1. Put the preliminary diagnosis.

2. Conduct a differential diagnosis.

3. What additional research is needed?

Answer

1. There is no evidence of the presence of viral hepatitis, no. The diagnosis: a tumor hepatoduodenal area subhepatic jaundice.

2. The differential diagnosis should be made between the pancreatic tumor, bile ducts and the major duodenal papilla. All these pathological conditions may be accompanied by the development of jaundice and subhepatic manifest cholera clinic syndrome stasis. The patient is likely pancreatic tumor, given the long history of the disease and the presence of chronic pancreatitis pain.

3. Recommended holding ultrasound of the abdominal cavity and the retrograde cholecystopancreatography.

Task 5

The patient, 18, was discharged from hospital on the 32 th day of illness with diagnosis "viral hepatitis B, acute form." Condition at discharge was satisfactory. Recommended monitoring by a doctor. A monitoring visit and examination after 2 weeks feel good, no complaints. The skin and the sclera clean.

Biochemical analysis of blood: total bilirubin - 23.4 mmol / L (normal to 20.5); ALT - 101 IU / L (normal 0-40); AST - 86 IU / L (normal 0-45). Discovered HBs IgM.

1. Determine the further tactics of the patient.

2. Do I need a re-hospitalization?

3. Assign the treatment if it is needed.

Answer

1. Taking into account the slight over UGA, increased activity of ALT, AST, HBsAg detection on the 45th day of the disease, it is necessary to investigate the blood DNA, HBsAg, anti-HBe and anti-HDV IgM, IgG (if the patient has not previously tested for markers of delta -hepatitis A).

2. In the event of situations that go beyond the usual course of the Acute viral hepatitis, to clarify the tactics of the patient is recommended to clarify the tactics of hospitalization.

3. When a replication markers HBV (DDP DNA, HBeAg) to prevent a protracted course of the disease or its transition phase in CHRONIC recommended the appointment of antiviral therapy (lamivudine (zeffiks *) or a-interferon) to their disappearance from the blood serum (antivirals not included in the officially recommended treatment standard OF acute viral hepatitis).

Task 6

The patient, 56 years old, sent to the hospital with a diagnosis of "hepatitis". Complaints on admission to the strong itching at night, insomnia, jaundice of the skin and sclera. Ill about 3 weeks ago, when darkening the color of urine, jaundice appeared. Itching disturbed patient before 1.5-2 years, but she bound it with diabetes which was diagnosed 3 yrs ago. She is not taking Antidiabetic drugs

On examination: condition is satisfactory. Increased supply. Jaundice is moderate. Traces scratching on the skin of the trunk and extremities. Palmar erythema. Xanthelasma under the skin of the periorbital area. Hyperpigmentation of the skin of face, neck. In the lungs vesicular breathing. Heart sounds are muffled, rhythmic. Blood pressure 140/80 mm Hg, pulse rate 72 per minute. Language moist, coated with white bloom at the root. Abdomen soft, painless on palpation. Palpated the liver edge to 5-6 cm below the level of ribes. Percussion increased spleen size. urine is dark in color.

Complete blood count: hemoglobin - 135.0 g / l, erythrocytes - 3.5x 1012 / L, platelets - 186.0 * 109 / L, white blood cells - 4.2 * 109 / L, stab - 5%, segmented - 65 % eosinophils - 5% lymphocytes - 18% monocytes - 7%, ESR - 35 mm / h.

Biochemical blood test: whole protein - 60 g / L (normal 65-85); albumin - 31 g / L (normal range 35-50); creatinine - 105.2 mmol / L (normal 55-115); Cholesterol - 7.4 mmol / L (normal 3,5-5,2); total bilirubin - 124.5 mmol / L (normal to 20.5); direct bilirubin - 82.0 mmol / L; ALT - 147 IU / L (normal 0-40); AST - 153 IU / L (normal 0-45); AP - 643 IU / L (normal 64-306); GGT - 747 IU / L (normal 5-50); Glucose - 7.5 mmol / L (normal 3.5-5.5); prothrombin index - 120% (normal 80-100).

HBsAg, IgM anti-HBc, anti-HCV, anti-HAV IgM, anti-NEV IgM were detected in the blood.