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EndoTODAY ³»½Ã°æ ±³½Ç


[¹«´äÅä·Ð - ¼ÒÈ­¼º ±Ë¾ç 002. ½ÊÀÌÁöÀå ±Ë¾ç]

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À§¾Ï ³»½Ã°æÄ¡·á ÈÄ °æ°ú°üÂû ÁßÀΠȯÀÚÀÇ ½ÊÀÌÁöÀå ¼Ò°ßÀÔ´Ï´Ù. ¿©·¯ºÐÀº ¾î¶»°Ô ±â¼úÇÏ°í, ¾î¶»°Ô Áø´ÜÇÏ°í, ¾î¶»°Ô ¼³¸íÇÏ°Ú½À´Ï±î? ¿©·¯ºÐÀÇ ÀÇ°ßÀ» º¸³»Áֽñ⠹ٶø´Ï´Ù.


MERS »çÅ·Π´Ùµé Èûµå½ÃÁö¿ä? Á¶¼ÓÈ÷ À̹ø »çŸ¦ ¸¶¹«¸®Çϱâ À§ÇÏ¿© ´ÙÇÔ²² º´¿ø ¹æħ¿¡ ÇùÁ¶ÇսôÙ. ±×·¯³ª °øºÎ´Â °è¼ÓÇØ¾ß ÇÕ´Ï´Ù. ¿À´Ã ´äº¯ ÁֽŠ¿©·¯ºÐ²² °¨»çÇÕ´Ï´Ù. Á¾Á¾ ¹®Á¦¸¦ ¶Ç º¸³»°Ú½À´Ï´Ù.

[´äº¯ 1 - 4³âÂ÷ Àü°øÀÇ]

[º´¼Ò±â¼ú] duodenal bulb¿¡ µÎ °³ÀÇ ulcer º´º¯ÀÌ º¸ÀÌ°í ÀÖ½À´Ï´Ù. Proximal partÀÇ º´º¯Àº ¾à 0.3cm ÀÇ round depressed º´º¯À¸·Î º´º¯ÀÇ margin°ú edge´Â clear Çϸç base´Â even ÇÏ°í whitish exudate·Î µ¤Çô ÀÖ½À´Ï´Ù. unler margin ÁÖº¯À¸·Î regenerating epitheliumÀÌ ±ÕÀÏÇÏ°Ô ºÐÆ÷ µÇ¾î ÀÖ½À´Ï´Ù. Distal partÀÇ º´º¯Àº Å©±â°¡ ¾à 0.25cm Á¤µµ·Î »ý°¢µÇ¸ç slightly depressed º´º¯À¸·Î º´º¯ÀÇ margin°ú edge´Â clear Çϸç whitish exudate·Î µ¤Çô ÀÖ½À´Ï´Ù.

[Impression] #1. Duodenal ulcer, H1

[°èȹ]

#1. º´·Â ûÃ븦 ÅëÇÏ¿© NSAID, asprin º¹¿ë ¿©ºÎ¸¦ È®ÀÎ ÈÄ º¹¿ëÇÑ Hx. °¡ ÀÖÀ» °æ¿ì À̸¦ Áß´Ü Çϵµ·Ï ÇÏ°Ú½À´Ï´Ù. ¶ÇÇÑ PPI 4~6 ÁÖ Åõ¿©¸¦ ½ÃÀÛÇÏ°Ú½À´Ï´Ù.

#2. stomach¿¡¼­ HP test¸¦ À§ÇÑ Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇÏ°í PPI °æ±¸ Åõ¿©¸¦ ½ÃÀÛÇÏ°Ú½À´Ï´Ù
- HP test ¿¡¼­ ¾ç¼º ¼Ò°ßÀ» º¸ÀÎ °æ¿ì Á¦±ÕÄ¡·á¸¦ ½ÃÇàÇÏ°í Á¦±ÕÄ¡·á ¹× ulcer Ä¡·á Á¾·á(PPI Åõ¿© Á¾·á) 2~4 ÁÖ ÈÄ Á¦±Õ¿©ºÎ¸¦ ¿ä¼Ò È£±â°Ë»ç·Î È®ÀÎ.
- HP test ¿¡¼­ À½¼º ¼Ò°ßÀ» º¸ÀÎ °æ¿ì PPI ´Üµ¶À¸·Î 4~6 ÁÖ Åõ¿©

#3. ÀϹÝÀûÀ¸·Î ÃßÀû°Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê´Ù°í »ý°¢µÇ³ª ºÒ¿ÏÀü Ä¡À¯¸¦ ½Ã»çÇÏ´Â Áõ»óÀÌ ÀÖÀ» °æ¿ì ÃßÀû ³»½Ã°æÀ» ½ÃÇàÇÏ°Ú½À´Ï´Ù.

