78 aspirin 10 (light-headed)(pale) (cold): (hematocrit) 29% (: 3646%)Table 1 (diverticula (diverticula (diverticula (diverticula (diverticula (diverticula (diverticula ) 2

,

1. ()1. 50%30%90%21210%15%2. 5%10%.3. 10%80%4. 1%7%

2. 1. 0.50.52. (NSAIDs) (NSAIDs) Crohn's disease3. (:)

3. 1. 2. 5-10 mmHg6 mmHg12 mmHg 3. 50%1. 2. 3. 4. 1. (Mallory-Weiss syndrome) 5~10%5%5. 1. () ()()BarrettBarrett Barrett

1. 1. 3%2040% 2.

/

3. 1. 2. 3. 4. 5. 6. 2. ()()10~30 () 3. 1. 1 (Type 1, neonatal staining) 2 (Type 2, intradermal capillary hemangioma) (salmon patch) (port-wine stain) (spider hemangioma) 3 (Type 3, juvenile hemangioma) (strawberry mark) (strawberry capillary hemangioma) (capillary-cavernous hemangioma) 4 (Type 4, A-V fistula) (arterial hemangioma) (hemangiomatous gigatism) 5 (Type 5, cirsoid angioma)2. 40%Valdo(1983)60%Dr Bower(1960)50%65%70%90%1. 2. 3. 4. Dopamanin SerotononNorepinephrine1. Dopamanin1. (mesocorticalA8A10) (prefrontal) (cingulated) (entorhinal) 2. 1. (ultra-short system ) 1. (interplexiform) (amacrine-like) (inner plexiform layer) (outer plexiform layer)2. (olfactory bulb) (periglomerular dopamine cellA16) (glomeruli) (mitral cell) 2. (intermediate length system) 1. (tuberohypophyseal dopamine cellA12) (arcuate nuclei) (periventricalar nuclei) (intermediate lobe) (median eminence) (prolactin) prolactin(PRL)(pure D2 blocker)(galactorrhea)(menstrual disorders) 2. (incertohypothalamic neuronsA14A15) (dorsal) (posterior) (hypothalamus) (lateral septal nuclei)3. (medullary periventricular cellsA11A13) (dorsal motor nucleus) (nucleus tractus solitarius) (periaqueductal gray matter) 3. (long length system) 1. (nigrostriatalA8A9) (substantia nigraSN) (basal ganglia) (Amalric and Koob, 1987)Parkinsons disease2. (mesocorticalA8A10) (prefrontal) (cingulated) (entorhinal) (Schizophrenia)(pure D2 blocker)(negative syndrome)(blunt affect,)() 3. Mesolimbic system(VTA-NA)(reward behavior)(addiction)hallucination,(delusion)4. --> (nucleus accumbens)(pure D2 blocker)hallucination(delusion)2. Serotonin1. 5-HT5-HT5-HT5-HT5-HT5-HT75-HT5-HT36G7335-H5-HT1. 5-HT15-HT5-HT325-HT5-HT235-HT5-HT22.5-HT5-HT25-HT45-HT3. 5-HT5-HT5-HT5-SSRIsMAOIs5-HT2. 5-HT(receptor)(function)(medicine)(pharmacological receptor)(treatment)

5HT1cAMPBuspirone5 HT1A

Sumatriptan5 HT1D

5HT2IP3DAGGqRisperidoneClozapine5-HT2(Dopamine receptors)

MirtazapineTrazodone5-HT25-HT

Ketanserin5-HT1C5-HT2alpha 1(Adrenoceptors)Carcinoid tumor

Cyproheptadine5-HT25-HT1Carcinoid tumor

5-HT3Na/KOndansetronGranisetron5-HT3

AlosetronIBS

5-HT4cAMPMospride5HT4GERD

Metoclopramide5HT4D2 receptor

Tegaserod5-HT4IBS

5-HT5cAMP

5-HT65HT-7cAMP

3. 3. Norepinephrine:

Adrenergic neuronAdrenergic neuronCholinergic neuron1. Tyrosine()adrenergic neurontyrosine hydroxylaseDopaNEDOPADOPA decarboxylasedopaminedopamine(synaptic vesicle)dopamine hydroxylase norepinephrinenorepinephrineepinephrine85%epinephrine15%norepinephrineNENENE(acetylcholinecholineacetatecholine)(uptake)uptake1[(sympathetic nerve terminal)] uptake 2()NEuptake 1NEMAO(monoamine oxidase)COMT(catechol-O-methyltransferase)MAONEdopamine5-HTCOMTnorepinephrineNorepinephrineepinephrineVMA (vanillylmandelic acid)norepinephrineepinephrine12DopamineNEserotonin1Phenylephrinenaphazolinemethoxamine12Clonidine22Terbutaline

: (): 1. (1)85%,,70%55%44%30%50%(2) 20 2. (1)B12130-140 g/L13-14 g/dL120-130 g/L12-13 g/dL (2)TC200LDL130HDL40mg/dl150mg/dl200239130159150199 mg/dl2401602003. (1) :()()() ()A. B. C. D.;ACTH;;;A.B.C. D. ;;A.B.C.()(1)1(2)(3)(4)()(5)()()A.;();-50 4.: (1) : ()(2) :5.() : :6. : : .~ .~ .~ .~ 1.100 2.

A.1. (1) 1015(2) 30(3) 40

2.

3. ()(1) (16)(2) (11)(MCV)80 fL(MCH)25 pg

4. (1)

(2) EPO(Platinum)(Taxane)(Navelbine)EPO(RecormonEprex)EPO(Aranesp)

(3) (EPO)glomerular filtration rate (GFR) < 60 ml/ min/1.73m2GFR) < 30 ml/ min/1.73m2

(4)

5. B12(1) (2) (3)()() B12

6.

B. -(1) (2)

1. http://www.kgh.com.tw/health/01-136.html2. http://www2.hkedcity.net/sch_files/a/abc/abc-lnk/public_html/Medicine/nerve2.html3. 2013:24:278-287

Case 1 1. ? ?20530%20%50%2.5 (1) (2) (3) (4) (5) (1)90mmHg20mmHg100/20/1020

(2)6090mmHg>

BP130-140 / 90-95mmHg

BP(90/60 ) > (75/45)

SBP>20DBP>10mmHg1. 2. 3. 4. 5.

4. (105 beats/min) (135 beats/min) baroreflex stretch receptorsafferent nervenucleus tractussolitarii carotid sinuses glossopharyngeal nervenucleus tractus solitariicaudal ventrolateral medullarostral ventrolateral medullaintermediolateral gray columnnucleus ambiguusdorsal motor nucleus of vagus60 mmHg120 mmHg60 mmHg120 mmHgarotic arch vagus nerve 40 mmHg

5. (central venous pressure) (pulmonary capillary wedge pressure) eEDV EDP

6. (hematocrit)? ? 1.()41~53%36~46%25% 24~48 6~126~11152~335 3025

7. ?(1)(2)(3)(4)

8. (Na+) RAAS0. Antidiuretic Hormone, ADH0. angiotensinogenangiotensin Iangiotensin I(Angiotesin converting enzymeACE)angiotensin II0. angiotensin II1. (aldosterone)1. (arteriole)(peripheral resistance)

9.

10. 1) reninangiotensinaldosterone system (RAAS) 2antidiuretic hormone (ADH)less that 20mL/hour inadequate renal perfusionprostaglandins ?Prostaglandin aldosteroneADH aspirin (prostaglandin)

11. (dopamine) dopamine (vasodilator)dopamine (vasoconstrictor)

(hypovolemic shock)?