[Description exercise 11 Çؼ³]

[ÀÌÁØÇà ÀܼҸ®]

ºñÁ¾¾ç¼º ½ÄµµÁúȯÀ» ¸ð¾Æ °­ÀÇÇÑ µ¿¿µ»óÀÔ´Ï´Ù. Âü°í¹Ù¶ø´Ï´Ù.

ºñÁ¾¾ç¼º ½ÄµµÁúȯ.


Case 71. ÇϺΠ½Äµµ

Áø´Ü: Sliding hiatal hernia with reflux esophagitis (LA grade A)


[ÀÌÁØÇà comment]

Hiatal herniaÀÇ anatomy¿¡ ´ëÇÑ ¾Æ·¡ ¼³¸íÀ» ´Ù½Ã Çѹø Àо±â ¹Ù¶ø´Ï´Ù. ÀÌ Áõ·Ê¿¡¼­´Â squamocolumnar junction, ±×·¯´Ï±î mucosal ringÀÌ ½Äµµ ³»°­À¸·Î inward indentationµÈ °ÍÀÌ Àß º¸ÀÌ°í ÀÖ½À´Ï´Ù.

Sliding hiatal hernia°¡ ÀÖÀ¸¸é LES ÇÏ´ÜÀÇ squamous columnar junction ºÎÀ§°¡ web ºñ½ÁÇÏ°Ô inward indentationÀ» º¸À̴µ¥ À̸¦ mucosal ring ȤÀº B ringÀ̶ó°í ºÎ¸£¸ç, ÀÌ ºÎÀ§°¡ fixedµÇ¾î Á¼¾ÆÁö¸é Shatzki ringÀ̶ó°í ÇÕ´Ï´Ù. LES »ó´ÜÀÌ ¾à°£ ¹¶ÅüÇÏ°Ô ¼öÃàµÇ¾î º¸À̴µ¥ À̸¦ muscular ring ȤÀº A ringÀ̶ó°í ºÎ¸¨´Ï´Ù. ½ÇÁ¦·Î ÀÌ ºÎÀ§°¡ anatomicalÇÏ°Ô Á¼¾ÆÁöÁö´Â ¾Ê½À´Ï´Ù. ³»½Ã°æÀ» ÇÒ ¶§ ³»½Ã°æ »ðÀԺθ¦ ¾à°£ Á¶ÀÌ°í ÀÖ´Â µíÇÏ°Ô º¸ÀÏ »ÓÀÔ´Ï´Ù. Sliding hiatal hernia°¡ ÀÖÀ» ¶§ musclar ring°ú mucosal ringÀÇ »çÀÌ(±×·¯´Ï±î LES ºÎÀ§¿Í ÀÏÄ¡ÇÕ´Ï´Ù)°¡ ¹èÈ긲±âµÕó·³ ¾à°£ ¹Ù±ùÀ¸·Î ºÒ·èÇѵ¥ ÀÌ ºÎÀ§¸¦ ampulla ȤÀº vestibuleÀ̶ó°í ºÎ¸¨´Ï´Ù. Sliding hiatal hernia°¡ ÀÖÀ» ¶§ mucosal ring (= squamocolumnar junction = EG junction) ¾Æ·¡ºÎÅÍ diaphragmatic orfice »çÀ̵µ ¹èÈ긲±âµÕó·³ ¾à°£ ¹Ù±ùÀ¸·Î ºÒ·èÇѵ¥ ÀÌ ºÎÀ§¸¦ hernia sacÀ̶ó°í ºÎ¸¨´Ï´Ù.

µ¿¿µ»ó °­ÀÇ µÎ °³¸¦ ¼Ò°³ÇÕ´Ï´Ù.

2017-5-19 one point lesson

À§½Äµµ¿ª·ùÁúȯ °ø°³°­Á µ¿¿µ»ó

*Âü°í: EndoTODAY Hiatal hernia


Case 72

Áø´Ü: Reflux esophagitis LA-A with sentinel polyp

[ÀÌÁØÇà comment]

»ê¿ª·ù Áõ¼¼·Î ³»¿øÇϽŠ18¼¼ ÇлýÀ̾ú½À´Ï´Ù. ¿ª·ù¼º ½Äµµ¿°Àº ¼Ò¾Æû¼Ò³â°ú ¿µ¿ª¿¡¼­µµ Á¾Á¾ ¹ß°ßµÇ°ï ÇÕ´Ï´Ù.

