问题 问答题 简答题

男性,40岁患者。乙肝病史10年,近2周发热,腹痛用泻,继之腹胀尿少,嗜睡。查体:T38℃慢性肝病面容,表情淡漠,计算力下降,巩膜黄染,肝掌(+)。双肺(-),心率83次/分,律齐,腹膨隆,腹壁静脉显露,全腹轻压痛,无明显肌紧及反跳痛,肝未及,脾肋下2cm,质中,移浊(+),WBC1.2×10/L,N89%,HBsAg(+),A/G0.6,ALT65U/L,AST55U/L,问本病例的基本诊断及诊断依据是什么?应作哪些检查明确诊断及检查目的?(与诊断相关的检查)

答案

参考答案:

1.本病例的基本诊断及诊断依据:

(1)乙肝后肝硬化失代偿期并脾功能亢进。依据:长期乙肝病史;慢性肝病面容.巩膜黄染(+).肝掌(+);出现门脉高压表现(腹壁静脉显露,腹水);脾大;白细胞总数减少

(2)肝性脑病(二期)。依据:肝病基础上出现精神症状,以嗜睡、计算力下降为主要表现:有肝性脑病诱因(感染:发热、腹痛、中性粒细胞比例增高提示感染存在)

(3)感染:肠道感染或(和)自发性腹膜炎。依据:肝硬化失代偿期基础;有发热、腹痛、腹泻、中性粒细胞比例增高应考虑肠道感染;同时有腹胀、尿少腹水征阳性(移动性浊音阳性);腹部压痛;中性粒细胞比例增高应考虑自发性腹膜炎

2.应作哪些检查明确诊断及检查目的(诊断相关的检查)

(1)腹部B超、乙肝六项及肝功能检查:可确诊乙肝后肝硬化失代偿期并脾功能亢进

(2)腹水检查:明确有无自发性腹膜炎

(3)血氨:明确有无肝性脑病

(4)大便常规加培养:明确有无肠道感染

单项选择题
完形填空

    61    Being angry doesn’t really solve much, but what people do when they feel angry is important. The goal is to calm down and try to solve what is bothering you. This is hard for some kids and adults, too. Instead of calming down, some kids might keep getting more and more upset until they explode like a volcano!

   62    Their anger might be so strong that they lose control of their temper. They may act in ways unacceptable and hurtful. People may say that someone has trouble controlling their temper.    63   

Some kids might get so angry that they scream at their parents, break something, or even worse, hit their brothers and sisters.    64    However, it’s not OK for a kid to do any of those things. Kids don’t want to act in this way, but sometimes angry feelings can be hard to manage. So what to do?

Well, the good news is that kids don’t just have to keep making the same mistakes over and over again.    65     Imagine your temper as a puppy inside you that needs some training. The puppy is not bad-it will probably turn out a great dog. It just needs to learn some rules because, right now, that puppy is causing some problems to you.

You can train your temper.

You don’t want to cause trouble.

Kids should be allowed to express their feelings, even angry ones.

Everybody gets angry sometimes.

In fact, they usually mean that a kid behaves badly when feeling angry.

Instead of thinking of the person you are angry with, think of something else.

Some kids get angry more often or more easily than some others.