1. Case II

2. Chief complain : RUQ pain o/s) 2 days ago Present illness : a 45 years old woman with hypertension and ASD had taken medicine at local clinic. He noticed recently abdominal pain 2 days ago. So, he visited local clinic. She was diagnosed acute cholecystitis, so she was referred for Op(cholecystectomy) to KMC GS

3. Past Medical History HTN (+) : 6 years ago Dx DM(-) / Hepatitis(-) / Pulmonary TB(-) Personal History Alcohol (+) : 막걸리 3 병 daily Smoking (-) Family History Unremarkable

4. General Fatigue(-) Febrile sensation(-) Chill(-) Skin Rash(-) Pigmentation(-) Itching(-) H&N Headache(-) Sore throat(-) Dysarthria (-) Respiratory Cough(-) Sputum(-) Hemoptysis(-) Cardiac Chest pain(-) Orthopnea(-) Dyspnea(-) Edema(-) dyspnea on exertion (-) G-I Postprandial abd. discomfort (-) Anorexia(+) Nausea(-) Vomiting(-) Abd. pain(+) : RUQ Renal Dysuria(-) Urgency(-) Frequency (-) Hematuria(-) B/Ext. Upper back pain(-) Lower back pain (-)

5. V/S 120/80mmHg – 76/min – 20/min – 36.4°C General Appearance Alert mental status Acutely ill-looking appearance Head & Neck No cervical LN enlargement Neck vein engorgement (-/-) No thyroid enlargement Eye & ENT Isocoric pupil with PLR(++/++) Pinkish conjunctiva with white sclera

6. Chest Clear breathing sound without rale diastolic murmur (Gr I ) Regular heart beat with diastolic murmur (Gr I ) Abdomen Soft & flat abdomen Normoactive bowel sound Tenderness(+) : RUQ Rebound tenderness(-) Shifting dullness(-) No Hepatosplenomegaly Back & Ext. CVA tenderness (-/-) Pretibial pitting edema(-/-) Neurologic examination Babinski (-/-) motor/sensory : intact

7. CBC/DC 12,710 /mm 3 –14.5 g/dL – 41.6 % – 310 k/mm 3 (Seg. 80.2%) Chemistry T. Bilirubin/D. Bilirubin 1.79/0.51 mg/dL Prot/ Alb 7.1 / 4.2 g/dL AST/ALT 24 / 22 U/L ALP/ GTT 59/ 97 U/L CRP 3.4 mg/dL BUN/ Cr 8/0.5 mg/dL Na/K/Cl 139/3.3/102 mg/dL

12. #1. Acute cholecystitis #2. Hypertension #3. ASD

13.  Echocardiography 시행이유 For preOP evaluation of cardiac function Known ASD

14. #1. Acute cholecystitis with GB stone #2. ASD with pulmonary Hypertension