论文部分内容阅读
患者,女性,74岁,因持续性上腹痛1d入院。20年前因十二指肠球部溃疡行胃大部切除Roux-en-Y吻合术,10年前因胆囊结石行胆囊切除术,术后反复发作急性胰腺炎10余次,均经药物治疗后好转。今患者上腹痛,进餐后加重,伴恶心、呕吐,呕吐物为胃内容物,弯腰抱膝位无缓解。查体:剑突下及左上腹压痛,无反跳痛。查血淀粉酶:232U/L;血清总胆红素193.3μmol/L,直接胆红素139.6μmol/L,间接胆红素53.7μmol/L,ALT 200U/L,AST 313U/L,rGT 637U/L,ALP 627U/L。腹部B超:肝内外胆管扩张,胰腺回声增强伴胰管扩张,盆腹腔积
Patient, female, 74 years old, admitted to hospital for persistent upper abdominal pain 1d. 20 years ago due to duodenal ulcer gastric resection Roux-en-Y anastomosis, cholecystolithiasis 10 years ago underwent cholecystectomy, recurrent acute pancreatitis after more than 10 times, are drug treatment After the improvement. This patient has abdominal pain, aggravating after eating, with nausea, vomiting, vomit for the stomach contents, bending over the knee without remission. Physical examination: under the xiphoid and left upper quadrant tenderness, no rebound tenderness. Serum total bilirubin 193.3μmol / L, direct bilirubin 139.6μmol / L, indirect bilirubin 53.7μmol / L, ALT 200U / L, AST 313U / L, rGT 637U / L, ALP 627U / L. Abdomen B ultrasound: intrahepatic bile duct dilatation, pancreatic echo enhancement with pancreatic duct dilatation, abdominal pelvic plot