´Ù¾çÇÑ Áõ·Ê¿¡ ´ëÇÑ ±Ýº¸¶ó ±³¼ö´Ô °­ÀǸ¦ ÃßõÇÕ´Ï´Ù.

* Âü°í: EndoTODAY º¸ÃÊ ¿ëÁ¾ sentinel polyp


Case 73

Áø´Ü: Barrett's esophagus, C2M6


[ÀÌÁØÇà comment]

ÇÑ Àü°øÀÇ ¼±»ý´Ô²²¼­ "SC junctionÀÌ pallaside zoneÀÇ distal end¿¡ ºñÇØ ´õ À§·Î ¿Ã¶ó¿ÍÀÖÀ¸¸ç ÀϺδ tongue-like ÇÏ°Ô ´õ ¿Ã¶ó¿Í º¸ÀÔ´Ï´Ù. ÀϺο¡¼­´Â squamous island°¡ º¸ÀÔ´Ï´Ù. Sliding typeÀÇ hiatal hernia°¡ µ¿¹ÝµÇ¾îÀÖ½À´Ï´Ù"¶ó°í ´äº¯À» Áּ̽À´Ï´Ù. Àß Çϼ̽À´Ï´Ù¸¸, EG junctionÀ» Á¤ÇÏ´Â ¹æ¹ý¿¡ ´ëÇÑ °í¹ÎÀÌ ÇÊ¿äÇÕ´Ï´Ù. EG junctionÀº ±âº»ÀûÀ¸·Î proximal end of the gastric fold·Î Á¤ÇÏ°í, ÀÌ°ÍÀÌ ¾î·Á¿ï ¶§¿¡¸¸ distal end of the pallisading zoneÀ¸·Î ÇÕ´Ï´Ù. ÀÌ Áõ·Ê¿¡¼­´Â gastric fold´Â ¶Ñ·ÇÇÏÁö¸¸, (±ÙÁ¢»çÁøÀÌ ¾ø±â ¶§¹®¿¡) pallisading vesselÀº Àß º¸ÀÌÁö ¾Ê°í ÀÖ½À´Ï´Ù.

2009³â ÀúÀÇ Á¾¼³À» Àо½Ç °ÍÀ» ±ÇÇÕ´Ï´Ù (¹Ù·¿½Äµµ - ³»½Ã°æÁø´ÜÀ» Áß½ÉÀ¸·Î). ÀÌ ¹®Á¦ÀÇ Áõ·Ê´Â Á¦°¡ 2005³â¿¡ °Ë»çÇϸ鼭 »ó¼¼È÷ ±â¼úÇÑ ¹Ù ÀÖÀ¸´Ï Âü°íÇϽñ⠹ٶø´Ï´Ù.

EndoTODAY 'À§³»½Ã°æ »ðÀÔ°ú °üÂû' 169ÂÊÀ» Âü°íÇϽʽÿÀ.

* Âü°í: EndoTODAY ¹Ù·¿ ½Äµµ


Case 74. »óÀýÄ¡ 27cm ºÎÀ§

Áø´Ü: Tuberculous esophagitis


[ÀÌÁØÇà comment]

¿ì¸®³ª¶ó¿¡¼­ °áÇÙÀº ¿©ÀüÈ÷ Áß¿äÇÑ ÁúȯÀÔ´Ï´Ù. ½Äµµ°áÇÙÀ̶ó´Â disease entity¸¦ ¾Ë°í °è½Ã¸é ¾ðÁ¨°¡ µµ¿òµÇ´Â °æ¿ì°¡ ÀÖÀ» °ÍÀÔ´Ï´Ù. Áߺνĵµ¿¡ ±Ë¾ç¼º º´¼Ò°¡ Àִµ¥ GERD³ª ¾ÏÀÌ ¾Æ´Ï¸é ½Äµµ °áÇÙÀ» ÀǽÉÇØ º¸¾Æ¾ß ÇÕ´Ï´Ù. ÀÌ Áõ·Ê´Â subcarinal lymph node¿¡ °áÇÙÀÌ ÀÖÀ¸¸é¼­ ½Äµµ¸¦ ¹Ù±ù¿¡¼­ ¾ÈÂÊÀ¸·Î ÆÄ°í µç °æ¿ìÀÔ´Ï´Ù. ±×·¯´Ï±î incisor 27cm ºÎÀ§ÀÌ°í 12½Ã ¹æÇâ(spinal indentation ¹Ý´ëÂÊ = ¾ÕÂÊ)¿¡ º´ÀÌ ÀÖ´Â °ÍÀÔ´Ï´Ù.

