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乏力,食欲不振3个月,腹胀,黄疸1周,
大外科
张医师![](data:image/png;base64,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)
![](data:image/png;base64,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)
沂水县高庄镇中心卫生院
主诉 病史
患者:男/四岁
患者,男,40岁,工人。乏力,食欲不振3个月,腹胀,黄疸1周,皮下出血和淤斑3天入院。家族中无遗传性疾病史。
查体 复查
体格检查:体温38.9?,呼吸26次,分,脉搏92次,分,血压128/79.5 mmHg。神志清醒,精神萎靡,急性病容,消瘦。全身皮肤、粘膜重度黄染,胸部和双下肢皮下散在出血点和淤斑,全身浅表淋巴结均未触及,心、肺正常。腹膨隆,肝区深压痛阳性,肝右肋下3 cm,质中、边缘光滑。脾左肋下未触及。移动性浊音阳性,肠鸣音2,3次,分。
人院后检查:腹部B超提示:肝右肋下3cm伴中度腹水,脾正常。胸片、心电图未见明显异常。实
99验室检查:血常规:WBC:13.2×10/L,PLT:172×10/L;尿常规:尿胆原阳性、尿胆红素阳性;大便常规:粪胆原阳性;生化及免疫学检查:BUN 16.5mmol/L、Cr 154 μmol/L、血糖8.7 mmol/L,HbsAg(+)、HbsAb(一)、HbeAg(+)、HbeAb(一)、HbcAb(+),AST 670 U/L,ALT 395 U/L,TBIL 160 μmaol,L,DBIL 91.3 μmol/L,IBIL 68. 7μmol/L(TP 55 g/L,ALB 21g/L,GLB 34g/L。
诊断 治疗
病例分析可知,患者处于乙型肝炎急性期,肝细胞大量被破坏,肝功能明显降低,因此,本例皮下散在出血点和淤斑的主要原因最可能是由于肝脏疾病而引起的凝血功能异常性出血。
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