Jaundice syndrome. Patient S. , 40 y.o., admitted to the hospital in severe condition with complaints of intense pain in the right upper quadrant

CASE# 8

Patient S., 40 y.o., admitted to the hospital in severe condition with complaints of intense pain in the right upper quadrant, fever, yellow skin. Anamnesis: from the words of relatives - get sick for two weeks, when there was paroxysmal pain in the right upper quadrant, and then - fever and yellowness of the skin and sclera. Did not applied any hospital,used self-medication. Over the past two days the patient's condition progressively worsened, increased pain in the upper quadrant, the body temperature rose to 39-40 ° C.

On examination: general condition of the patient is severe, confused consciousness. Pulse 126 bpm, blood pressure of 80/ 60 mm Hg. body temperature of 40 ° C. Skin and visible mucous icteric. Stomach participates in the act of breathing, palpation - soft, tender in the right upper quadrant, where it is determined increased (up to 6 cm), painful liver. Gallbladder not palpable. Peritoneal signs are negative.

CASE# 9

Patient B., 60 y.o., was admitted to hospital complaining of icteric staining of the skin and sclera, skin itching, general weakness, loss of appetite. From history: feels sick for the past 2 months, the cord noticed that dark urine and feces light. Then came icteric staining of the sclera and skin, first a small and then gradually narostaet jaundice, pruritus appeared. 2 months body weight decreased by 4 kg.

On examination: general condition of the patient of average weight, the skin and visible mucous membranes intensive jaundiced color, traces of scratching the skin. On palpation: the abdomen is soft, moderately tender in the right upper quadrant, the liver performs at 2 cm below the costal margin, moderately painful on palpation. Gall puzir clearly palpable (bottom puzirya), painless. Peritoneal signs are negative. Ultrasonography showed signs of chronic inflammation of the gallbladder, stones missing, choledoch in diameter and 15 mm in the lower third of it - luminal narrowing.

CASE# 10

Patient B., 56 y.o., was admitted to hospital complaining of icteric staining of the skin and sclera, skin itching, general weakness, loss of appetite. From history: sick about 3 months, noticed a light cord dark urine and feces, and then appeared jaundiced sclera and skin staining intensity MDM narostaet slowly. Body weight for 3 months decreased by 7 kg.

On examination: general condition of the patient of average weight, the skin and visible mucous membranes intensive jaundiced color, traces of scratching the skin. On palpation: the abdomen is soft, moderately tender in the right upper quadrant, the liver acts 4 cm below the costal margin, moderately painful on palpation. Gall puzir not palpable. Peritoneal signs are negative. Ultrasound: dilated intrahepatic bile ducts, in the gate of the liver tumor is determined, up to 3.5 cm in diameter, with indistinct outlines, common bile duct diameter of 0.5 cm

CASE# 11

Patient K., 40 y.o., he turned to the doctor complaining of icteric staining of the skin and visible mucous membranes, mild pain in the right upper quadrant. From history: p'yat days ago, after the error in the diet originated paroxysmal pain in the right upper quadrant, and one day noticed the yellowness of the sclera and skin, body temperature to povіsilas subfebrile. In the past there have been episodes of pain in the right upper quadrant, ultrasound revealed stones in the gallbladder.

On examination: general condition of the patient is relatively satisfactory. Skin and visible mucous icteric. Abdomen symmetrical anterior abdominal wall is involved in the act of breathing. On palpation - the abdomen is soft, moderately tender in the right upper quadrant, where palpable enlarged, moderately painful gallbladder. Symptoms Grekova - Ortner, Kera negative signs of peritoneal irritation not.

CASE# 12

Patient R., 48 y.o., entered the department with complaints of icteric staining of the skin and visible mucous membranes, dull pain in the right upper quadrant, discoloration of feces. History of jaundice appeared a month ago, for no apparent reason, gradually increased. Besides patient notes that over the last 3 months decreased body weight by 6 kg, have a common weakness. 10 days before admission the patient turned to the family doctor, EGD was performed, in which found that a large duodenal papilla increased its bumpy surface, a contact bleeding (biopsy is not taken).

On examination: general condition of the patient of average weight, the skin and visible mucous membranes intensive jaundiced color. Abdomen symmetrical anterior abdominal wall is involved in the act of breathing. On palpation - belly m'yaky, chuvtvitelny in the right upper quadrant, the liver performs at 2 cm below the costal margin, gall puzir enlarged, tense, painless.. Symptoms of peritoneal irritation negative.

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