1) Clinical symptoms of esophageal tuberculosis
- Systemic symptoms: wt. loss, fever, chill
- Local sx. : chest pain, dysphagia(m/c),cough

2) Endoscopic findings of esophageal tuberculosis
- Ulcerative lesion (m/c): mid-esophagus,irregular outline and a grayish base with an irregularly infiltrated edge.
- Infiltrative growth: hyperplastic and granular type lesion
- Tumor-like growth with stricture: can be confused with esophageal cancer

3) Radiologic finding: Nonspecific changes associated with LN or contiguous organ
- Subcarinal LN enlargement: most common finding on chest CT
- Lung lesions, lymphatic lesions and complications such as BEF

* Âü°í: EndoTODAY °áÇÙ¼º ½Äµµ¿°


Case 75. Intermittent dysphagia

Áø´Ü: Eosinophilic esophagitis


[ÀÌÁØÇà comment]

È£»ê±¸ ½Äµµ¿° ³»½Ã°æ ¼Ò°ß
1) Stacked circular rings ("feline" esophagus)
2) Stricture (particularly proximal stricture)
3) Attenuation of the submucosal vascular pattern
4) Linear furrowing that may extend length of the esophagus
5) White papules (representing eosinophilic microabscess)
6) Small caliber esophagus

¸ÕÀú ¾Æ·¡ µ¿¿µ»ó °­ÀǸ¦ º¸½Ã°í Áõ·Ê¸¦ »ìÆ캸½Ê½Ã¿À.

2021 ¼øõ¸¸³»½Ã°æ¼¼¹Ì³ª ¹ÚÈ¿Áø ±³¼ö´Ô °­ÀÇ

´ëÇѼÒÈ­±âÇÐȸÁö 2010;56:285-292

EoE

EoE (»çÁøÁ¦°ø: ±è¹ÌÁø)

Evan S. Dellon (Endoscopy 2014)

Representative endoscopic images suspicious of EoE. a Linear furrows. b Rings including ringed esophagus (left) and corrugated esophagus (right). c Whitish exudate. d Reddening.(Shimura. Digestion 2014)

EoE vs GERD (Hori K. Digest Endosc 2014)

PPI ȤÀº flucatisone inhaler »ç¿ë ÈÄ È£ÀüµÈ ¸ð½À (´ëÇѼÒÈ­±âÇÐȸÁö 2010;56:285-292)

Ä¡·á ÈÄ¿¡´Â longitudinal furrow´Â healingÀÌ µÇ´Âµ¥ circular ringÀº ±×´ë·ÎÀÎ °æ¿ì°¡ ¸¹´Ù°í ÇÕ´Ï´Ù. Fixed circular ringÀº ÀÌ¹Ì fibrotic stageÀ̱⠶§¹®ÀÎ °Í °°½À´Ï´Ù.

¹ÚÈ¿Áø. ´ëÇѼÒÈ­±âÇÐȸÁö 2018

* Âü°í: EndoTODAY È£»ê±¸ ½Äµµ¿°


Case 76. Hematemesis. Mid-esophagus

Áø´Ü: Aorto-esophageal fistula (clinically, hematemesis from aorto-esophagieal fistula due do aortic aneurysm in hypertension patient)


[ÀÌÁØÇà comment]

°ÅÀÇ Á¢±ÙÇߴµ¥ ¾Æ½½¾Æ½½ÇÏ°Ô impressionÀ» ºÙÀÌÁö ¸øÇÑ °æ¿ì¿´½À´Ï´Ù.

