1. Put the preliminary diagnosis.

2. What research is needed?

4. Severity of the disease and determine the treatment strategy.

Answer

1. CSO or delta virus superinfection in patients with chronic hepatitis B, taking into account the postponed last UGA, occurred 1.5 months ago genera transfusion of blood products, initially viral hepatitis.

2. It is necessary to get the results of blood count, total analysis urine, biochemical blood analysis, to evaluate the coagulation, prothrombin index, creatinine and urea levels in the dynamics and the ELISA results in which the infection should be identified, anti-HBc (for negative results of the survey for anti-HBc Ig M), anti-HDV IgM.

3. Given the acute onset of the disease, the severity of symptoms intoxication phenomena thrombus syndrome and acute hepatic encephalopathy degree, I can think of acute viral hepatitis (fulminant hepatitis). Treatment is carried out under the scheme therapy UGA heavy degree of inclusion in complex therapy components of the treatment of fulminant hepatitis. Treatment and monitoring of the patient should be carried out in the ward or intensive care unit.

Task 3

The patient, 57 years old, admitted to the Department of viral hepatitis with complaints of pain in the right hypochondrium permanent nature, nausea, vomiting, loss of appetite, fever, jaundice of the skin and sclera. Acutely ill, 3 days ago, with the appearance of pain in the right upper quadrant, associated with an error in the diet. The next day the pain was gone, there was nausea and was vomiting. The pain calmed down after taking shpy inside. The body temperature on the day of admission has raised to 38.5 ° C, and at reception in the clinic, doctor noticed yellowness of the skin and sclera.

On examination: a state of moderate severity. The body temperature of 38,4 ° C. Increased supply. The skin and the sclera are with moderate yellowness. No Rash. In the lungs vesicular breathing. Heart sounds muffled, rhythmic. Blood pressure 140/90 mm Hg, pulse rate 85 per minute. Tongue dry, brown and coated with white bloom. The abdomen was soft, painful in the right hypochondrium. Liver palpated at 4-5 cm below the costal margin, dense, painful. Positive symptomof Ortner. The spleen is not enlarged. Kalaholichen. The urine is dark brown.

Complete blood count: hemoglobin - 131.0 g / l, erythrocytes - 3.4 1012 / L, white blood cell, are you - 11,0h 109 / L, stab - 9%, segmented - 51%, eosinophils - 2%, lymphocytes - 30% monocytes - 8%, ESR - 19 mm / h.

Biochemical analysis of blood: total bilirubin - 123 umol / L (normal to 20.5); ALT - 63 U / L (normal 0-40); AST - 41 IU / L (normal 0-45); AP - 443 IU / L (normal 64-306); total cholesterol - 6.3 mmol / L (normal 3,5-5,2).

The results of blood tests on NVAg, IgM anti-HBc, anti-HCV, anti-HAV IgM, anti-IgM negative NEV.

1. Place and justify a preliminary diagnosis.

2. Make a plan to survey and determine the tactics of the patient.

Answer

1. There is no evidence of the presence of viral hepatitis. Given the onset of the disease with pain that arise after the errors in the diet that bears persistent character, the appearance of a feverish reaction against jaundice, moderate leukocytosis in the general analysis of blood, sex and age of the patient,we should think about gallstone disease with the development of cholecystitis. It is necessary to exclude the development of the secondary (relative to cholelithiasis), pancreatitis.

2. It is recommended to conduct ultrasound of the abdomen, with optionally-sary - retrograde cholecystopancreatography. General and bio-chemical blood tests in the dynamics. Carrying detoxification therapy, painkillers and antispasmodics. The issue of cholecystectomy (detecting stones inn gallbladder).

Task 4

The patient, 72 years old, was admitted to hospital with complaints of epigastric pain, fatigue, itching, yellowness of the skin and sclera, constipation alternating with diarrhea.

Ill about 2 months ago. There wasweakness, epigastric pain, no appetite, lost during the illness. To the doctor did not address. About 2 weeks ago, appeared itching, stool disorders, then turned yellow sclera. Directed at the hospital doctor clinic with a diagnosis of "hepatitis B".

The history: suffering from chronic pancreatitis. The last examination and treatment for acute pancreatitis - about half year ago (in a hospital).

On examination: condition is satisfactory. Right physique, reduced power. The skin and the sclera moderate yellowness. Traces scratchingon the skin of the lower limbs and trunk. In the lungs vesicular breathing. Heart sounds are muffled, rhythmic. BP 130/80 mm Hg, pulse 72 per minute. Tongue dry, coated with white bloom. The abdomen was soft, painful in the epigastric region. Palpated the liver edge, painless. The spleen is not enlarged. The urine is dark in color.

Complete blood count: hemoglobin - 125 g / l, erythrocytes - 3.2 * 1012 / L, leukocyte - 4.0><109 / L, stab - 5%, segmented - 70%, esinophils- formula - 1% lymphocytes - 20% monocytes - 4%, ESR - 29 mm / h.

Biochemical blood test: whole protein - 65 g / L (normal 65-85); Al-Bumin - 35 g / L (normal range 35-50); creatinine - 101.2 mmol / L (62-124); total bilirubin - 114.0 mmol / L (normal to 20.5); Cholesterol - 5.2 mmol / L (normal 3,5-5,2); ALT - 67 U / L (normal 0-40); AST - 63 IU / L (normal 0-45); AP - 358 IU / L (normal 64-306); GGT - 247 IU / L (normal 5-50); Glucose - 8.6 mmol / L (normal 3.5-5.5).

HBA IgM, IgM anti-HBc, anti-HCV, anti-HAV-IgM wives Detect not in the blood.