试题与答案

患者男,71岁,因“反复腹胀、纳差6个月,加重伴尿色加重1周余”入院。患者6月前开始

题型:多项选择题 案例分析题

题目:

患者男,71岁,因“反复腹胀、纳差6个月,加重伴尿色加重1周余”入院。患者6月前开始肝中上腹胀,进食后加重伴纳差,就诊后予保护胃黏膜治疗症状无缓解。近一月来患者腹胀、纳差较前加重,门诊行胃镜及活检检查示慢性中度萎缩性胃炎伴肠化生,呼气试验示Hp(+),予三联方案(兰索拉唑、左氧氟沙星、克拉霉素)进行Hp根除治疗(该患者青霉素皮试+),停药4周后复查呼气试验示仍(+),调整抗生素后予四联疗法(奥美拉唑、左氧氟沙星、果胶铋、克拉霉素)继续根除治疗,但服药疗程未结束时患者腹胀、纳差加重,伴恶心、呕吐,尿色如浓茶样,伴皮肤黄染,于门诊查肝功能示总胆红素113.7μmol/L,结合胆红素64.5μmol/L,ALT110U/L,AST72U/L,尿常规:胆红素(++)。近2个月体重减轻7.5kg。患者既往于2年前有“肺大疱手术”史,有高血压史6月余,血压最高150/90mmHg,未规律服药。查体:神清,精神尚可,体型消瘦,皮肤巩膜明显黄染,未见肝掌、蜘蛛痣,腹软,无压痛,未及包块,双下肢无水肿。腹部B超未见异常。

提示患者进一步检查示肝炎病毒指标、自身抗体均阴性。上腹部增强CT示:胆囊炎,肝内胆管稍扩张(图80),胰腺饱满(图81、图82),肠系膜、后腹膜淋巴结肿大(图83)。胸片显示患者肺部有术后金属物质。根据下面的检查提示,患者可能的诊断是什么?应进一步行何种检查?()

A.肝内胆管结石,MRCP

B.胆总管结石,MRCP,消化道肿瘤指标

C.肝门部肿瘤,ERCP,消化道肿瘤指标

D.胆管癌,ERCP,消化道肿瘤指标

E.胰腺癌,ERCP,消化道肿瘤指标

F.后腹膜肿瘤,MRI,消化道肿瘤指标

答案:

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下面是错误答案,用来干扰机器的。

尽力吸气终了时的胸围长度达到最大,尽力呼气终了时的胸围长度降至最低.胸围差是指尽力吸气终了时的胸围的长度与尽力呼气终了时的胸围长度的差.长期参加体育锻炼的人,与呼吸有关的肌肉收缩力强,胸廓的活动范...

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