¾î·Á¿î ¹®Á¦¿´´Âµ¥ ¿­½ÉÈ÷ °Ë»öÇÏ¿© ´äÀ» ¾Ë°Ô µÇ¾úÁö¸¸, ´Ù½Ã ºÁµµ »çÁøÀ» º¸°í´Â Á¤´äÀ» ¸ÂÃ߱⠾î·Æ´Ù°í ¼ÖÁ÷ÇÑ ÀÇ°ßÀ» ÁֽŠ3³âÂ÷ Àü°øÀÇÀÇ ´äº¯ÀÔ´Ï´Ù. °¨»çÇÕ´Ï´Ù.

³»½Ã°æÀ» ÇÑ ¹øµµ ¾È Çغ» 3³âÂ÷ Àü°øÀÇ°¡ ¾ÆÁÖ Á¤È®È÷ ¸ÂÃè½À´Ï´Ù. BRAVO! µµÀå ¿Õâ Âï¾î¼­ ´äº¯À» º¸³Â½À´Ï´Ù.

AirwayÀÇ fistula¸é ±¸¸ÛÀÌ º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù. Tracheoesophageal fistula°¡ ±×·¸½À´Ï´Ù. ±¸¸ÛÀÌ º¸ÀÌ°í ±×·Î ÀÎÇÏ¿© °¡²û pneumonia°¡ »ý±â°í barium study¸¦ ÇÏ¸é ±âµµ·Î »õ´Â °ÍÀÌ º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª vascular fistula´Â ´Ù¸¨´Ï´Ù. ÇÇ°¡ ÆãÆã ³ª´Â °æ¿ìµµ ÀÖ½À´Ï´Ù¸¸... ±× Á¤µµ¸é »ý¸íÀ» À¯ÁöÇÒ ¼ö ¾ø°ÚÁö¿ä. ÇÇ°¡ ³µ´Ù°¡ ¸Ü¾ú´Ù°¡ ÇÏ´Â °æ¿ìÀ̹ǷΠÃÖ±Ù¿¡ ÇÇ°¡ ³­ ÈçÀûÀÌ º¸ÀÌ´Â °æ¿ì°¡ ¸¹Áö fistula°¡ º¸À̰ųª ÇÇ°¡ pumping ÇÏ´Â °ÍÀ» ¸ñ°ÝÇÏ´Â ¿¹°¡ ¸¹Áö´Â ¾Ê½À´Ï´Ù. SMT °°Àº °ÍÀÌ ÀÖÀ¸¸é¼­ topÀÌ ÆÄ¿© ÀÖ°í ¹º°¡ exposed vessel °°°Å³ª ºÓÀº °ÍÀÌ ÀÖÀ¸¸é aortoesophageal fistula¸¦ ÀǽÉÇØ¾ß ÇÕ´Ï´Ù. ³»½Ã°æ Àǻ簡 ÀǽÉÇÏÁö ¸øÇϸé ȤÀº ¾Æ¹« »ý°¢¾øÀÌ Á¶Á÷°Ë»ç¸¦ Çϸé ȯÀÚ´Â Á×°Ô µË´Ï´Ù. ±×·¯´Ï ¹«¼­¿î »óȲÀÔ´Ï´Ù.

[Áõ·Ê ¼³¸í]

7³âÀü °íÇ÷¾Ð ¹ß°ßµÇ¾î Ç×°íÇ÷¾ÐÁ¦ Åõ¾àÁßÀÎ 80´ë ¿©¼ºÀ¸·Î ÃÖ±Ù ÅäÇ÷ÀÌ ¹ß»ýÇÏ¿© °¡±î¿î º´¿øÀ» ¹æ¹®ÇÏ¿´½À´Ï´Ù. ³»½Ã°æ¿¡¼­ ÁߺνĵµÀÇ ±Ë¾çÀÌ ¹ß°ßµÇ¾ú°í CT¿¡¼­´Â ÈäºÎ ´ëµ¿¸ÆÀÇ µ¿¸Æ·ù·Î Áø´ÜµÇ¾î ÀǷڵǾú½À´Ï´Ù. CT Æǵ¶¿¡¼­´Â "descending thoracic aorta°¡ rupture µÇ¸é¼­ pseudoaneurysm formationÀÌ mediastinumÂÊÀ¸·Î ÀÖ°í esophagusÂÊÀ¸·Î focal rupture°¡ µÈ °Í"À¸·Î ÆǴܵǾú½À´Ï´Ù.

