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患者,男,53岁,因反复黄疸腹胀脾大18年,于1986年7月21日入院。18年前不明原因感上腹部不适,食欲下降,巩膜皮肤渐黄染,查脾大,肝功能正常,按肝炎用中药治疗3个月,症状减轻。黄疸时隐时现,6年前皮肤巩膜中度黄疸,脾肋下3cm,网织红4%,GPT40u,黄疸指数35u,凡登白氏试验间接反应强阳性。骨髓像红细胞碎片,疑诊为自体免疫性溶血性黄疸。以后诊为肝胆脾综合征,给予对症处理。2个月来出现间歇性上腹部绞痛,伴寒战发热,灰白色大便。当地诊为胆石症,门诊以原发性硬化性胆管炎收住院。其弟曾因脾大切除10年余,现仍健在。检查:T37.4℃:精神不振,中度贫血貌。皮肤重度黄疸,无出血点。巩膜呈桔黄色。心正肺常。上腹部轻度压痛无反
The patient, male, aged 53, was admitted to hospital on July 21, 1986 because of repeated abdominal distension and splenomegaly for jaundice for 18 years. 18 years ago, unexplained sense of the upper abdominal discomfort, loss of appetite, scleral skin gradually yellow dye, check the spleen, normal liver function, according to hepatitis treatment with Chinese medicine for 3 months, reduce the symptoms. Jaundice is now hidden, moderate scleral jaundice 6 years ago, 3cm spleen ribs, reticulocyte 4%, GPT40u, jaundice index 35u, Fadden White’s test indirect reaction was strongly positive. Bone marrow fragments like red blood cells, suspected autoimmune hemolytic jaundice. After diagnosis of liver and gallbladder syndrome, giving symptomatic treatment. 2 months to appear intermittent upper abdominal cramps, accompanied by chills fever, gray stool. Local diagnosis of cholelithiasis, outpatient admission to primary sclerosing cholangitis admission. His younger brother had splenectomy more than 10 years, is still alive. Check: T37.4 ℃: lack of energy, moderate anemia appearance. Severe skin jaundice, no bleeding point. Sclera was orange. Heart is often lungs. Upper abdomen mild tenderness