山东大学：《诊断学》课程教学资源（PPT课件讲稿）From Hemobilia to Hematochezia

From Hemobilia to Hematochezia •A49-year-old woman transferred from an outside hospital because of severe hematochezia with a drop in hemoglobin from 14 to 8.3 g/dl

From Hemobilia to Hematochezia •A 49-year-old woman •transferred from an outside hospital because of severe hematochezia with a drop in hemoglobin from 14 to 8.3 g/dl

She initially presented because of a sudden onset of intense and constant sharp pain in the epigastric area that started soon after food intake

• She initially presented because of a sudden onset of intense and constant sharp pain in the epigastric area that started soon after food intake

Two months prior to her hospitalization she underwent a laparoscopic cholecystectomy for recurrent abdominal pain

• Two months prior to her hospitalization she underwent a laparoscopic cholecystectomy for recurrent abdominal pain

Her surgery and initial recovery was uneventful although she occasionally experienced brief episodes of epigastric pain that were less intense and never lasted longer than 30 min

• Her surgery and initial recovery was uneventful • although she occasionally experienced brief episodes of epigastric pain that were less intense and never lasted longer than 30 min

prior medical history Her prior medical history was otherwise only remarkable for a quiescent ulcerative colitis

prior medical history • Her prior medical history was otherwise only remarkable for a quiescent ulcerative colitis

physical examination The main findings on physical examination were icteric sclerae ●and mild skin icterus as well as dark blood in the rectal ampulla

physical examination • The main findings on physical examination were icteric sclerae • and mild skin icterus • as well as dark blood in the rectal ampulla

laboratory tests demonstrated a moderate elevation of her bilirubin with 4.7 mg/dl (direct bilirubin: 4.5 mg/dl) liver enzymes with alkaline phosphatase of 127U/1, ·AST197U/I 。ALT469U/1

laboratory tests • demonstrated a moderate elevation of her bilirubin with 4.7 mg/dl (direct bilirubin: 4.5 mg/dl) • liver enzymes with alkaline phosphatase of 127 U/l, • AST 197 U/l • ALT 469 U/l

ultrasound examination To further delineate the underlying problem an ultrasound examination was performed which demonstrated a fluid collection in the gallbladder fossa and a dilation of the intra-and extrahepatic biliary tree

ultrasound examination To further delineate the underlying problem an ultrasound examination was performed • which demonstrated a fluid collection in the gallbladder fossa • and a dilation of the intra- and extrahepatic biliary tree

4V1 H3.0MHz 160 Abdomen TRANS LIVER LT General 85dB s1/+1/片 Gain= 2dB $8 Dilated intrahepatic biliary tree

4V1 H3.0MHz 140 Abdomen CHD General 85dBs1/+1/2 Gain=10dB S16 Dilated common hepatic duct and fluid collection in gallbladder fossa