@ ÀÌÁØÇàÀÇ one point lesson: ¾Ñ. º´¼Ò°¡ µÎ°³¶ó´Â °ÍÀº Àúµµ ¸ô¶ú½À´Ï´Ù. µè°í º¸´Ï roundÇÑ º´¼Ò µÚÂÊÀ¸·Î fold ³¡¿¡ ÀÛ°í ºñ½ÁÇÑ °ÍÀÌ Çϳª ´õ Àֳ׿ä. ÈǸ¢ÇÑ °üÂû·ÂÀÔ´Ï´Ù. ±×·±µ¥ ±Ë¾çº¸´Ù´Â ¹Ì¶õÀÔ´Ï´Ù. ½ÊÀÌÁöÀå ¹Ì¶õÀÌ Çѵΰ³ ÀÖ´Â °ÍÀº ÀÓ»óÀû ÀÇÀÇ°¡ °ÅÀÇ ¾ø½À´Ï´Ù. µû¶ó¼­ Helicobacter °Ë»çµµ, Á¦±ÕÄ¡·áµµ, PPIµµ, ÃßÀû³»½Ã°æµµ ¸ðµÎ ÇÊ¿ä¾ø½À´Ï´Ù. ±×³É ¹«½ÃÇصµ µÇ´Â º´¼ÒÀÔ´Ï´Ù. ¹°·Ð aspirinÀ̳ª NSAID¸¦ º¹¿ëÇÏ´Â ºÐ¿¡¼­ ÀÌ·± º´¼Ò´Â Á¾Á¾ º¸ÀÔ´Ï´Ù. ±×·¯³ª aspirinÀ̳ª NSAID¸¦ µå½Ã´Â ºÐ¿¡¼­ ÀÌ°ÍÀÌ º¸¿´´Ù°í °©Àڱ⠺λêÀ» ¶³ ÀÌÀ¯´Â ¾ø¾î º¸ÀÔ´Ï´Ù.


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Duodenum bulb ¿¡ ¾à 0.4cm size ÀÇ ulcer °¡ º¸ÀÌ¸ç ºñ±³Àû clear ÇÑ edge ¸¦ °¡Áö°í ÁÖº¯¿¡ hyperemic regenerating epithelium À» º¸ÀÌ°í ÀÖ½À´Ï´Ù. H1 DU ·Î »ý°¢µÇ¸ç, ½ÊÀÌÁöÀå Á¶Á÷°Ë»ç´Â ½ÃÇàÇÏÁö ¾Ê°í, À§¾Ï ³»½Ã°æ Ä¡·á ÈÄ °æ°ú°üÂû ÁßÀÌ´ø ºÐÀ¸·Î HP °Ë»ç ¹× PPI + HP Á¦±ÕÄ¡·á¸¦ ½ÃÇàÇÏ°Ú½À´Ï´Ù.

@ ÀÌÁØÇàÀÇ one point lesson: 4 mm¶ó¸é ³Ê¹« Å©°Ô º¸½Å °Í °°½À´Ï´Ù. ÇÔ¸ôºÎÀ§°¡ 2-3mm Á¤µµÀÏ °Í °°½À´Ï´Ù. MERS »çÅ°¡ ³¡³ª°í ´Ù½Ã ³»½Ã°æÀ» ÇÏ°Ô µÇ¸é ÀÌ·± º´¼Ò¿¡¼­ Á¶Á÷°Ë»ç °âÀÚ¸¦ Á¢±Ù½ÃÄÑ º¸½Ê½Ã¿À. Á¶Á÷°Ë»ç °âÀÚÀÇ µÎ²²´Â 2 mm ¹Ì¸¸ÀÔ´Ï´Ù. ÀÛÀº ¹Ì¶õ¿¡ ÁØÇÏ¿© °æ°ú°üÂû ÇϽñ⠹ٶø´Ï´Ù. Á¶Á÷°Ë»ç³ª Á¦±ÕÄ¡·á´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù.


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Duodenal bulb LC ºÎÀ§¿¡ 2°³ÀÇ shallow ulcer°¡ º¸ÀÔ´Ï´Ù. Proximal ÂÊÀÇ ulcer´Â ¾à 0.3cm°¡·®ÀÇ Å©±â·Î edge°¡ sharpÇÏ°í, base´Â evenÇϸç whitish exudate·Î µ¤¿©ÀÖ½À´Ï´Ù. distalÂÊÀÇ º´º¯Àº »çÁø¿¡¼­ ¸íÈ®È÷ Å©±â¸¦ °¡´ÆÇϱ⠾î·Á¿ì³ª Àå°æÀ¸·Î´Â ¾à 0.3cm°¡·®À¸·Î »ý°¢µÇ¸ç ¸¶Âù°¡Áö·Î even base, whitish exudate·Î µ¤¿©ÀÖ½À´Ï´Ù. º´¼Ò¿¡¼­ Malignancy¸¦ ½Ã»çÇÒ¸¸ÇÑ ¼Ò°ßÀº °üÂûµÇÁö ¾Ê°í, Duodenitis¶ó°í º¸±â¿¡´Â ºñ±³Àû º´¼ÒÀÇ °³¼ö°¡ Àû¾î Benign duodenal ulcer (H2)°¡ Àǽɵ˴ϴÙ.