¼ö¼úÀ» °í·ÁÇÏ¿´À¸³ª very high risk·Î ÆǴܵǾî stent-graft insertionÀ§ÇØ ³»°ú·Î Àü°úµÇ¾î stent¸¦ »ðÀÔÇÏ¿´½À´Ï´Ù. ´ç½Ã ¡°aortogram»ó diaphragm ¹Ù·Î À§ levelÀÇ descending thoracic aorta°¡ ruptureµÇ¾î ÀÖ´Â °ÍÀ» º¼ ¼ö ÀÖÀ¸¸ç proximal neck°ú distal neckÀÇ ±æÀ̸¦ ÇÑ ¹ø ´õ ÃøÁ¤ÇÑ ´ÙÀ½ celiac axisº¸´Ù ¾à°£ À§¿¡ stent graft distal marginÀÌ ¶³¾îÁöµµ·Ï stent graft size¸¦ ¸ÂÃã. Right common femoral artery puncture site¸¦ ÅëÇؼ­ Lunderquist Extrastiff guide-wire¸¦ insertion ÇÑ ÈÄ¿¡ guide-wire¸¦ µû¶ó¼­ SEAL stent graft¸¦ ¼³Ä¡ÇÏ¿´°í stent graft´Â proximal neck°ú distal neckÀÌ ¸ðµÎ aorta º®¿¡ Àß ¹ÌÂøµÇ¾î full distension µÇ¾úÀ½"À¸·Î º¸°íµÇ¾ú½À´Ï´Ù.

³»½Ã°æ ÀÇ»çÀÇ ÀÔÀå¿¡¼­ º¼ ¶§ aorto-esophageal fistulaȯÀÚ°¡ »ç¸ÁÇÏÁö ¾Ê°í Àû±ØÀûÀÎ Ä¡·á±îÁö µµ´ÞÇÑ °Í ¸¸À¸·Îµµ ¸Å¿ì ´ÙÇེ·¯¿î ÀÏÀÔ´Ï´Ù. ù ÃâÇ÷½Ã shock¿¡ ºüÁö¸é¼­ »ç¸ÁÇÏ´Â ¿¹°¡ ¸Å¿ì ¸¹±â ¶§¹®ÀÔ´Ï´Ù. ÁßÇϺΠ½Äµµ¿¡¼­ ¿À´ÃÀÇ Áõ·Ê¿Í °°Àº ¼Ò°ßÀÌ º¸ÀÌ¸é ³»½Ã°æÀû ÁöÇ÷¼úÀ» ½ÃµµÇÏÁö ¾Ê°í º¸´Ù Àû±ØÀûÀÎ ¼ö¼úÀ» ½ÃÇàÇÏ´Â °ÍÀÌ ÃÖ¼±ÀÇ ¹æÃ¥À̶ó »ý°¢µË´Ï´Ù.

»ý¼±»À ½Äµµ À̹° (FBFB; fish bone foreign body)ÀÇ ÇÕº´Áõ Áß °¡Àå Ä¡¸íÀûÀÎ °Íµµ aortoesophageal fistulaÀÔ´Ï´Ù. °©ÀÚ±â hematemesis¸¦ Çϸ鼭 »ç¸ÁÇÒ ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù. ¼Ò·®ÀÇ tea spoon Á¤µµÀÇ ÃâÇ÷ÀÎ herald bleedingÀÌ Àְųª ³»½Ã°æ¿¡¼­ ±Ë¾çÀ» µ¿¹ÝÇÑ SMT°¡ ÀÖÀ» ¶§¿¡´Â ²À ÀǽÉÇÏ°í Àû±ØÀûÀ¸·Î ´ëóÇØ¾ß ÇÕ´Ï´Ù. ³»½Ã°æ »çÁøÀÌ º» Áõ·Ê¿Í À¯»çÇÕ´Ï´Ù. ±Ë¾çÀ» µ¿¹ÝÇÑ SMT·Î º¸ÀÔ´Ï´Ù. ³»½Ã°æÇÐȸ ÄûÁî(2018/5)¿¡ ÀüÇüÀûÀÎ Áõ·Ê°¡ À־ ¿Å±é´Ï´Ù.

