医学生物ppt般内科病例讨论（1）课件

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1、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.

2、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.Thenhetooksomegastricmedicationhomeandfeltb

3、etter.Buttheintermittentpainwasstillpersisted.Severeabdominalpaininrecentlytwoweeks.Feverandmildweaknesswasalsonoted.ThepainpatternlocatedinRUQ.Lastformorethan30mins.Intermittent.Noradiation.Noaggravatefactorbutrelifeinbedrest.In斗六醫院,abdominalsonographyshowedonelivermasstransfferto台大雲林醫院thesamefi

4、nding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]withSegmen

5、t[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.Usualmedicat

6、ion: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(-)Hear

7、tdisease(-)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(-),anicteric