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(题干)患者女，75岁。反复上腹隐痛、腹胀4年，多在进食油腻食物后发作，并向右肩背部放射。1天前出现上腹剑突下阵发性绞痛，伴畏寒、发热。既往有高血压、冠心病史10年。查体：T 38.5℃，P 120次/分，R20次/分，BP 95/65mmHg。神志尚清，表情淡漠，急性痛苦面容。巩膜与皮肤黄染，双瞳孔等圆等大，光反射敏感。双肺正常，心率120次/分，律齐。腹平坦，右上腹腹肌紧张，有明显压痛及反跳痛。肝右肋下2cm可扪及，移动性浊音(一)，肠鸣音减弱。根据患者情况，应进行诊断和鉴别诊断的是A.反流性胃炎
B.胆管结石
C.急性化脓性胆管炎
D.胃，十二指肠溃疡
E.肝脓肿
F.慢性结石性胆囊炎
根据检查，临床可珍断为提示：凝血功能：PT 11.5s，FIB 3.52s/L，TT 14.85s，APTT 31.20s。血钾3.8mmol/L，血钠136 .4mmol/L,血糖5.6mmol/L，肌酐87μmol/L，尿素氮2 Immol/L。心电图及胸部X线片无异常发现。A.胆管癌
B.胆总管结石
C.急性化脓性胆管炎
D.胃十二指肠溃疡
E.肝脓肿
F.慢性结石性胆囊炎
根据患者情况，应采取的治疗措施是A.抗感染、抗休克
B.胆囊切除术
C.胆总管切开取石，T管引流术
D.胆总管切开取石，胆肠吻合术
E.胆囊造瘘术
F.保守治疗，择期手术
为明确诊断，需要进行的检查是提示：检查结果：WBC 16 X 109/L，N89%,RBC 4.26×1012/L,HGB 12.9g/L,HCT 35%;肝功能：总蛋白76.1g/L，白蛋白35.6g/L，总胆红素89μmol/L，直接胆红素72μmol/，谷丙转氨酶120U/L，葡萄糖5.60mmol/L;B超：肝外胆管直径约0.9cm，胆管下段可见胆囊壁厚0.3cm，腔内可见多个大小约0.5～1.5cm的强回声光团伴声影，MRCP：胆总管下段可见卵圆形低信号，直径0.7cm。A.MRCP
B.腹部CT
C.肝功能，血常规
D.腹部B超
E.电子胃镜
F.ERCP
请帮忙给出每个问题的正确答案和分析，谢谢！

A.5℃，P
B.反流性胃炎
B.胆管结石
C.急性化脓性胆管炎
D.胃，十二指肠溃疡
E.肝脓肿
F.慢性结石性胆囊炎
根据检查，临床可珍断为
C.5s，FIB
D.52s/L，TT
E.85s，APTT
F.20s。血钾3.8mmol/L，血钠136
G.4mmol/L,血糖5.6mmol/L，肌酐87μmol/L，尿素氮2
H.胆管癌
B.胆总管结石
C.急性化脓性胆管炎
D.胃十二指肠溃疡
E.肝脓肿
F.慢性结石性胆囊炎
根据患者情况，应采取的治疗措施是A.抗感染、抗休克
B.胆囊切除术
C.胆总管切开取石，T管引流术
D.胆总管切开取石，胆肠吻合术
E.胆囊造瘘术
F.保守治疗，择期手术
为明确诊断，需要进行的检查是
I.26×1012/L,HGB
J.9g/L,HCT
K.1g/L，白蛋白35.6g/L，总胆红素89μmol/L，直接胆红素72μmol/，谷丙转氨酶120U/L，葡萄糖5.60mmol/L;B超：肝外胆管直径约0.9cm，胆管下段可见胆囊壁厚0.3cm，腔内可见多个大小约0.5～1.5cm的强回声光团伴声影，MRCP：胆总管下段可见卵圆形低信号，直径0.7cm。A.MRCP
B.腹部CT
C.肝功能，血常规
D.腹部B超
E.电子胃镜
F.ERCP

【参考答案】

问题 1 解析：ABCDEF
反复上腹隐痛、腹胀，并向右肩背部放射，系慢性胆囊炎的表现，90%以上的患者伴胆囊结......

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