27¼¼ ¿©ÀÚ°¡ 300cc °¡·®ÀÇ ÅäÇ÷ÀÌ ÀÖ¾î ÀÀ±Þ½Ç¿¡ ¿Ô´Ù. 2°³¿ù Àü »ý¼± °¡½Ã°¡ ½Äµµ¿¡ °É¸®´Â ´À³¦ÀÌ ÀÖ¾ú°í ÀÌÈÄ °£ÇæÀûÀ¸·Î µî ÅëÁõÀÌ ÀÖ¾úÀ¸³ª Å©°Ô ºÒÆíÇÏÁö´Â ¾Ê¾Ò´Ù. ³»½Ã°æ °Ë»ç¿¡¼­ »óÀýÄ¡ 24cm¿¡¼­ 33cm±îÁö ±Ë¾çÀ» µ¿¹ÝÇÑ »óÇÇÇϺ´º¯ ÀÇ½É ¼Ò°ßÀ» º¸¿´´Ù.

´ëµ¿¸Æ-½Äµµ ´©°øÀº »ý¸íÀ» À§ÇùÇÒ ¼ö ÀÖ´Â »óºÎÀ§Àå°ü ´ë·® ÃâÇ÷ÀÇ µå¹® ¿øÀÎÀ¸·Î, 1914³â Chiari ¿¡ ÀÇÇØ Ã³À½ ±â¼úµÇ¾ú´Ù. ¿øÀÎÀ¸·Î´Â ´ëµ¿¸ÆÀÇ °¡¼ºµ¿¸Æ·ù³ª ÀÌÀüÀÇ ÈäºÎ´ëµ¿¸Æ ¼ö¼ú, ½Äµµ À̹°, ½ÄµµÀÇ ¾ç¼º ȤÀº ¾Ç¼ºÁúȯ µîÀÌ ÀÖ´Ù. ±Ù·¡¿¡´Â thoracic endovascular aortic repair (TEVAR)¸¦ ÀÌ¿ëÇÑ ¼ö¼úº¸´Ù ´ú ħ½ÀÀûÀÎ Ä¡·á¹ýÀÌ ½ÃµµµÇ°í ÀÖ´Ù.

º» Áõ·Ê¿¡¼­µµ ÈäºÎ Àü»êÈ­´ÜÃþÃÔ¿µ¿¡¼­ ´ëµ¿¸ÆÀÇ °¡¼ºµ¿¸Æ·ù¿Í ´ëµ¿¸Æ-½Äµµ ´©°øÀÌ È®ÀεǾî TEVAR¸¦ ÅëÇÏ¿© ÁöÇ÷À» ½ÃÇàÇÏ¿´´Ù. °Ë»ç¿¡¼­ È®ÀÎµÈ ¹Ù´Â ¾øÁö¸¸, 2°³¿ù Àü ½Äµµ¿¡ °É·È´ø »ý¼± °¡½Ã°¡ ¿øÀÎÀ̾úÀ» °ÍÀ¸·Î ÃßÁ¤µÈ´Ù. À§Àå°ü ÃâÇ÷ÀÌ ÀÖ¾î »óºÎÀ§Àå°ü ³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÒ ¶§, ÁߺΠ½Äµµ¿¡ ±Ë¾çÀÌ µ¿¹ÝµÈ »óÇÇÇÏÁ¾¾çÀ¸·Î ÀǽɵǴ º´º¯ÀÌ ÀÖÀ» °æ¿ì ´ëµ¿¸Æ-½Äµµ ´©°øÀÇ °¡´É¼ºµµ ¿°µÎ¿¡ µÎ¾î¾ß Çϸç, ¹«¸®ÇÏ°Ô ³»½Ã°æ °Ë»ç¸¦ Áö¼ÓÇϱ⺸´Ù´Â ÈäºÎ Àü»êÈ­´ÜÃþÃÔ¿µÀ» ½ÃÇàÇÏ¿© °¨º°Áø´ÜÇÏ·Á´Â ³ë·ÂÀÌ ÇÊ¿äÇÏ´Ù.

