Akanksha Williamabout 5 years ago

Patient T., 42 years, admitted to the hospital in the direction of the district doctor with complaints of fatigue, daytime drowsiness, jaundice of skin, feeling of heaviness in the right hypochondrium, periodic nasal bleeding after physical work, increased abdominal volume, edema in the lower extremities in the feet and shins. Anamnesis: heaviness in the right hypochondrium has been troubling for the last 3 months. Over the past month, there has been an increase in General weakness, abdominal enlargement and jaundice. Consumes vodka on 200 g daily in for the last year, is observed have narcologist. Drug use denies. There were no blood transfusions, no surgeries. St praesens objectivus: the state of moderate severity. Growth-178 centimeters, Weight-62 kg. Skin usual moist, jaundiced. In area breast and the upper parts of backs are visible "vascular asterisks." The sclera of the eyes are jaundiced. Swelling of the feet and lower third of the shins. In the lungs vesicular breathing, lateral breathing sounds. Respiratory rate-18 in min. at auscultation heart tones are rhythmic, there is no noise. Heart rate-78 beats per minute. Blood pressure-110/70 mm Hg. the language of wet, crimson, papillae smoothed. The abdomen is enlarged in volume, the navel is smoothed, on the anterior abdominal wall, dilated, convoluted veins are defined radially from the navel. In the supine position, the abdomen is flattened. Under palpation soft, painful in right hypochondrium. The size of the liver according to Kurlov is 15×15×13 cm. the lower edge of the liver is dense, bumpy when palpated. Chair decorated, brown, without pathological impurities. The size of the spleen is 15×12. Urination is free, painless, urine is dark yellow. General blood test: erythrocytes-4.1×1012/l; HB-122 g / l; color index-0.9%; leukocytes-3.2×109/l, eosinophils-1%, rod neutrophils-4%, segmentonuclear neutrophils-63%, lymphocytes-29%, monocytes –3%, ESR-22 mm / h.Biochemical analyses: total bilirubin-130 mmol / l, direct bilirubin-100 mmol/ l, ALT-120 U/l, AST-164 U / l. albumin-28 g / l. fibrogastroduodenoscopy: varicose veins of the esophagus I art. ultrasound of the abdominal cavity: anteroposterior size of the right lobe of the liver-170 mm, the contours are clear and uneven. Parenchyma diffusely unevenly increased echogenicity. The diameter of the portal vein is 16 mm. the gall bladder is of normal size, the contents are bile. Hepaticocholedochus has not been extended. Spleen located usually, the structure is homogeneous, the average parenchyma echogenicity. The area of the spleen is 36.1 cm2. Free fluid in the abdomen.