@ ÀÌÁØÇàÀÇ one point lesson: ÀÚ¼¼ÇÑ °üÂû·ÂÀ» ĪÂùÇÏ°í ½Í½À´Ï´Ù. ±Ë¾çº¸´Ù´Â ¹Ì¶õÀÌ ¸Â½À´Ï´Ù. 'Duodenitis¶ó°í º¸±â¿¡´Â ºñ±³Àû º´¼ÒÀÇ °³¼ö°¡ Àû¾î'¶ó°í ¾²½Å °÷Àº Á¶±Ý ÀÌ»óÇÑ ¼³¸íÀÔ´Ï´Ù. ±×³É ¹Ì¶õÀÌ 1°³¸é single erosion, 2°³ ÀÌ»óÀ̸é erosive duodenitis¶ó°í ¾²¸é µË´Ï´Ù. ²À ¸Å¿ì ¸¹À» ÇÊ¿ä´Â ¾ø½À´Ï´Ù. ±×·±µ¥, º´¼ÒÀÇ À§Ä¡ ±â¼úÀÌ Á¶±Ý ÀÌ»óÇÕ´Ï´Ù. ½ÊÀÌÁöÀå ±¸ºÎ¿¡¼­ Á¦ 2ºÎ·Î ³Ñ¾î°¡´Â °æ°èÀ̸ç, °³³ä»ó ´ë¸¸¿¡ ÇØ´çÇÏ´Â superior duodenal angleÀÇ ¹Ý´ëÂÊÀ̹ǷΠ¼Ò¸¸À̶ó°í ºÎ¸£´Â °ÍÀÌ ¸ÂÀ» °Í °°±â´Â ÇÕ´Ï´Ù¸¸... »ç½Ç ±×·¸°Ô ºÎ¸£´Â »ç¶÷Àº °ÅÀÇ ¾ø½À´Ï´Ù. ±×³É '±¸ºÎ¿Í Á¦ 2ºÎÀÇ °æ°èºÎ, SDAÀÇ ¹Ý´ëÆí'À¸·Î ¾²¸é ³²µéÀÌ ´õ Àß ÀÌÇØÇÒ °Í °°½À´Ï´Ù.


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±â¼ú : Duodenal bulb ¿¡ 2°³ÀÇ 0.5cm Á¤µµ Å©±âÀÇ shallow depressed lesion ÀÌ ÀÖ°í, ºñ±³Àû edge °¡ sharp Çϸç, regenerating epithelium ÀÌ ±ÕÀÏÇÏ¿´À½.

Áø´Ü : Duodenal Ulcer, H1 stage

À§¿¡¼­ H.pylori °Ë»ç 2°³ ½ÃÇàÇÏ°í, º´º¯¿¡¼­µµ Á¶Á÷°Ë»ç 2°³Á¤µµ ½ÃÇàÇÒ °Í °°½À´Ï´Ù. ȯÀÚ ºÐ²²´Â ½ÊÀÌÁöÀå±Ë¾çÀÌ ÀÖ¾ú°í, ÇöÀç Ä¡·áµÇ´Â ¼Ò°ßÀ̶ó°í ¼³¸íÀ» ÇÏ°í, HP °Ë»ç È®ÀÎ ÈÄ ÇÊ¿ä½Ã Á¦±ÕÄ¡·á ÇÏ°Ú½À´Ï´Ù. H.pylori °¡ À½¼ºÀ̶ó¸é ±»ÀÌ ÇöÀç »óȲ¿¡¼­ PPI ó¹æÀ» ÇÏÁö´Â ¾ÊÀ» °Í °°½À´Ï´Ù.

@ ÀÌÁØÇàÀÇ one point lesson: 4³âÂ÷ ¼±»ý´ÔµéÀº ¸ðµÎ ±Ë¾çÀÌ¶óµµ ´äÀ» Áּ̽À´Ï´Ù. ¾ÆÁ÷ °æÇèÀÌ Âª¾Æ¼­ Å©°í ÀÛÀº °ÍÀ» ±¸ºÐÇϱ⠾î·Á¿ïÁö ¸ð¸¨´Ï´Ù. ±×·¯³ª ¾èÀ¸¸é ¹Ì¶õÀ¸·Î º¸½Ã±â ¹Ù¶ø´Ï´Ù. ¹Ì¶õÀ» ±Ë¾çÀ¸·Î À̸§À» ºÙÀ̸é ÀÏÀÌ ¸Å¿ì º¹ÀâÇØÁý´Ï´Ù. ÀÏÁ¾ÀÇ ºÒÇÊ¿äÇÑ °úÀ×Áø·á°°Àº °ÍÀÌ µÇ°í ¸¿´Ï´Ù.


