PROBLEM №1 PATIENT B 28 YEARS OLD WAS UNDER

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Problem №1

Problem №1

Patient B., 28 years old, was under observation in the hospital for two months. Complaints icteric staining of the skin and mucous membranes, weakness, nausea, itching. Malaise appeared soon after birth. The liver is enlarged, painful. Blood - direct bilirubin 82 mmol / L, bilirubin detected in urine, urobilin no reaction to sterkobelin weakly positive, ER - 3.8 × 1012 / L, NV - 110 g / l. The patient performed the operation, which resulted from the common bile duct stone removed, which completely covers the gap.

1. Name the syndrome that was observed in the patient.

2. Identify the cause of its development.

3. To explain its mechanism.

4. Explain why the blood found direct bilirubin.

5. Explain why the urine in this syndrome is not urobilin?


Problem №2

Patient M., 30 years old, enrolled in the therapeutic department of the city hospital complaining of chills, fever up to 400C, headache, increasing weakness. On the eve of the patient ate mushrooms. The blood found ER - 3 × 1012 / L, indirect bilirubin - 45 mmol / l, urobilin, sterkobelin in large quantities.

1. Name the syndrome that developed in a patient.

2. Identify the cause of its development.

3. Which group of pathogenesis of this syndrome refers?

4. Explain any changes in blood and urine tests confirmed the diagnosis of this syndrome.

5. Explain why the exchange of bilirubin is broken in this syndrome.


Problem №3

Patient T., aged 58, was treated in a regional hospital with a diagnosis of cancer of major duodenal papilla, jaundice, jaundice, intestinal bleeding.

1. Identify which group relates to the pathogenesis of the disease.

2. Explain what caused the development of the jaundice.

3. Identify what bile pigments can be detected in blood and urine at this jaundice.

4. Answer the question: how the content of bile acids in the blood and intestines.

5. Explain why this patient was observed bleeding.


Problem №4

Patient Z., 57, a nurse entered the isolation hospital with complaints of weakness, lack of appetite, nausea, vomiting, chills, fever, headache, pain in the joints. On the 2nd day of stay in the hospital appeared yellowness, found slightly painful enlargement of the liver, blood: direct bilirubin - 32.5 mmol / L, indirect bilirubin - 35 mmol / l, act. transferase - 43 units. Urine: direct bilirubin, urobilin. Diagnosed with hepatitis.

1. Name the syndrome, which is available in this patient.

2. Identify the cause of its development.

3. Which group of pathogenesis of such syndromes include the syndrome?

4. Explain what changes bilirubin metabolism confirm the presence of this syndrome.

5. Can be seen in this syndrome acute liver failure?


Problem №5

Patient G., 60 years old, were followed for 4 months. The disease started acutely, fever, pain in the liver, jaundice appeared. The patient was admitted to the hospital, where, after the survey was diagnosed with a tumor of the pancreas. The blood found direct bilirubin 70 mmol / l in the urine - bilirubin, ER - 3.2 × 1012 / L, NV - 100 g / l. In just a few days before his death in the urine and feces of the patient began to show up and bilirubin stercobelin.

1. Name the syndrome that was observed in this patient.

2. Identify the cause of its development.

3. Which group of pathogenesis of this syndrome refers?

4. Explain any changes in blood and urine confirms the diagnosis of this syndrome.

5. Explain, as evidenced by the emergence of what caused urobilin stercobelin and in urine and feces in the last stage of the disease in this patient?

Problem №6

1. Make a conclusion about the presence of jaundice if:



Blood

Urine

Feces

direct bilirubin

80 mkmoll/l

+


indirect bilirubin

35 mkmoll/l



urobilin


-


stercobilin



-

bile acid

+




2. If it is available, to name what she pathogenesis?

3. The possible causes of call (diseases) that may cause it to develop (3-4 disease).

4. Calling for this jaundice symptom that is associated with the detection of blood bile acids.

5. Explain, as evidenced by the appearance of a given jaundice urobilin in the urine.



Problem №7

1. Make a conclusion about the presence of jaundice if:



Blood

Urine

Feces

direct bilirubin

-

-

-

indirect bilirubin

60 mkmoll/l

-

-

urobilin


+++


stercobilin



+++

bile acid





Erythrocytes 3.3 × 1012 / L, Hb - 110 g / l

1. If it is available, to name what she pathogenesis.

2. Identify the causes.

3. Identify syndrome that occurs simultaneously with jaundice in this case.

4. Violated at this jaundice liver function?



Problem №8

1. Make a conclusion about the presence of jaundice if:



Blood

Urine

Feces

direct bilirubin

120 mkmoll/l

+

-

indirect bilirubin

60 mkmoll/l

-

-

urobilin


+++


stercobilin



+

bile acid

+



transaminase

40 ed.




1. If it is available, to name what she pathogenesis.

2. Identify the causes (3-4 disease).

3. Respond to the question whether the function of the liver is broken at this jaundice?

4. Can develop liver failure?

5. Violated at this jaundice, blood clotting? What is the reason?



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