2. Chief complaint Yellowish skin color change Present Illness M/50, 특이병력 없는 자로 매일 소주 2~3 병씩 마셔오다가 2011 년 6 월 21 일 부터 시작된 Yellowish skin color change, Itching sensation 있어서 동네 병 원에서 치료 받아 왔으나 증상 호전되지 않아 외래 경유하여 입원함. GI Case 1 금 O 철 (M/50) 11748108 Admission date : 2011.7.18 Onset 3 weeks ago

3. Past-medical history DM / HTN / Tbc / Hepatitis (-/-/-/-) Operation Hx : none Medication Hx : none Family history None Personal history S S moking : none Alcohol : 소주 2-3 병 daily

4. Review of system Abdominal pain(-) A/N/V/D/C(-/-/-/-/-) Melena(-) Hematochezia(-) Hematemesis(-) Physical examination Icteric sclera Soft and flat abdomen Normoactive bowel sound Td/RTd(-/-)

5. Initial Lab Findings CBC/DC 7840/mm 3 (58.7%)-15.4g/dL – 48.2% – 300,000/mm PT/INR 12.6 sec(1.00) aPTT 32.9sec Chemistry TB/DB 12.75/9.61mg/dL Prot/Alb 7.0/4.0g/dL AST/ALT 38/13 U/LBUN/Cr 13/0.6 mg/dL ALP/GGT 307/351 U/LNa/K/Cl 138/4.5/101 mmol/L LD/CK 426/33 U/LCa/P/Mg 8.9/3.4/2.2 mg/dL CRP 1.41

6. Work up Image study 2011.07.18 Abdomen sono 2011.07.19 Abdomen CT 2011.07.20 ERCP c EST & EPBD 2011.07.22 PET CT 2011.07.22 ERCP c Stent insertion 2011.07.29 ERCP c Metalic stent insertion

7. Final diagnosis Ampulla of vater cancer stage Ib

8. Chief Complaint Evaluation for multiple lymph nodes enlargement Present Illness F/70, 2010 년 EGC 로 본원 IG (Prof. 장재영 ) 에서 ESD 시행 후 F/U 받는 자로 2011 년 6 월 영상검사에서 multiple lymph nodes metastasis 가 의심되어 supraclavicular lymph node FNA 시행 후에도 정확한 진단이 내려지지 않아 lymph node biopsy 위해 GS 입원 GI Case 2 추 O 연 (F/70) 12118421 Admission date : 2011.6.22

9. Past-medical history DM / HTN / Tbc / Hepatitis (-/-/-/-) Operation Hx : none Medication Hx : none Family history None Personal history Smoking : none Alcohol : none

10. Review of system Abdominal pain(-) A/N/V/D/C(-/-/-/-/-) Melena(-) Hematochezia(-) Hematemesis(-) Physical examination Palpable right supraclavicular lymph node (+) Soft and flat abdomen Normoactive bowel sound Td/RTd(-/-)

11. Initial Lab Findings CBC/DC 8,000/mm³ – 13.8 g/dL – 40.8% - 274,000/mm³ Chemistry TB/DB 0.44/0.14 mg/dL AST/ALT 16/11 U/L ALP/GGT 98/12 U/L Prot/Alb 6.7/4.0 g/dL CK/LD 48/309 U/L BUN/Cr 10/0.7 mg/dL Na/K/Cl 141/3.9/108 mmol/LCa/P/Mg 8.5/3.0/2.5 mg/dL

12. Work up Image study 2010.05.24 EGD, ESD 2010.05.25 Colonoscopy 2010.05.25 Abdomen CT 2010.08.12, 2010.12.16 EGD 2011.05.24 EGD & Abdomen CT 2011.06.07 PET CT

13. Final diagnosis Early gastric cancer, CR Tuberculous lymphadenitis

14. Chief Complaint LLQ pain o/s) 3DA Present Illness M/74 HTN, Stable angina, Carvenous meningioma s/p GKRS, Bladder tumor s/p TUR-BT (2006 년 ) 병력 있는 자로 내원 3 일전 부터 발생한 LLQ pain 주소로 검사 및 치료 위해 외래 통해 입원함. GI Case 3 11589387 이 O 학 (M/74) Admission date: 2011.9.8

15. Past-medical history DM / HTN / Tbc / Hepatitis (-/+/-/-) (‘04) Stable angina (`09) Operation (+): Carvenous meningioma s/p GKRS (04. 6. 15) Bladder tumor s/p TUR-BT (06. 10.30) Family history None Personal history Smoking : (+): 50 pack years Alcohol : none

16. Review of system Fever (-) Chill (-) Abdominal pain (+) : LLQ A/N/V/D/C (-/-/-/-/+) Physical examination Soft and flat abdomen Normoactive bowel sound Td/RTd(+/-) : LLQ

17. Initial Lab Findings CBC/DC 4,460/mm³(54.9%) – 13.4 g/dL – 39.6% - 235,000/mm³ ESR 51 mm/hr Chemistry TB/DB 0.85/0.38 mg/dL AST/ALT 26/46 U/L ALP/GGT 81/90 U/L Prot/Alb 6.8/3.9 g/dL CK/LD 67/301 U/L BUN/Cr 14/1.0 mg/dL Na/K/Cl 139/4.0/105 mmol/LCa/P/Mg 8.8/3.5/2.2 mg/dL CRP 4.33 mg/dL

18. Work up Image study 2011.09.08 Abdominal CT

19. Final diagnosis Epiploic appendagitis