1. Put the preliminary diagnosis.

2. Conduct a differential diagnosis.

3. What additional studies need to spend?

4. Assign a treatment plan based on the presumptive diagnosis.

Answer

1. There are no indicationsfor the presence of viral hepatitis.Diagnosis: primary biliary cirrhosis.

2.Banti syndrome, secondary cutaneous signs, jaundice may indicate the presence of chronic hepatitis with cirrhosis in the outcome. A frequent cause of chronic hepatitis viruses are B, C and D, or a combination thereoies, which is not confirmed in the case of blood test ELISA. However, complaints about long itching history, xanthelasma, sex and age of the patient, the data of biochemical analysis of blood (increased rates of alkaline phosphatase, exceeding values ​​of ALT and AST, increased glucose, total cholesterol) with negative results of a survey on the marker of viral hepatitis indicate probable diagnosis of primary biliary cirrhosis. It is necessary to eliminate the disease accompanied by jaundice subhepatic nature, and liver metastases. In the absence of these conditions indicates a long history of the disease.

3. It is necessary to study blood autoantibodies, primarily - on mitochondrial and antinuclear; Ultrasonography of the abdomen.

4. Main drug for the treatment of biliary cirrhosis is the preparation of ursodeoxycholic acid (Ursofalk * ursosan * * ursodiol), at a dose of 15-18 mg / kg of body weight per day in 2 admission, a long term (appointment of the drug prevents fibrosis ,It reduces itching).

Task 7

The patient, 25 years, appealed to the clinic with complaints of nausea and heaviness in the epigastric region. Ill three days ago.

On examination: condition is satisfactory. Jaundice is not. The skin and the sclera clean. In the lungs vesicular breathing. Cardiac clear, rhythmic. Blood pressure 120/80 mm Hg, pulse rate 66 per minute. Language clean, wet. The abdomen was soft. Palpated the liver edge, painful. The spleen is not palpable. stool is colored, the urine is light.

The general analysis of blood and urine - without features.

Biochemical blood test: whole protein - 77 g / l; total bilirubin - 25.4 mmol / l; ALT - 3856 IU / L; ACT - 2543 IU / L; GGT - 117 IU / L; SCHF- 124ME / L.

The results of blood tests for anti-HCV (additional) positive. The results of blood tests for HBsAg, anti-HBc IgM anti-HAV IgM negative.

1. Put the preliminary diagnosis.

2. What additional research should be carried out?

3. Make a treatment plan.

Answer

1. The diagnosis of "acute hepatitis C", given the presence of symptoms before jaundice period of high activity of ALT, AST, bilirubin increase, the negative results of the survey on the markers of viruses A and B.

2. Blood test for anti-HCV IgM and RNA NSO.

3. Currently recommended a course of antiviral therapy with interferon in a dose-3 million IU daily subcutaneously 3 times a week for 12-24 weeks or more, depending on response to therapy. With the ever-higher levels of ALT, AST, detecting HBeAg or DNA DDP index of liver fibrosis, and 2 more recom-mended course of antiviral therapy (including those without a liver biopsy).

Task 8

The patient, 35 years old, was examined in the clinic for employment. Life history and epidemiological history unremarkable Man parenterally-intervention is not carried out in the last 6 months prior to this treatment, ported diseases - influenza, sore throat.

On examination, no pathology was found in the internal organs. Laboratory tests, in the general analysis of blood and urine revealed no pathology. In the biochemical analysis of blood revealed an increase of ALT to 134 IU / L, the other parameters are not changed. The blood ELISA detected HBsAg, anti-HCV have been identified.