医学生物ppt般内科病例讨论（1）课件

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ㄧ般內科病例討論2009-02-05奇美PGY楊清傑/VS鐘焜明1业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 BasicdataName:杜慶XGender:maleAge:57y/oOccupation:workerBednumber:9003AChartNumber:27248554Dateofadmission:98/02/012业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 ChiefcomplaintAbdominalintermittentdullnesspainfor1yearandprogressedinrecent2weeks.3业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 PresentillnessHepatitisBcarrierfor30yearsandtook保肝片formlocalpharmacy.Surgicalhistory:sciaticn.pains/pmanyyearsago.Sufferedfromabdominalintermittentdullnesspainfor1year.Hecametolocalclinicforhelpandwastoldjustgastriculcer.Thenhetooksomegastricmedicationhomeandfeltbetter.Buttheintermittentpainwasstillpersisted.Severeabdominalpaininrecentlytwoweeks.Feverandmildweaknesswasalsonoted.ThepainpatternlocatedinRUQ.Lastformorethan30mins.Intermittent.Noradiation.Noaggravatefactorbutrelifeinbedrest.In斗六醫院,abdominalsonographyshowedonelivermasstransfferto台大雲林醫院thesamefinding屏東基督教醫院CTsuspectedliverabscessortumor.4业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 PresentillnessAtourER‧Nofever,nocoldsweating,novomiting,nodyspnea,nochestpain,nodysuria,butmalaise,poorappetite,abdominaldullnesspainnoted.‧CXRshowednormal,nodefiniteactivelunglesion.‧LabdatashowedW.B.C.[12.9]withSegment[82.5]，CRP[141.3]。GOT[142]，GPT[24]。Impressionoffeversuspectedliverabscessandhepaticmass.Admittedon98/02/01forfurtherevaluationandmanagement.5业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 PastMedicalHistory1.Previousdisease:HTN(-),DM(-),CAD(-),HBVcarrierfor30+years.2.Drugallergy:Noknownallergy.3.Usualmedication:保肝片6业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 PersonalHistorySmoking:1ppdfor30~40yearsDrinking:oneglassof洋酒/dayBetelnutsuse:quitfor30+years.Historyofoverseatravel:deniedHistoryofcontactwithanimalsorsickpeople:denied.7业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 FamilyHistoryDiabetesMellitus(-)Hypertension(-)Heartdisease(-)HBVdisease(+)Cancerhistory(-)8业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 PhysicalExaminationGeneral:acuteill-looking,weakness.Vitalsign:T/P/R=36.2/114/20,BP=124/60HEENT:paleconjunctiva(-),anictericsclera(-)Chest:bilateralairentry(+),breathingsounds:clearHeart:RHBwithoutmurmur,S1(＋)；S2(＋)；S3(－)；S4(－)Abdomen:Soft,flat,nodistension,adnominalpainoverRUQ,murphysign(-),mass(-),woundoropscar(-)Extremities:freelymovable,pittingedema(-),bedsores(-),rash(-)9业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 LabdataWBC:12900PT/aPPT:12.7/28.9Seq:82.5%INR:1.2RBC:4.00Hgb:12.8MCV:93%CRP:141.3Platelet:14310业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 LabdataSMA:Glucose:146BUN:15Cr:0.7Na:126K:3.88GOT:142GPT:24Albumin：3.1，BiliTotal：1.1811业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 ImagestudyCXR12业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 Tentativediagnosis1.Feversuspectedliverabscess2.Livermass,cancerorabscess?3.HBVcarrier.13业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 AdmissioncourseAdmissionon98/02/01Panadol1#QIDpoMorphine4mgprnimFlumarin1gmq12hivN/S40ccq1hiv14业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 AdmissioncourseAbdominalsonographyon02/02Liver:Theechogenicitywascoarse.Thesizewasnormal.Thesurfacewassmooth.Onehugemass(>6cm)withscatteredcalicifiedspotsatLtlobeandinvolvingtoRtlobe.Portalvein:ThrombosisofLtportalvein.Intrahepaticduct:MilddilatationofLtIHD.Diagnosis:1.Parenchymalliverdisease2.Hepatictumor,R/OCholangiocarcinomaorHCC3.LtIHDdilatation4.Ltportalveinthrombosis15业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 16业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 Admissioncourse98/02/03LabdataCEA：8.51CA199：1119Anti-HCV(-)HBsAg(+)AFP：pending17业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 Admissioncourse98/02/04AbxchangetoZinacef750mgq8hivCToftheabdomenThereisaninhomogeneoushypodensetumor,about10x9x6cmindimensionsintheleftlobe.Theproximalintrahepaticductsaredilated.IMP:1.Intrahepaticcholangiocarcinomaintheleftlobe.2.MetastaticparaaorticLNP,cephadaltotheleftrenalvein.18业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 19业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 20业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 AdmissioncourseConsultGSforsurgicalevaluation.21业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 Thankyouforyourlistening~22业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 23业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 24业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友 25业精于勤荒于嬉行成于思毁于随→【医学生物PPT，欢迎收藏分享】豆丁网友