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病例资料患者,男,51岁,因“阵发性腹痛9 d”收入笔者所在医院。入院前9 d无明显诱因出现阵发性腹痛,以右上腹及剑突下为主,逐渐加重,无呕吐及腹泻,无右胸和背部放射痛,无心悸。入院前1 d腹痛加重,并伴畏寒和发热。门诊胸部X线平片示:心肺(-),膈下未见游离气体。查体:生命体征平稳,巩膜轻度黄染,浅表淋巴结不大,腹平软,右上腹压痛、无反跳痛,肝区及右肾区叩痛,肠鸣音正常。WBC 13.6×109/L,N 0.894;血尿淀粉酶均正常;总胆红素(TBIL)82.9μmol/L,直接胆红素(DBIL)48.5μmol/L,
Case information patients, male, 51 years old, because “paroxysmal abdominal pain 9 d ” income author’s hospital. 9 d before admission there was no obvious incentive to have paroxysmal abdominal pain, mainly to the right upper quadrant and xiphoid, gradually aggravating, no vomiting and diarrhea, no right chest and back radiating pain, no heart palpitations. Abdominal pain increased 1 d before admission and with chills and fever. Outpatient chest X-ray showed: cardiopulmonary (-), no gas under the diaphragm. Physical examination: stable vital signs, mild yellowish scleral stained, superficial lymph nodes, abdominal soft, right upper quadrant tenderness, no rebound tenderness, percussion pain in the liver and right kidney area, bowel sounds normal. WBC 13.6 × 109 / L and N 0.894 respectively. Both hematuria and amylase were normal; total bilirubin (TBIL) 82.9μmol / L, direct bilirubin (DBIL) 48.5μmol / L,