conference
외 과
배영식

2. Case I C.C) RUQ pain o/s) 한달전
박 O 순 M/74
C.C) RUQ pain o/s) 한달전
P.I) M/74 11월 초 abrup한 RUQ pain 발생하여 응급실 방문하여 GB stones 진단받고 소화기내과 F/U 하던중 증세 severe 해져 응급실 재방문 후 소화기 내과로 입원함.이후 수술 위하여 외과로 전과됨.
PMHx) DM/HTN/hepatitis/TB (-/+/-/-)
OpHx) (-)
PHx) alcohol (-)
smoking (-)

3. Review of Systems 1.General Fever(+): 37.7℃ Chill(+) Fatigue(-) 2.Skin
Itching(-) Rash(-)
Pigmentation(-) Jaundice(-)
3.H/Neck
Headache(-) Stiffness(-) Sore Throat(-)
4.Cardiopulmonary
Dyspnea(-) Cough(-) Sputum(-) Hemoptysis(-)
PND(-) Chest Pain(-) Palpitation(-)

4. Review of Systems
5. Abdomen
A/N/V/D/C(+/-/-/-/-)
Abdominal Pain(+): RUQ & epigastric
Abdominal Discomfort(-)
Hematemesis(-)
Melena(-)
Hematochezia(-)
Stool Caliber Change(-)
Bowel Habit Change(-)

5. Physical Examination 1.General
Alert Mentality, acute ill-looking appearance
2.E/ENT
Isocoric Pupil with PLR(++/++)
no yellowish sclera
Pinkish Conjunctiva
3.H/Neck
NVE(-) LNE(-)
4.Chest
Symmetric Expansion
RHB without Murmur, CBS without Rale

6. 5. Abdomen Physical examination Soft & flat Abdomen
Hypoactive Bowel Sounds
Tenderness(+) : RUQ
Rebound tenderness(-)
Murphy’s sign(+)
Muscle Guarding(-)
CVA Td(-/-)

7. Lab findings CBC 14000 – 13.3 – 39.4 – 240K (seg.86.8%) CRP 7.2
Na/K/Cl 125/3.1/94 BUN/Cr 14/1.2
TB/DB 1.19/ AST/ALT 27/26
ALP /rGT 69/249
Amylase / Lipase 77 /8
U/A RBC WBC 0-1

8. Work up
Abdominal US ( – ER)
Abdominal US ( )
Liver CT ( )
EUS ( )

9. Impression
Acute cholecystitis
with GB stones

10. Laparoscopic cholecystectomy
Operation ( )
Laparoscopic cholecystectomy

11. Case II C.C) Fever o/s) 한달전
김 O 원 M/61
C.C) Fever o/s) 한달전
P.I) M/61,한달전 fever(38.8℃), chill, vomitig, watery diarrhea 증세보여 응급실 경유 감염내과로 입원함. 이후 시행한 abdominal US에서 GB perforation 소견보여 소화기내과로 전과후 PTGBD insertion 시행함. 이후 수술 위하여 외과 입원함,
PMHx) DM/HTN/hepatitis/TB (-/-/-/-)
OpHx) (-)
PHx) alcohol (-)
smoking (-)

12. Review of Systems 1.General Fever(+): 38.8℃ Chill(+) Fatigue(-) 2.Skin
Itching(-) Rash(-)
Pigmentation(-) Jaundice(-)
3.H/Neck
Headache(-) Stiffness(-) Sore Throat(-)
4.Cardiopulmonary
Dyspnea(-) Cough(-) Sputum(-) Hemoptysis(-)
PND(-) Chest Pain(-) Palpitation(-)

13. Review of Systems
5. Abdomen
A/N/V/D/C(+/+/+/+/-)
Abdominal Pain(+): RUQ & epigastric
Abdominal Discomfort(-)
Hematemesis(-)
Melena(-)
Hematochezia(-)
Stool Caliber Change(-)
Bowel Habit Change(-)

14. Physical Examination 1.General
Alert Mentality, acute ill-looking appearance
2.E/ENT
Isocoric Pupil with PLR(++/++)
no yellowish sclera
Pinkish Conjunctiva
3.H/Neck
NVE(-) LNE(-)
4.Chest
Symmetric Expansion
RHB without Murmur, CBS without Rale

15. 5. Abdomen Physical examination Soft & flat Abdomen
Hypoactive Bowel Sounds
Tenderness(+) : RUQ
Rebound tenderness(-)
Murphy’s sign(-)
Muscle Guarding(-)
CVA Td(-/-)
PTGBD inserted state

16. Lab findings CBC 6800 – 13.5 – 37.7 – 106K (seg.89.2%) CRP 27.9
Na/K/Cl 138/3.6/104 BUN/Cr 24/1.5
TB/DB 2.41/ AST/ALT 127/88
ALP /rGT 197/108
Amylase / Lipase 28/25
U/A RBC WBC 0-1

17. Work up
Abdominal US ( )
Abdominopelvic CT ( )
PTGBD insertion ( )
Gastroscope ( )
PTGBD tubogram ( / )

18. with GB stones, perforated
Impression
Acute cholecystitis
with GB stones, perforated

19. Laparoscopic cholecystectomy
Operation ( )
Laparoscopic cholecystectomy