¾Æ·¡ Áõ·Ê¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù.

¿ä¾à: Aortoesophageal fistula¿Í visceral vascular aneurysmÀº ³»½Ã°æ Àǻ簡 ÀØÁö ¸»¾Æ¾ß ÇÒ Áß¿äÇÑ vascular ÁúȯÀÔ´Ï´Ù. ²À ±â¾ïÇØ ÁÖ¼¼¿ä.


Case 77. À½ÁÖ ÈÄ ½ÉÇÑ ±¸Åä

Áø´Ü: Boerhaave syndrome


[ÀÌÁØÇà comment]

MW tear°¡ ½ÉÇϸé õ°øÀÌ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. º¸ÇϺ£¶ó°í ºÎ¸£´Â »óȲÀÔ´Ï´Ù. °£È¤ Á×½À´Ï´Ù.

* Âü°í: EndoTODAY Mallory Weiss tear


[Archives]

2018³â 1¿ù ÇÑ Àü°øÀÇ 3³âÂ÷ÀÇ ´äº¯

2018³â 11¿ù ÇÑ Àü°øÀÇ 3³âÂ÷ÀÇ ÆíÁö. BookreadingÀÌ µµ¿òµÇ¾ú´Ù°í ÇÕ´Ï´Ù.


[2019-2-22] º»°ú 3Çгâ ÇлýÀÇ DEX quiz ´äº¯¿¡ ´äÇÕ´Ï´Ù. ¿ÃÇغÎÅÍ´Â ÀÇ´ë»ýÀ» ´ë»óÀ¸·Î description exercise¸¦ °¡¸£Ä¡°í ÀÖ½À´Ï´Ù.

71. ¿¹ mucosal ringÀÌ º¸ÀÌ´Â °Í ¸Â½À´Ï´Ù. Hiatal herniaÀÇ 2Â÷ ¼Ò°ßÀÔ´Ï´Ù. ÀÌ Áõ·Ê¿¡¼­ °¡Àå Áß¿äÇÑ point´Â triangle shapeÀÇ mucosal break°¡ ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù.

72. Àß º¸¿´½À´Ï´Ù. Erosion (=mucosal break)ÀÌ ÀÖ°í ±× ¾Æ·¡ ¿ëÁ¾ (=sentinel polyp)ÀÌ ÀÖ´Â °ÍÀÔ´Ï´Ù. GERD´Â ÀÓ»ó Áø´ÜÀÌ°í ³»½Ã°æ Áø´ÜÀº reflux esophagitisÀÔ´Ï´Ù. GERD Áß ³»½Ã°æ¿¡¼­ mucosal break°¡ ¾ø´Â °æ¿ì°¡ Àý¹Ý ÀÌ»óÀÔ´Ï´Ù.

74. Anatomy¸¦ Àß °í¹ÎÇϸé ÀÌ ºÎÀ§°¡ ¹Ù·Î ÈäºÎÀÇ 7¹ø ¸²ÇÁÀýÀÌ À§Ä¡ÇÏ´Â °÷°ú ¸Å¿ì °¡±õ´Ù´Â °ÍÀ» ÀÌÇØÇÒ ¼ö ÀÖ°í, ¿ì¸®³ª¶ó¿¡¼­´Â °áÇÙÀ» °í·ÁÇØ¾ß ÇÕ´Ï´Ù.

75. È£»ê±¸ ½Äµµ¿°ÀÇ ÀüÇüÀûÀÌ ¼Ò°ßÀÌ´Ï °ü·Ã ºÎºÐÀ» Àß Àо¼¼¿ä.

76. ±×·¡¿ä. Ç÷°üÁúȯ ÀǽÉÇÑ °Í ÁÁ¾Ò½À´Ï´Ù. Varix´Â ¾Æ´Ï¾úÁö¸¸. ¾Æ·¡ ¼³¸í º¸¼¼¿ä.

77. ±Â. B¸¦ ´ë¹®ÀÚ·Î... »ç¶÷ À̸§À̴ϱî...

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