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[2015-11-5. ¾Öµ¶ÀÚ ÆíÁö]

¾È³çÇϽʴϱî? Ç×»ó ¸¹Àº °øºÎ¸¦ ÇÒ ¼ö ÀÖ°Ô ÀÚ·á¿Í ÀÚ±ØÀ» Áּż­ °¨»çÇÕ´Ï´Ù. Angiodysplasia¿¡ ´ëÇÑ case 2°³ °æÇèÀÌ ÀÖ¾î ¸ÞÀÏÀ» º¸³À´Ï´Ù.


Áõ·Ê 1

Aortic valve stenosis·Î ½ÉÀå³»°ú¸¦ ´Ù´Ï´Â ȯÀÚÀÔ´Ï´Ù. ÀÌÀü¿¡ 2Â÷·Ê Á¤µµ hematochezia°¡ ÀÖ¾î »óÇϺγ»½Ã°æ °Ë»ç¸¦ ¹Þ¾Ò´Âµ¥ ¸íÈ®ÇÑ ÃâÇ÷ ºÎÀ§°¡ ¾ø¾ú´Ù°í ÇÕ´Ï´Ù. À̹ø¿¡ hematochezia·Î ´Ù½Ã °Ë»ç¸¦ Çߴµ¥ cecum¿¡¼­ angiodysplasia°¡ ÀÖ¾ú½À´Ï´Ù. CecumÀÇ angiodysplasia¸¦ VIO 300DÀÇ spray coagulationÀ¸·Î Ä¡·áÇß½À´Ï´Ù. ÀÌÈÄ ÇöÀç±îÁö ÃâÇ÷ÀÌ ¾ø½À´Ï´Ù. ÀúÈñ º´¿ø¿¡´Â ¾Æ¸£°ïÇöóÁ°¡ ¾ø¾î¼­ spray coagulationÀ» »ç¿ëÇß½À´Ï´Ù. ÀÌ È¯ÀںР´öºÐ¿¡ Heyde's syndromeÀ̶ó´Â°Ô ÀÖ´Ù´Â °É ¾Ë°Ô µÇ¾ú½À´Ï´Ù.


[2015-11-5. ÀÌÁØÇà ´äÀå]

³õÄ¡±â ½¬¿î angiodysplasia¸¦ Àß ¹ß°ßÇÏ°í ÀûÀýÈ÷ Ä¡·áÇϽŠ°Í °°½À´Ï´Ù. ÃàÇÏÇÕ´Ï´Ù. Heyde's syndromeÀº Àúµµ Á¤È®È÷ ¾ËÁö ¸øÇÏ¿© Wikipedia¸¦ ã¾Æº¸´Ï ´ÙÀ½°ú °°ÀÌ ³ª¿Í ÀÖ¾ú½À´Ï´Ù. "Heyde's syndrome is a syndrome of gastrointestinal bleeding from angiodysplasia in the presence of aortic stenosis. It is named after Dr. Edward C. Heyde, who first noted the association in 1958. It is caused by the induction of Von Willebrand disease type IIA (vWD-2A) by a depletion of Von Willebrand factor (vWF) in blood flowing through the narrowed valvular stenosis."

±×¸²¼³¸í: Pathophysiology of Heyde's Syndrome
a. von Willebrand Factor (vWF) passes through a normal aortic valve and remains in its coiled form.
b. vWF passes through a stenotic aortic valve and uncoils.
c. Coiled vWF is unaffected by the catabolic enzyme ADAMTS13.
d. Uncoiled vWF is cleaved in two by ADAMTS13.
e. In damaged arterioles vWF uncoils and becomes active. It binds collagen, platelets bind to vWF, and a clot forms.
f. Inactive vWF cannot bind to the collagen, no clot forms.


Áõ·Ê 2

¸î Â÷·Ê melena ÀÖ¾î EGD»ó upper body¿¡ angiodysplasia ¿Ü ÃâÇ÷ º´¼Ò ¾ø¾î VIO 300DÀÇ spray coagulation ÀÌ¿ëÇÏ¿© Ä¡·áÇÑ ºÐ ÀÔ´Ï´Ù. ÀÌ ºÐµµ Ä¡·á ÈÄ ÇöÀç±îÁö melena°¡ ¾ø¾ú½À´Ï´Ù. ÇÑ ¹ø¾¿ º¸ÀÌ´Â angiodysplasia°¡ ÃâÇ÷ º´¼Ò°¡ µÉ ¼ö ÀÖ´Ù°í »ý°¢¿¡ case ¸ÞÀÏ·Î º¸³À´Ï´Ù. ¾È³çÈ÷ °è½Ê½Ã¿À.


´ë´ÜÈ÷ °¨»çÇÕ´Ï´Ù. ÇâÈÄ¿¡µµ ÁÁÀº Áõ·Ê°¡ ÀÖÀ¸¸é ÇÔ²² °øºÎÇϸé ÁÁ°Ú½À´Ï´Ù. ÇÔ²² °øºÎÇÏ¿© ½Ç·ÂÀ¸·Î ȯÀÚ¿¡°Ô ºÀ»çÇÏ´Â ÁÁÀº Àǻ簡 µË½Ã´Ù.

ÀÏ¿øµ¿¿¡¼­ ÀÌÁØÇà.


[References]

1) EndoTODAY ¾Öµ¶ÀÚ Áõ·Ê ÆíÁö

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.