Interesting Case16-8-15 Sx gen4.pptx

7/23/2019 Interesting Case16-8-15 Sx gen4.pptx

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Interesting Case17.08.2015


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Patient Identifcation HN IZ6233 ! "# 6$ %

&'(&)*

+',*-./ "0

.'1" 454&7*/8( (97":"%; !-/

&,!(!"


3/27

C?ie@ CoABaint

>4.5*1">.5*1"'7DEF/ 3 .1"/

7"/'G(;:*


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PRESENT ILLNESS


5/27

Present iness .1"/PJ'%"7(.5'1"/'%"9()!5(1"8"!%K

5*4/D ''%(!%KL &4.7>.5M/>/.">4,.5*1"DEF/

.1"/PJ *7&!47>4.5*1")*9>.5*1"'7DEF/ '%D.M/O5O ('74:'%D>-KOL/7"//"/ '%

"7(84/>',5/4:(,.*->4 &4.7>4&&9

>/."'%&%.D''7DEF/ 8*&% QRS$T 7>,1K'/-F4/*9

R )7 4&&94/*9 UR$ 8(4F ''%)&:D4' '%

4&&9*-:7 (4:(9!/"5(>'7>,

''%.:1K""5( )>.'1K"(4:(9!/"5(.M/)*'479'%!""1('


6/27

3 .1"/PJ "7(>.5*1".5M/4./

DEF/ ('74:'%"#(9*47=9'%&%V%L/:

8(4F ''%.*1"/ ''%"7(!"7 !"( .(,K'(&E7'%"7(.5/1K"DEF/ )>''%

"7(5L*-:7 L&4K/ )*9L/ 2R3.1"/!%K/' ;: /-F5/47**76U

Wg .5*1"$Wg XSTY L/ 3 .1"/ G(4:

(9!/"5(.!.,' 55'"!%KG(

;:*(9-454 );![!-

\traso\nd &&4'9.(ML/!"!.,//-F%- 4 4 4 %K


7/27

^ee_ant Histor` 2 .1"/ PJ );![!%KG(;:*

](%/8(,/!([ );![,/,4.M/'9.(M!"/-F%

)/9/-L5)>b,.&< D"7*4:(E7=>,7"/

S .1"/ PJ >4.5*1">.5*1"'7DEF/ '

;:);!["7)* !- P XS$

.;1K".>(%'>4.1"/5/


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PAST HISTORY


9/27

Past Histor`

b,.&,7(); );"5(LO b,.&,"#:4>,.5>#!%K>"(4:7(>4

b,.&4

.8!- P XS$


10/27

Persona Histor` '&::#5(%K

.*,71K'(' $ % .81K'(>'/

.!]7* 1K'&45[*92R3)7

1K'.M/.*UT %

":(4:(9!/"5(O,:O *:,:7"*,:

(4:(9!/*(:"8(4F

b,.&,>'5'"&'#/;(


11/27

aAi` Histor` b,.&&L/8(":8(4

b,.&


12/27

Systemic review

hJ '%&>,% ;8#(.(1K" HjjN ']%(=9 ''%.&'59 >'".5M/ 5,/.!

74/!4F&"D

Heart ''%L&4K/ /"/(: ''%5":.5/1K">"/7*81/ k\ng 5L7>, ''%".(1F"(4'5": JldoAen !""15*4(4:(9!/"5(.M/ "#(9&%V%''%!"7&*4:!".&%

m ''%4&&9)&:D4 ''%4&&9D#/ N (&E7>4% '&4:&/ ' '47 '""/)( Q\sc\osWeeta ''%7*'./1F"*%: 'D"


13/27

Pro_isiona iagnosis C?oangiocarcinoAa


14/27

iperentia iagnosis qq


15/27

iperentia iagnosis S HeBatoce\ar carcinoAa 2 hastone

3 C?ronic HeBatitis U $


16/27

P?`sica jaAination


17/27

P?`sica eaAination henera aBBearance Jn eder`

Aan ooWs sicWgood conscio\snesse cooBerati_e0

uita sign 360v wC P^ 62 lBA ^^ 2T tBA P S22 AAHg

HjjN BinW conx\ncti_ae ictericscerae cer_ica `AB? node ands\Braca_ic\ar `AB? node ereiABaBale


18/27

Heart norAa S2 no A\rA\r k\ng norAa lreat? so\nd ey\a lot?

\ngs no ad_entitio\s so\nd JldoAenso@t no tenderness No

s\Berfcia _ein diatation No _isileBeristasis No aldoAina distention norAoacti_e loe so\nd z\id t?rinegati_e s?i@ting d\ness negati_e BaBale i_er S leo rig?t costa Aargin

P on Bosition deeB `eois? liecoor no oo{ing o\nd UTTR$TT cc jtreAities No Bitting edeAa No ras?

No Betec?iae


19/27

JldoAen

deepyellowish

bile color


20/27

kal In_estigationCCJkCoag\ograA

jectro`te|Rra`jmhCjJ

^ena \nctionC|^C scan}


21/27

CC Hl ~ S20S gd Hct ~ 3U0S Y Pateet~ 326TTT C ~ 6TTces

QCu ~ v$06 @k PQN~ 6$0v Y k`AB?oc`te ~ 03 Y

Qonoc`te ~ v0v Y josinoB?is ~ U0S Y asoB?is ~ T 03 Y


22/27

ki_er \nction test C?oestero SvT

ota Brotein0$ Jl\Ain 30U hol\in U0S

$06 $0U Jk STU J S2S JkP ST


23/27

ood C?eAistr` Na S3S Ajyk m 303 Ajyk C v2 Ajyk Ca 0$ Ajyk

HC3

2v02 Ajyk Qg 20S P 30T N v0 Cr T0


24/27

rine Jna`sis Coor `eo \rlidit` cear B0gr0 S ^C negati_e BH $ Cnegati_e

ke\Woc`te negati_e Nitrite negati_e h\cose negati_e metone negati_e

iir\lin negati_e ood negati_e CR ^C R


25/27

InvestigationCEA : 7!.10 "0#2.5$CA1%#% : 281.5 "0#!7$A&' : .51 "0#10$()sAg : *eg

Anti#()s : 'osAnti#(C+ : *eg

Anti#(I+ : *on#reactive


26/27

Q^CP X2v$ IABression ki_er Aass at segAent $6

it? sAa nod\es nearl` CHCJ it?nod\es Aetastases0 Berid\cta a Aass

at rig?t ?eBatic d\ct ca\sing liiar`olstr\ction se_ere on t?e rig?t ole i_er0jncased anterior and Bosterior lranc? o@rig?t Borta _ein0

Q\tiBe aldoAina kNs Aetastases0Qid distension o@ h it? stones denselie and c?ronic inzaAAation0


27/27

,reat-ent# 'lan : ight lobe(epatecto-y# 'alliative d/e to iver cirrhosis

# edication :# Aldactone :# eno3ot

# 4o6acine # etronidaole # ) co-ple6

'araceta-ol

Interesting Case16-8-15 Sx gen4.pptx

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