普通外科（General surgery）.doc

普通外科（General surgery） Case history summary: patient male, 44 years old. Hematemesis three, emergency admission. The first half of patients often abdominal distension, nausea, loss of appetite, tired of the oil, acid reflux, thinner. Three days ago, because drinking more, eat chilled foods, vomiting, a total of three times, two times before the relatively fresh, about 400 ml, after a kind of coffee, about 150 ml. Physical examination: blood pressure 14 / 12kPa. Emaciated, anaemic appearance, cheek and front chest have five spider mole, heart, lung have no unusual, liver is not big, the spleen can touch, the edge is more tough. 1. questions: according to the medical history and signs, what should be the primary examination for the patient after admission? A. routine blood test B. liver function test C. serum hepatitis antigen test D. B over check E. X ray barium swallow examination F.CT scan G. liver biopsy H.AFP I. radionuclide liver and spleen scan Tip: Hb90g / L, RBC3.2 * 10[~12.gif] * 10[~9.gif] / L, WBC3.6 / L, platelet 40 * 10[~9.gif] / L, liver function tests: zinc sulfate turbidity 16 units, 28g / L albumin, immunoglobulin 32g/L, GPT160, quantitative analysis of bilirubin was 25 mol / L, HbsAg (+). B ultrasonic examination: the liver was reduced, the portal vein thickened, the diameter was 15mm, and the spleen was slightly enlarged. X-ray examination of barium swallow of esophagus: when the barium is filled, it can be seen that the shape of insect bite changes, and the varicose veins are beaded negative when emptying. 2. questions: in order to further clarify the cause and location of the upper gastrointestinal bleeding, which examination should be carried out? A. three cavity balloon inflation compressed gastric fundus and lower esophagus, such as no bleeding, esophageal and gastric varices bleeding If the blood is drawn out after the compression of the B. two sac, the gastric and duodenal ulcers may coexist with the rupture and bleeding of the esophagogastri