问题 单项选择题 案例分析题

患者女,48岁。早餐进食煎鸡蛋后出现右上腹痛。追问病史,患者近半年数次发作性右上腹疼痛,为绞痛,多为夜间睡眠后发作,并向右肩部放射,无发热,偶有恶心,无呕吐。查体:肥胖体质,BP110/80mmHg,P90次/分,右上腹轻度压痛,无腹肌紧张。

提示:该患者就诊后第3天,再次出现腹痛,为持续性疼痛,并出现黄疸,发热。应首先考虑有()。

A.急性坏死性胰腺炎

B.胆囊穿孔性腹膜炎

C.亚急性肝坏死

D.胆囊癌侵犯肝总管

E.胆囊结石进入胆总管并堵塞远端

F.胆囊结石进入胆囊管并嵌顿

G.胆囊结石发作

H.暴发性肝衰竭

答案

参考答案:E

解析:

2.腹部B超为首选检查方法,ERCP为有创检查手段,不做首选。

3.该患者表现为发作性右上腹绞痛,伴右肩部放射痛,提示胆道结石可能大。B超提示胆囊内可见多个高回声结石,后方有声影,可诊断为胆囊结石。

4.该患者有胆囊结石,再次出现腹痛,伴有黄疸,发热,考虑为胆囊结石进入胆总管并堵塞远端所致。

7.该患者已经出现化脓性胆管炎,结石嵌顿,此时最关键的治疗措施应为胆道引流解除梗阻。若在未考虑到化脓性胆管炎的情况下,予以止痛治疗可能会延误病情。

专家点评:急性梗阻性化脓性胆管炎是急性胆管炎的严重阶段。其特点是在胆道梗阻的基础上伴发胆管急性化脓性感染和积脓、胆道高压,大量细菌内毒素进入血液,可导致败血症、感染性休克以及多器官功能衰竭等。此患者有胆囊结石,出现了肝外梗阻的表现(较明显的腹痛、寒战高热、黄疸)。本病发病急骤,病情迅速发展,治疗原则是立即解除胆道梗阻并引流。

阅读理解

My friend, Victor, is a zoo keeper in the National Zoo. His work is very interesting but it is hard. Sometimes it is dangerous, too. Every morning the zoo keepers have to get up at five to prepare the food for the animals. Each kind of animal is given special food. For example, the lions must be given meat; the deer must be given grass and leaves; and the parrots must be given fruit and nuts. Sometimes some animals won't let the others eat their food. If this happens,  each of them must be fed separately(分离地) .

Every morning each cage must be washed by the zoo keepers. This can be dangerous, especially with lions and tigers. To make the work easier, the animals are locked in the sleeping compartments (隔间) while the cages are being washed. When the animals are sick, the zoo keepers must look after them. Each sick animal is kept in a separate cage and given medicine. Sometimes they must be given injections. It is not easy to inject(打针) a sick lion!

All the keepers live near the zoo. Each of them has a small house. There he lives with his family. They do not have holidays on Sundays and public holidays. Instead, each of them has a day off during the week. Each keeper has a holiday on a different day from that of the other keepers.

The most important job of the keepers is to look after the safety of the visitors. People must be prevented from doing dangerous things. Many people have been injured because they did careless things, like putting their hands into the lion's cage.

小题1:What kind of food must be given to the animals like tigers, lions and bears?

A.Nuts.

B.Fruit.

C.Meat.

D.Grass and leaves.小题2:Some animals must be fed separately because         .

A.they eat special food

B.they often quarrel with each other while eating

C.they always cause the zoo keepers much trouble

D.they won't let the others eat their food小题3:All the zoo keepers must work       .

A.seven days a week

B.on Saturdays

C.on special festivals

D.on weekdays小题4:The underlined word "injured" in the last paragraph(段落) means       .

A.受伤

B.被打

C.杀害

D.抓住

问答题 简答题