Yun Suk Shim Tae Hoon Lee SangHeum Park
- Slides: 15
대한소화기내시경학회 월례 집담회 Yun Suk Shim, Tae Hoon Lee, Sang-Heum Park, Sun-Joo Kim Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University, Cheonan Hospital.
Past medical history v 고혈압/당뇨 (-/-) v recurrent abdominal pain Personal history v 음주 (+) : social v 흡연 (+) : 30 PY v 직업력 (+) : 수의사
ROS and Physical Exam. v Acute ill-looking appearance v 120/80 mm. Hg – 62/min – 18/min – 36. 6℃ v General weakness(+) v Abdominal pain (+) v HEENT: unremarkable v Chest: unremarkable v Abdomen Tenderness/RT (+/-) Decreased Bowel sound
Laboratory Finding v CBC: 8580 mm 3 - 15. 1 g/d. L-197 K v Albumin: 4. 5 g/d. L T-bil: 0. 6 mg/d. L ALP/r-GTP: 50/55 IU/L AST/ALT: 19/22 IU/L, Glucose: 100 mg/d. L v Amylase/Lipase: 2827 /5864 U/L v BUN/Cr: 14. 2/1. 2 mg/d. L v Calcium: 9. 6 mg/d. L v LDH: 242 IU/L
Pancreatic-Biliary CT 07 -09 -08
Diagnosis v Initial diagnosis: Acute pancreatitis due to drug induced or Brucellosis
Hospital course v Abdominal pain (+) -> improved ! v WBC : 8580 -> 15390 -> 9120 (mm 3) v Amylase/Lipase : 2827/5864 -> 1116/766 -> 553/261 -> 127/43 U/L conservative management
HAD #6 v Fever : 37. 8 ℃ v Abdominal and back pain v Amylase/Lipase : 127/43 -> 1241/ 78 U/L v CRP : 2. 5 -> 139. 3 mg/L
MRCP 07 -09 -13
ERCP 07 -09 -14
Duodenoscopic View
Hospital Course v Abdominal pain -> improved v Amylase/Lipase 761/56 -> 158/83 U/L v CRP 25 mg/L v Discharge (HAD #12)
Final Diagnosis v Recurrent acute pancreatitis due to Pancreatic divisum with Santorinicele
Pancreatic divisum with Santorinicele v Acute and Recurrent pancreatitis § Brucellosis – infection § Drug – Rifampin, Doxicycline § Congenital anomaly (<- recurrent abdominal pain)
