问题 单项选择题 案例分析题

患者男,42岁。10小时前饱餐后出现持续性上腹痛,2小时前开始出现咳嗽,进行性呼吸困难。查体:BP85/50mmHg,P122次/分,T38.8℃,巩膜黄染,全腹压痛,伴反跳痛及肌紧张。血淀粉酶700U/L。

为了进一步评价该患者的病情,下列哪项检查最合适?()

A.胰腺CT增强

B.腹部超声

C.胃镜

D.消化道血管造影

E.肾功能

F.慢性胆囊炎

答案

参考答案:A

解析:5.根据题干提供的信息,要求掌握重症急性胰腺炎的诊断标准,该患者出现腹膜炎体征,所以考虑为重症急性胰腺炎。除了腹膜炎体征以外,还出现进行性呼吸困难,所以要化验血气分析除外ARDS,急查心电图除外心律失常或心肌梗死。急性胰腺炎的发病原因有多种,题干提示“饱餐”,即暴饮暴食,暴饮暴食使短期内大量食糜进入十二指肠,引起 * * 水肿和0dii括约肌痉挛,同时刺激大量胰液与胆汁分泌,由于胰液和胆汁排泄不畅引发急性胰腺炎。鉴别胰腺炎的病情,胰腺增强CT是最佳方法。胰腺炎外科治疗适应证:胰腺坏死合并感染;胰腺脓肿;胰腺假性囊肿;胆道梗阻或感染;诊断未明,疑有腹腔脏器穿孔或肠坏死者行剖腹探查术。该患者腹部超声提示肝内外胆管未见扩张,应该内科保守治疗。

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单项选择题

Don’t have time to read anymore Now you can get free, quick literature via email. More than 100,000 people open their email each day to read a chapter of a book, through Chapter-A-Day, an online book club created two years ago. It’s a free email service that provides a short daily reading for busy people, exposing them to literature they may not find on their own, inspiring some to recommit to the reading habit. About 550 public library systems representing over 3,000 branch libraries already have signed up to offer Chapter-A-Day. Via email, participants get about five minutes’ worth of reading every day. After three chapters are emailed, the installments stop, and those who want to keep reading can borrow the book at their public library or purchase it online. Chapter-A-Day has eight free book clubs, and sells thousands of books each month.

Chapter-A-Day started in 1999 when Suzanne Beecher, a lifelong book lover, realized how many of the women who worked part-time for her software development company didn’t have time in their busy lives to read. She decided to type part of a chapter of a book, and send it to her employees through email. The next day she typed a little more, and continued to send literary installments each day. She says she started getting feedback from the staff about how reading made them feel. "They were interested, and realized that, though they didn’t have time in their busy lives for reading, just reading that little bit each day got them back in the habit." Realizing that many other people could benefit, she decided to take the idea even further and start an email "chapter-a-day" book club to help others ease their way back into daily reading. "Reading makes changes in people’s lives," Beecher says.

Pat Dempsey, a librarian at a public library in Ohio, has found Chapter-A-Day helps her library clients get back in the habit of reading. "It’s a different way to get people hooked on hooks," she says.

The passage was written in ().

A. 1999

B. 2000

C. 2001

D. 2002