医学生物ppt般内科病例讨论课件

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 1 般內科病例討論2009 02 09 PGY侯欣妤 VS鐘焜明 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 2 Basicdata Name 方x山Gender maleAge 43y oBednumber 9001AChartNumber 24114219Dateofadmission 98 02 01 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 3 Chiefcomplaint tarrystoolpassagesincelastmorning 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 4 Presentillness Caseoflivercirrhosis alcoholrelatedwasdiagnosedon93 10Admissionhistory severaltimesduetoEVbleedng GVbleeding hepaticencephalopathy andDUwithbleedingThistime hesufferedfromtarrystoolpassageoncelastmorningnofever nodizziness noabdominalpain novomiting nodyspnea nochestpain nodysuria nohematuria 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 5 Presentillness AtourER Vitalsign T P R 36 8 109 18 BP 115 89mmHgDevelopedofhematemesisonceatourERPE anemiaconjunctivaandictericscleraLabdata Hb9 7 P T 19 3A P T T 39 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 6 Endoscopy 98 01 31 Esophagus noevidenceofvaricesStomach Largeamountofcoffee groundmaterialwasaccumulatedinthefundusandhighbody Duodenum Multipleulcers 6mm 8mm overbulb Diagnosis UGIbleeding thebleederunclear r ogastricvaricesbleeding Duodenalulcers admittedon98 02 01forfurtherevaluationandmanagement 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 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 8 PastMedicalHistory 1 Medicalhistory Hypertension Diabetesmellitus ChronichepatitisB ChronichepatitisC Others livercirrhosis Acutepancreatitis2 Surgicalhistory THR bil 3 Drugallergy Noknownallergy 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 9 PersonalHistory 1 Smoking 1PPDfor20 years2 Alcohol 2bottlesofbeerfor20 yearsquiteforonemonth3 Betelnut nil4 Herbalmedication nil 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 10 FamilyHistory DiabetesMellitus Hypertension Heartdisease Cancerhistory 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 11 PhysicalExamination Vitalsigns BP 153 72mmHgPR 88 minutesRR 20 minutesBT 37 Consciousness Clear GCS E4M6V5HEENT Suppleneck ictericsclera paleconjunctiva 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 12 PhysicalExamination Chest Symmetricexpansion NormalrespiratorypatternClearbreathingsound nowheezing noralesHeart Regularheartbeat nomurmurAbdomen Soft distension striaeNotenderness nopalpablemassNormalactivebowelsounds 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 13 Laboratorydata 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 14 Imagestudy CxR Bluntingofleftcostophrenicangle eitherduetopleuralchangeorsmallamountofpleuraleffusion 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 15 Tentativediagnosis 1 UGIbleeding r ogastricvaricesbleeding2 Duodenalulcers 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 Admissioncourse Admissionon98 02 01 Pantoloc1Vq12hivGlypressin1mgq6hG5W 0 9 N S98 02 02Trysoftdiet 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 17 Admissioncourse 98 02 03Feverdeveloped 38 c abdominalpainAscitestapping draining1000ccZinacef750mlq8hVitB com1 tidFolicacid1 qdDCGlypressin1mgq6h 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 18 Imagestudy Sonographyofabdomen 98 2 3 Liver verycoarseecehogenicity smallliversizeunevenliversurfacenodefinitefocallesionintheliverGallbladder wallthickenedPancreas negative Spleen markedenlargedAscites Others Massiveascites 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 Ascites 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 Admissioncourse 98 02 04feversubsideAldactone1 bidLaxis1 qd 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 21 98 02 05Bloodculture 先行報告 GPCinchainAbxchangeto Augmentin 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 22 Admissioncourse 98 02 06B C Rocephin1gq12h 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 Spontaneousbacterialperitonitis 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 Spontaneousbacterialperitonitis Aninfectiouscomplicationofportalhypertension relatedascitesOccursin19 ofcirrhoticsClinicalmanifestationsFeverAbdominalpainReboundtenderness Cirrhoticp twithascites anyclinicals s DxpracentesistoexcludeSBP 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 DDxofBacterialperitonitis 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 26 RiskfactorsAscitesfluidtotalprotein2 5mg dlPriorSBPPathogens70 GNR E coli klebsiella30 GPC S pneumococcus otherstreptococci Enterococcus Spontaneousbacterialperitonitis 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 27 TreatmentCeftriaxone2gIVqdx5daysCefotaxime2gmIVq8hx5daysIValbumin1 5g kgatdiagn