Clinical case studies

(Correct answers are marked *)

 

Problem number 1. Patient A., '55, turned in CCCs with complaints of pain in the right upper quadrant and epigastrium, loss of appetite, weight loss, fever, increased abdominal volume. In history: moved hepatitis B, liver cirrhosis suffer. Objectively: skin and visible mucous icteric, palpable enlarged, dense liver, which comes from the subcostal to 12 cm in it palpable dense nodes. Determine the presence of ascitic fluid in the abdominal cavity. When puncture abdominal ascitic fluid sero-hemorrhagic nature - 6 p. Liver ultrasound: a diffuse increase in detected multiple nodes. Study on AFP revealed the presence of serum.

1. Put diagnosis.

A. Exacerbation of chronic hepatitis. Ascites

B.   Cirrhotic ascites

C. Tumor of the gallbladder

D.   Hepatocellular carcinoma liver T 4 N2M1. Ascites. *

E. Hepatocellular liver cancer T 3 N 1 M 0. Ascites.

2. Assign treatment.

A. In ydalennya ascitic fluid. Chemotherapy *

B.   Vnutryocherevyna polychemotherapy

C. Radiotherapy

D.   Removing ascitic rydyny.

E. Removing ascitic rydyny. Radiotherapy.

 

Problem number 2. Patient S., 60 years old, turned to the clinic with complaints of epigastric pain, anorexia, weight loss, itching and jaundice. He considers himself a patient for 3 months, not treated. OBJECTIVE: ikterychnist skin and sclera, abdominal palpation revealed resistance in the epigastrium, enlarged gall bladder. When radiography of the stomach and duodenum: Advanced Horseshoe duodenum, the narrowing of the intestine. CT: found a tumor in the head of the pancreas to 9 cm in diameter. Diagnosis: cancer of head of pancreas. jaundice. Assign treatment.

A. imposition holetsystoyeyuno ­ anastomosis

B.   polychemotherapy

C. imposition holetsystoyeyuno ­ anastomosis + polychemotherapy *

D.   pancreatoduodenal resection

E. symptomatic therapy

 

Problem number 3. Patient 47 years and three months noticed progressive pozho in shadow skin, dark urine and feces achromatic. When OBST is Jenny found a large tumor papilla placed and rum 2 cm distant metastases were found. What is the treatment for the patient would be best where?

A. Konservaty in the ter and Pius spazmolit and Kami and bile Ginn e pr e Paraty

B. Papilosfin k retot at miya

C. Pankreatoduodenal b for resection *

D. Holedohot at miya from outside w it drains in the bathroom lounge is Doha.

E. Holedohot at miya from outside w it drains in the bathroom lounge is Doha.

 

Problem number 4. Patient 62 years for 2 months experienced general weakness, dull epigastric pain, lost appetite, lost 12 lbs. Two weeks ago, back home he noticed yellowing of the skin, which at hresuye Ave. Cal gray, dark urine. An examination of the right upper quadrant Avenue at matsuyetsya increased stressful zhovchevyy bubble. What research effectively help you Install and cause jaundice?

A. Ultrasound pankr e atoduoden and flax zone *

B. Angiograms and raphy

C. Oral and holanhiohr raphy

D. Hastrofibr at oxidized

E. Fluoroscopy gastrointestinal

 

Problem number 5. The patient in '48 diagnosed with pancreatic cancer T3N0M0, almost total defeat. Select the type of surgery.

A. Bypass holets and stoeyu Mr. oanast at MOH

B. Cholecystitis with volume

C. Distal resection pi d stomach cancer at ing

D. Pancreatectomy *

E. Pankreatod in odenal b for resection