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PREZENTARE DE CAZ CLINIC 8 IUNIE 2012

PREZENTARE DE CAZ CLINIC 8 IUNIE 2012. Dr. Paloma Manea Prof. Dr. Rodica Ghiuru. Pacient de 60 ani, mediul urban Motivele internarii : dureri in hipocondrul drept greata gust amar matinal Fumator 20 tigarete /zi ,39 ani Consum alcool 100g alcool pur/zi, 30 ani

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PREZENTARE DE CAZ CLINIC 8 IUNIE 2012

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  1. PREZENTARE DE CAZ CLINIC 8 IUNIE 2012 Dr. Paloma Manea Prof. Dr. Rodica Ghiuru

  2. Pacient de 60 ani,mediul urban • Motivele internarii: dureri in hipocondrul drept greata gust amar matinal • Fumator 20 tigarete /zi ,39 ani • Consum alcool 100g alcool pur/zi, 30 ani • APP:-Tuberculoza pulmonara cavitara dr., 1994, trat. 1 an -ulcer duodenal 1995 -hepatita cronica 1995 Ex clinic:-hipersonoritate pulmonara bilaterala -murmur vezicular diminuat bilateral -tiraj intercostal la baze si supraclavicular

  3. Ex.clinic –ficat palpabil la 3 cm sub rebord (m.sup . la nivelul ult .coaste) - puls diminuat la pedioase bilateral Dg. diferential clinic : 1.sdr.de hiperinflatie pulmonara :astm bronsic CONTRA: varsta, abs.atopiilor 2.zg. cardiace asurzite: pericardita CONTRA: abs. semne de IC hipodiastolica 3.ficat palp.la 3 cm sub rebord: de staza CONTRA :abs. reflux hepato-jugular

  4. Explorariparaclinice : -sdr.colestatic:bilirubinatotala 1,59mg/dl -ecogr.abd.:ficathiperreflectiv -fibroscan :explicareametodei ,indicatii -EKG:T negativavL, V1; supradenivelare ST (D.D.: diselectrolitemii) -Rad.toracica: -hiperinfl. pulmonara - sinus cardio-frenicobtuz (aderentepleuro-pericardice) - fibronodulicalcarihil dr. -Spirometrie: scaderea FEV1 80% -markerivirali abs.

  5. Explorari paraclinice: -rad. eso gastroduod.: refux g-e, hernie hiatala • Diagn. pozitiv: 1.BPOC std.I GOLD 2.Hepatita cronica alcoolica 3.Boala cronica de reflux gastro-esofagian 4.Hernie hiatala • Argumentarea dg. • Tratament: 1.Tiotropium 18μg 1cps/zi inhalator (mecanism de actiune, contraindicatii, precautii)

  6. Tratament : 2.Pantoprazol 40 mg /zi 4-6 sapt. +Amoxicilina 2g +Claritromicina 1g(daca H.P.+) 3.Regim igieno-dietetic 4.Hepatoprotectoare Complicatii: -cord pulmonarcronic -neoplasm bronhopulmonar ,esofagian -ciroza hepatica Particularitati :asocierealcool+tuberculostaticesi aparitiauneiafectarihepaticepersistenta, faratendinteevolutivespreactiva, in pofidaconsumului sustinut de alcool

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