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1 x /83mmHg 79/ 36.0
2 1
3 WBC 6900/mm 3 RBC 432x10 3 /mm 3 Hb 11.8g/dl Hct 39.1 MCV MCH MCHC 90.5fl 27.3pg 30.2g/dl Plt 299x10 3 /mm 3 granulocyte 38%
4 201x 9 27
5
6 S
7 S
8
9
10
11 2 3
12
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14 PAS
15 acute infectious colitis ulcerative colitis \ The preservation of crypt architecture and the lack of plasmacytosis in the lamina propria Arch Pathol Lab Med 2012
16 acute infectious colitis ulcerative colitis Biopsies taken even within a few days of a first bout of bloody diarrhea show expansion of the lamina propria and separation of the crypts by a dense, fullthickness inflammatory infiltrate dominated by plasma cells, lymphocytes, histiocytes, and eosinophils in varying proportions However, crypt branching and disarray, considered hallmarks of chronic IBD, commonly develop gradually during the course of subsequent months. Clin Gastro Hepato 2007
17 IBD non-ibd Sn,Sp>96% H1: H2: H3:Basal plasmacytosis + H4:Paneth ( S=2H1+3H2+3H3+2H4-4 S 2 IBD S=1 IBD S=0 S=-1 non-ibd S -2 non-ibd 0
18 TP 7.8g/dl Alb 55.9% α1-gl 3.5% α2-gl 10.1% β-gl 11.7% γ-gl 18.8% M-protein not detected stool culture negative Ig Free Light-chain κ 18.3mg/dl λ 18.8mg/dl κ/λ 0.97
19
20
21 TP 7.8g/dl Alb 55.9% α1-gl 3.5% α2-gl 10.1% β-gl 11.7% γ-gl 18.8% M-protein not detected stool culture negative Ig Free Light-chain κ 18.3mg/dl λ 18.8mg/dl κ/λ 0.97
22 Segmental colitis (Sigmoiditis with rectal sparing and skip lesion) Bacteria; (Campylobacter), Salmonella, Shigella, Yersinia, Vibrio, C. difficile, Spirochaetosis, Tb Enterohemorrhagic E. coli Virus; CMV Prasites; Entamoeba histolytica, Schistosoma Diverticulosis associated Ischemic colitis Acute mesenteric ischemia Mesenteric pannuculitis Drug induced: NSAIDs, Penicillin induced segmental colitis, Gold, Retinoic acid, Contraceptive Idiopathic mesenteric phlebosclerosis Allergic colitis / Eosinophilic colitis Radiational colitis GVHD Amyloidosis Collagenous colitis / Lymphocytic colitis Vasculitis associated; Henoch-Schönlein purpura, Beçhet disease, etc. Neoplastic disease Cancer: Scirrhous Lymphoma IBD UC:segmental colitis CD Indeterminate colitis
23 Segmental colitis (Sigmoiditis with rectal sparing and skip lesion) Bacteria; (Campylobacter), Salmonella, Shigella, Yersinia, Vibrio, C. difficile, E. coli, Spirochaetosis, Tb Enterohemorrhagic Virus; CMV Prasites; Schistosoma, Entamoeba histolytica Diverticulosis associated Ischemic colitis Acute mesenteric ischemia Mesenteric pannuculitis Drug induced: NSAIDs, Penicillin induced segmental colitis, Gold, Retinoic acid, Contraceptive Idiopathic mesenteric phlebosclerosis Allergic colitis / Eosinophilic colitis Radiational colitis GVHD Amyloidosis Collagenous colitis / Lymphocytic colitis Vasculitis associated; Henoch-Schönlein purpura, Beçhet disease, etc. Neoplastic disease Cancer: Scirrhous Lymphoma IBD UC:segmental colitis CD Indeterminate colitis CT MTZ new quinolone
24 CT sil-ii R 394U/ml ( )
25 201x/9/27 10/6 hematochezia MTZ 750mg STFX 100mg colonoscopy stool culture abdominal CT
26
27 201x/9/27 10/6 hematochezia MTZ 750mg STFX 100mg colonoscopy colonoscopy stool culture stool culture abdominal CT
28 10 9 2
29
30
31 IBD non-ibd Sn,Sp>96% H1: H2: H3:Basal plasmacytosis + H4:Paneth ( S=2H1+3H2+3H3+2H4-4 S 2 IBD S=1 IBD S=0 S=-1 non-ibd S -2 non-ibd +1
32 MPO-ANCA <10EU ASCA (anti-saccaromyces cerevisiae antibody) :not done 2nd stool culture: negative
33 Ulcerative colitis, segmental colitis
34 201x/9/27 10/6 10/14 10/26 10/31 11/8 11/17 11/25 12/4 hematochezia hematochezia MTZ 750mg STFX 100mg Amy100mg/dl SASP 3g 5-ASA 1.5g general fatigue 750mg PSL colonoscopy colonoscopy colonoscopy stool culture stool culture abdominal CT abdominal CT
35
36 SASP 5-ASA
37, 9-14, 2017 : cefcapene piperacillin 3 CT Clostridium difficile CD vancomycin CD 7 Clostridium difficile CD CD associate
37, 9-14, 2017 : 36 2015 8 6 cefcapene piperacillin 3 CT Clostridium difficile CD vancomycin 20 1983 2016 3 CD 7 Clostridium difficile CD CD associated diarrhea : CDAD CD 1,2 PPI 3 1 36 33 2015 8 6 5 5
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