Beruflich Dokumente
Kultur Dokumente
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Kruger National Park
The Big 5
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Cape Town 开普敦
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Case Report
Bed No. 5床
Name: 邵云 (Shao Yun)
Diagnosis: Gallstones with Mirizzi Syndrome
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Personal Information
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Personal Information
主诉 Chief complaints:
complaining of abdominal pain for 1 week
Abdomen: NORMAL
flat and symmetrical abdomen, no exposure of abdominal wall
vein, no gastrointestinal type and peristaltic wave, soft abdomen,
no tenderness, no rebound pain, no mass in abdomen. The
subcostal liver and spleen were not touched, but Murphy's sign was
negative. The abdominal percussion was drumming, the upper
hepatic boundary was between the fifth rib of the middle line of
the right clavicle, there was no percussion pain and no moving
murmur in the liver and kidney area. The sound of bowel sounds
is regular, 4 / min. No vascular murmur
ECG and other examinations were all NORMAL
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Work-up
既往史:Past history:
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Blood Results
2018-11-14: Admissions
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Ultrasound findings:
the common bile duct was dilated, the inner diameter was about 17 mm, and its
internal scan showed 14*6mm strong echo light mass accompanied by acoustic
shadow.
liver size, shape normal , capsule smooth, intrahepatic light distribution, vascular
network structure clear, intrahepatic bile duct dilatation, with portal vein type sign.
The volume reduction of bile was normal, no obvious abnormal echo was found in the
lumen
The spleen and pancreas was normal
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MRI Scan
The upper segment of the common bile duct had a
mixed high density shadow at the opening of the
cholecystic duct about 13.5mm in diameter. The
upper hepatic and extrahepatic bile ducts were
dilated,
abdomen and pelvis showed that the liver was
normal.
Pancreas, kidney, spleen and bladder size, shape and
density were normal, There were no ascites. no
obvious abnormal masses in the pelvic cavity,
uniform uterine density, no lymph nodes, obvious
effusion in the pelvic cavity,
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MRCP
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Differential Diagnosis
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Mirizzi Syndrome
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Surgery
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Gallbladder
Gallbladder stone
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Blood Results
2018-11- 24 : Post operation
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Summary
Name: 邵云 (Shao Yun)
Chief complaints:
complaining of abdominal pain for 1 week
Personal History
Patients came to the ER complaining of abdominal pain 1 week, blood
test show increased bilirubin, she was misdiagnosed and treated with
ERCP (endoscopic retrograde cholangiopancreatography) IDUS ENBD
(Endoscopic nasal bile drainage) on 2018.11.6
2018.11.9 the MRI scan in our hospital indicated that gallstone
Physical Examination: NORMAL
ECG and other examinations: NORMAL
Blood Results:
Pre-op: total bilirubin 41.5umol/L
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Post-op: total bilirubin 18.5umol/L
Summary
Ultrasound findings:
the common bile duct dilated, the inner diameter was
about 17 mm, and its internal scan showed 14*6mm
strong echo light mass accompanied by acoustic shadow.
MRI Scan
The upper segment of the common bile duct had a
mixed high density shadow at the opening of the
cholecystic duct about 13.5mm in diameter. The upper
hepatic and extrahepatic bile ducts were dilated,
Diagnosis:
Mirizzi syndrome and gallbladder stones
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Summary
Surgery:
Cholecystectomy, choledochus exploration,
external drainage of T tube
THANK YOU
FOR YOUR ATTENTION!
Shivar Sewpersad 谢瓦
6th year Student
MBBS Major 29