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On the bulb, 0.5cm sized round shaped ulcerative lesion with even base, sharp edge and regular hyperemic margin was seen. Just lateral to this lesion, 0.4cm sized shallow erosive lesion was also noticed.

Dx : DU, A2

Tx : À§¿¡¼­ HP random biopsy´Â ½ÃÇàÇÏ°í ȯÀÚÀÇ Áõ»óÀ¯¹«¸¦ ¹°¾îºÁ¼­ PPI Åõ¿© ¿©ºÎ´Â °áÁ¤ÇÒ °Í °°½À´Ï´Ù

@ ÀÌÁØÇàÀÇ one point lesson: ÀÏ´Ü ±Ë¾çÀÌ ¾Æ´Õ´Ï´Ù. ±Ë¾çÀ̶ó¸é Á¦¹ý ±×·²½ÎÇÏ°Ô ÆÄ¿© ÀÖ¾î¾ß ÇÏ°í °Ô´Ù°¡ active stage¶ó°í ÇÏ·Á¸é ÁÖº¯ÀÇ ºÎÁ¾µµ ÀÖ¾î¾ß ÇÕ´Ï´Ù. Å©±âµµ 5 mmº¸´Ù ÈξÀ ÀÛ½À´Ï´Ù. ¹Ì¶õÀÌ°í Çϸé ÁÁ½À´Ï´Ù.


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Bulb¿¡ 0.5cm ¹Ì¸¸ÀÇ erosionµéÀÌ º¸ÀÌ°í ÀÖÀ¸¸ç ÁÖº¯ Á¡¸·ÀÇ hyperemia ¼Ò°ßµµ °°ÀÌ º¸ÀÔ´Ï´Ù. Áø´ÜÀº erosive duodenitisÀÌ°í ¼ÒÈ­±â°è Áõ»ó(¼ÒÈ­ºÒ·®, ¾²¸², ÅëÁõ)ÀÌ ÀÖ´Ù¸é PPI »ç¿ëÀ» °í·ÁÇÏ°Ú½À´Ï´Ù.

@ ÀÌÁØÇàÀÇ one point lesson: ¹Ì¶õÀ¸·Î º¸½Å °ÍÀº ÁÁ½À´Ï´Ù. ±×·¯³ª ¼ÒÈ­±â°è Áõ»óÀÌ ÀÖ´Ù°í ÇÏ´õ¶óµµ ±× Áõ»óÀº ½ÊÀÌÁöÀå ¹Ì¶õ°ú ¹«°üÇÒ °Í °°½À´Ï´Ù.


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Erosive mucosal lesion À¸·Î ±â¼úÇÏ°í duodenitis ·Î º¸°í °æ°ú °üÂûÇϵµ·Ï ÇÏ°Ú½À´Ï´Ù

@ ÀÌÁØÇàÀÇ one point lesson: Excellent! 100Á¡.



[FAQ] ½ÊÀÌÁöÀå±Ë¾ç Áú¹®¿¡ ´äÇÕ´Ï´Ù.

2021-1-17


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Dduodenal bulb ÀÇ erosions -> biopsy¸¦ ÇÏ°í °á°ú¸¦ È®ÀÎÇÏ°Ú½À´Ï´Ù.

@ ÀÌÁØÇàÀÇ one point lesson: ªÀº ´äº¯ÀÔ´Ï´Ù. Á¤È®ÇÑ Áø´ÜÀ̱¸¿ä. À§ÀÇ single erosionÀº malignancyÀÇ °¡´É¼ºÀ» °í·ÁÇÏ¿© Á¶Á÷°Ë»ç¸¦ Çϵµ·Ï ±ÇÇÏ°í ÀÖ½À´Ï´Ù. ±×·¯³ª ½ÊÀÌÁöÀåÀÇ single erosionÀº º°´Ù¸¥ Àǹ̰¡ ¾ø´Â °æ¿ì°¡ ´ëºÎºÐÀ̹ǷΠƯº°È÷ ³ª»Û ¼Ò°ßÀÌ ¾øÀ¸¸é Á¶Á÷°Ë»ç´Â ÇÏÁö ¾Ê¾Æµµ ÁÁ½À´Ï´Ù.


[References]

1) EndoTODAY ¹«´äÅä·Ð - ¼ÒÈ­¼º ±Ë¾ç

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (2015-6-22)