1. CUMC GI 82/female, Jaundice 이인석, 박재명, 오정환, 한혜원, 조유경, 김상우, 최명규, 정인식 가톨릭대학교 의과대학 내과학교실

2. CUMC GI Case 82/female C/C painless jaundice for 10 days Present Illness 상기환자는 10 년전 고혈압 진단받고 혈압조절 중 내 원 10 일전부터 갑자기 시작된 황달을 주소로 응급실 경유 입원함 ROS) fever(-), chilling(-) Nausea/vomitting(-/-), pruritus(+) Constipation(+), clay color stool(+) abdominal pain(-) Dyspnea(+), cough(-), dizziness(-)

3. CUMC GI Case Past Hx: Hypertension for 10 years Family Hx: non specific Habitual Hx: smoking(-), alcohol(-)

4. CUMC GI Physical Examination G/A: icteric V/S: 180/100-90-20-36’C H/N: no cervical LN enlargement. EYE: icteric conjunctivae ENT: grossly free Chest: regular heart beat clear breathing sound Abdomen: obese no tender point, no palpable mass Extremity: no edema Skin: icteric

5. CUMC GI Initial Laboratory findings CBC Hb/Hct 10.5 g/dL/29.7%, WBC 13,850/mm 3 (Seg 77.5%), Platelet 358,000/mm 3 BC FBS 136mg/dL, BUN/Cr 20.7/0.4 mg/dL, Na/K 140/3.9 mEq/L, sGOT/sGPT 37/27 IU/L, Total Bili 24.75 mg/dL, Alk-P/rGT 790/63 IU/L, LDH 471, amylase 123 U/L ESR 45 mm/Hr, PT 71%, CA 19-9: 703.56 CA125 199.19 U/A protein(++), bilirubin(+++)

6. CUMC GI Chest PA Flat abdomen

7. CUMC GI Work Up Abdominal CT ERCP PTBD Percutaneous Transhepatic Biliary stent insertion Duodenoscopy Follow up tubogram

8. CUMC GI Abdominal CT CUMC GI

9. ERCP CUMC GI

10. ERCP CUMC GI

11. Percutaneous Transhepatic Biliary Drainage CUMC GI

12. Percutaneous Transhepatic Biliary Drainage CUMC GI

13. Percutaneous Endobiliary stent insertion CUMC GI

14. Percutaneous Endobiliary stent insertion CUMC GI

15. Clipping CUMC GI

16. Percutaneous Endobiliary stent insertion CUMC GI

17. Follow up Tubogram; POD 6 days CUMC GI

18. Progress Note fever bilirubin WBC perforation tubogram

19. CUMC GI Diagnosis 1. Common bile duct cancer 2. Duodenal diverticuli perforation 3. Successful suturing by Hemoclip.

20. CUMC GI

21. Review Duodenal diverticulum –Incidence: 10% (5%~23%) –Distribution: 62% in second portion Perivaterian diverticulum: within 2.5cm