Department of oncology

C/C Poor oral intake, abdominal distension (onset: 2 weeks ago) P/H DM (+): detection, medication 중 HTN/Hepatitis/Tuberculosis (-/-/-) Operation Hx (-) S/H Smoking/Alcohol (-/-) F/H N-S

2 주전부터 poor oral intake, abdominal distension 발생하여 타병원 방문하였고 내원하여 시행한 chest & abdomen CT 상 SPN in LUL, carcinomatosis peritonei, malignant ascite 소견 보여 추가적인 검사 위해 내원함.

Fever / chills (-/-) Sore throat (-) Cough / Sputum (-/-) Chest discomfort / Dyspnea (-/-) Hemoptysis(-) Anorexia / Nausea / Vomiting (+/-/-) Abd. Pain / Hunger pain (-/-) Diarrhea/costipation (+/-) Melena / Hematochezia (-/-) Dysuria / Urinary frequency (-/-) Cold sweating (-), Night sweating (-), Weight loss (+): 10 일동안 7kg

U/H As usual B/H Diarrhea V/S BP 130 / 80 mmHg BT 36.2 ℃ PR 80 회 /min RR20 회 /min

P/E G/A Chronic ill appearance Alert mental state H/S No scar, No deformity Eye Not anemic conjunctiva Anicteric sclera ENT Externally free No oral thrush Neck No JVE No LAP Chest Symmetrically developed NBS s rales RHB s murmur

P/E Abdomen Rigid and distended hyperactive bowel sound T/RT(-/-) CVA tenderness(-) No palpable organomegaly Pelvis No melena No palpable mass on DRE Extremity No pitting edema

MCUPS

1. Routine study including tumor marker Routine lab, ECG, chest & abdomen X-ray 2. Imaging study Chest & abdomen CT EGD & colonoscopy 3. Peritoneal fluid analysis & cytology

CBC & D/C WBC /uL(4000~10000) (N: 83.5% L: 8.9% E: 0.4% M: 7.1% B: 0.1%) Hgb 13.4 g/dL(12~17) Hct 39.2 %(37~52) MCV 81.2 fL(80~100) MCH 27.7 pg(27~32) MCHC 34.2 g/dL(33~37) PLT 363 K/uL(130~450)

RFS & Electrolytes BUN/Cr 11.0/0.9 mg/dl Na/K/Cl 136/4.7/97 mEq/L LFT T-Protein 7.1 mg/dL (6~8.3) Albumin 3.5 mg/dL (3.5~5) Bil(T) 0.6 mg/dL (0.2~1.2) AST 26 U/L (5~37) ALT 17 U/L (5~40) ALP 142 U/L (25~129) LDH 463 U/L (218~472) GGT 47 U/L (5~61)

U/A pH 5.5 Protein trace Glucose neg Ketone +1 Nitrite neg Bilirubin neg Blood neg Leucocytes neg

Coagulation Profiles aPTT 47.3/sec (26.5 ~ 41) PT 15.0/74/1.23 sec/% /INR Acute phase reactants CRP mg/dL (< 0.5) Tumor marker CEA ng/mL (0~4.7) AFP 2.22 IU/mL (0~5.8) PSA ng/ml (0~4) CA U/mL (0~39)

Peritoneal fluid analysis & cytology (2 회 ) WBC 600 /mm /mm 3 Neutrophils 10 % 13 % Lymphocytes 69 % 65 % Monocytes 21 % 22 % ADA 69.0 IU/L (5.8-23) 80.8 IU/L (5.8-23) Cell block negative for malignancy

1) EGD - Endoscopic atrophic gastritis - Gastric erosion 2) Colonoscopy -ileus 심하여 perforation 위험성 커서 시행하지 못함.

TB peritonitis Peritoneal fluid analysis & cytology Biopsy : Inflammatory debridement & tiny nodule AFB stain & TB PCR Peritoneal fluid analysis & cytology WBC 950/mm 3 Neutrophils 11 % Lymphocytes 53 % Monocytes 36 % Cytology negative for malignancy AFB stain & TB-PCR positive Peritoneal nodule chronic granulomatous inflammation