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상부 및 하부 위장관 출혈의 감별에서 Blood Urea Nitrogen/Creatinine 비의 유용성
김강희,박희욱,박승근 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.3
Background/Aims: When stools containing altered blood are the sole evidence for acute gastrointestinal bleeding, the bleeding source is uncertain. Because the absorption of blood products via the small intestine is responsible for azotemia after gastrointestinal bleeding, patients with colorectal bleeding rarely become azotemic. Therefore the blood urea nitrogen to creatinine ratio (BUN/Cr ratio) is believed to reliably discriminate upper gastrointestinal bleeding (UGIB) from lower gastrointestinal bleeding (LGIB). This study was conducted to evaluate the BUN/Cr ratio for distinguishing an upper versus lower source of gastrointestinal bleeding. Methods: Charts of patients who were admitted to Maryknoll hospital with the diagnosis of gastrointestinal bleeding from August 1994 to August 2000, were retrospectively reviewed for source of bleeding, initial blood urea nitrogen (BUN), creatinine (Cr), BUN/Cr ratio, hemoglobin, and hematocrit. Results: A total of 298 patients were eligible for inclusion, 210(70%) of whom were male. A total of 168 (56%) patients had and UGIB. Gastric ulcer disease (42%) and esophagenal varices (27%) were the most common causes of UGIB, whereas malignant neoplasm was etiologic in 29% of LGIB episodes. The mean±standard deviation BUN/Cr ratio was significantly higher in UGIB than LGIB (34.1±12.9 vs. 12.2±3.8; p$lt;0.0001). Conclusions: The BUN/Cr ratio may be a useful tool in distinguishing upper from lower sources of gastrointestinal bleeding, especially in patients with an uncertain source that could be upper or lower in origin.
수술중 내시경으로 진단된 장출혈을 동반한 공장 결핵 1 예
이규환,김대영,윤선희,김강희,옥종한,이동렬,조진훈,박희욱 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.2
Tuberculosis is a multiorgan disease. The incidence of pulmonary tuberculosis is declining due to improvement in public health, vaccination and the development of antituberculosis medication, but extrapulmonary tuberculosis has become more common, especially in immunocompromised individuals, AIDS patients and immigrants to western worlds. Gastrointestinal tuberculosis continues to give rise to diagnostic and therapeutic challenges. The jejunal tuberculosis is uncommon and presents a difficult diagnostic problem. Bleeding jejunal tuberculosis is a very rare source of lower gastrointestinal bleeding. We have recently experienced a case of a jejunal tuberculosis which was proven to be a source of gastrointestinal bleeding by intraoperative endoscopy and was confirmed by surgical exploration. This report summarized our experience and review of literature.