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患者 女性,55岁。因反复腹痛2个月,皮肤黄染20天入院。入院前2个月因脂餐后出现上腹部疼痛,数小时后自行缓解,症状曾多次出现,入院前20天皮肤出现黄染,乏力,纳差。既往史:10年前曾有脂餐后腹痛史。查体:体温36.5℃,脉搏90次/分,呼吸20次/分,血压126/70mmHg(16.8/9.3kPa),意识清楚,肥胖体型,皮肤巩膜中度黄染,心肺未见异常,腹膨隆,肝脾未扪及,移动性浊音(+)。实验室检查:WBC 13×10~9/L,N0.85,L0.15。总胆红素519μmol/L,直接胆红素410μmol/L,A/G 30.4/39.5,ALT 51U,HBsAg阳性。B超示胆囊结石,胆总管扩张。以亚急性肝坏死,结节性肝硬化,胆囊结石伴感染入院,给予保肝、利尿、抗感染、支持等治疗,患者病情逐渐加重,呼吸困难,消化道出血,尿少,皮肤黄染加深,双肺湿哕音,腹围达105cm,腹水呈黄色漏出液,复查ALT 13U,A/G 21/61.5,全身衰竭,共住院21天死亡。尸解:“全身组织水肿,皮肤巩膜重度
Patient female, 55 years old. Due to repeated abdominal pain for 2 months, the skin yellow dye 20 days admitted. 2 months before admission due to fat meal after the upper abdominal pain, relieve themselves after a few hours, symptoms have repeatedly appeared, 20 days before admission, the skin appears yellow dye, fatigue, anorexia. Past history: 10 years ago there was a history of abdominal pain after a meal. Examination: body temperature 36.5 ℃, pulse 90 beats / min, breathing 20 beats / min, blood pressure 126/70 mmHg (16.8 / 9.3kPa), clear consciousness, obese body shape, moderate scleral skin yellow, no abnormal heart and lungs, , No palpable liver and spleen, dullness of mobility (+). Laboratory tests: WBC 13 × 10 ~ 9 / L, N0.85, L0.15. Total bilirubin 519μmol / L, direct bilirubin 410μmol / L, A / G 30.4 / 39.5, ALT 51U, HBsAg positive. B ultrasound shows gallbladder stones, common bile duct dilatation. To subacute hepatic necrosis, nodular cirrhosis, gallstones with infection admitted to give liver protection, diuresis, anti-infection, support and other treatment, the patient’s condition was aggravated, dyspnea, gastrointestinal bleeding, oliguria, dark yellow skin deepen , Wet lung lung sounds, abdominal circumference up to 105cm, ascites was yellow leakage of liquid, review ALT 13U, A / G 21 / 61.5, systemic failure, a total of 21 days hospitalized death. Corpse solution: "systemic edema, scleral severe skin