2020-ACM2-1교시-36번

58세 남자가 1일 전부터 명치가 아파서 병원에 왔다. 한 달 전부터 간혹 몇 시간씩 명치가 아팠지만 참고 지냈다고 한다. 오늘은 통증이 심해지고 소변색도 짙어졌다고 한다. 혈압 139/93 mmHg, 맥박 85회/분, 호흡 18회/분, 체온 38.5℃이다. 공막에 황달이 있으며, 오른쪽 윗배에 압통이 있지만 반동압통은 없다. 혈액검사 결과는 다음과 같다. 복부 컴퓨터단층촬영 사진(사진 12)이다. 다음 치료는?<div class="box-block">백혈구 15,800/mm3, 혈색소 12.2 g/dL, 혈소판 183,000/mm3
아스파르테이트아미노전달효소 256 U/L
알라닌아미노전달효소 275 U/L
알칼리인산분해효소 385 U/L
총빌리루빈 4.8 mg/dL, 직접빌리루빈 3.7 mg/dL
아밀라아제 118 U/L (참고치, 20~98)</div><editable-image src="https://bzxuobvwdrvtfqhmvczv.supabase.co/storage/v1/object/public/images/34545" elements="[]"></editable-image>

ACM2

 58세 남자가 1일 전부터 명치가 아파서 병원에 왔다. 한 달 전부터 간혹 몇 시간씩 명치가 아팠지만 참고 지냈다고 한다. 오늘은 통증이 심해지고 소변색도 짙어졌다고 한다. 혈압 139/93 mmHg, 맥박 85회/분, 호흡 18회/분, 체온 38.5℃이다. 공막에 황달이 있으며, 오른쪽 윗배에 압통이 있지만 반동압통은 없다. 혈액검사 결과는 다음과 같다. 복부 컴퓨터단층촬영 사진(사진 12)이다. 다음 치료는?   백혈구 15,800/mm 3 , 혈색소 12.2 g/dL, 혈소판 183,000/mm 3 
아스파르테이트아미노전달효소 256 U/L
알라닌아미노전달효소 275 U/L
알칼리인산분해효소 385 U/L
총빌리루빈 4.8 mg/dL, 직접빌리루빈 3.7 mg/dL
아밀라아제 118 U/L (참고치, 20~98)     1. 개복쓸개절제술 2. 복강경쓸개절제술 3. 피부간경유쓸개배액술 4. 피부간경유쓸개관배액술 5. 내시경역행쓸개이자조영술 - 해설: 

넵 GB와 밑에 하얀색이 GB stone입니다. CBD는 아마 빨간색 동그라미 일텐데 담관확장과 CBD stone은 관찰되지 않아 보입니다:)<editable-image src="https://bzxuobvwdrvtfqhmvczv.supabase.co/storage/v1/object/public/images/11539" 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제가 빨간색으로 표시한부분은 쓸개와 쓸개돌이 맞나요? 그리고 쓸개관돌과 쓸개관 확장이 어디서 보이는지가 궁금합니다. -   

제가 빨간색으로 표시한부분은 쓸개와 쓸개돌이 맞나요? 그리고 쓸개관돌과 쓸개관 확장이 어디서 보이는지가 궁금합니다.

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