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yxfbbiedtj · Wysłany: Pią 15:19, 11 Mar 2011

Lupus erythematosus with acute gastrointestinal tract symptoms in 1 case

Bleeding body pale skin, superficial lymph nodes are not palpable,[link widoczny dla zalogowanych], liver jugular vein reflux symptoms (a), the thyroid is not. Coarse breath sounds lungs, lungs and the wet did not hear the end of 哕 tone. Rhythm together. Bulging belly, abdomen soft, upper abdominal tenderness,[link widoczny dla zalogowanych], particularly under the xiphoid, both whole abdominal rebound tenderness, upper abdominal obvious, palpable liver and spleen are not satisfied, Mur-phy'S sign (a), shifting dullness (+) bowel sounds 2 ~ 3bpm, no edema of both lower extremities, spine, joints and nervous system examination were normal. AGED initial diagnosis: (1) intestinal obstruction; (2) ascites of unknown origin. After treatment: one at the hospital blood test, urine and stool were normal. Liver function showed albumin 27.78g / L, urine amylase, renal function and electrolytes were normal. People to the hospital by the use of anti-inflammatory Ericsson, high Shuda acid, somatostatin octreotide treatment of abdominal pain symptoms after 1 week, review signs of abdominal plain film without obstruction, but there abdominal circumference increased 104cm, still with the increased frequency of bowel movements , rare yellow with white lumps like it, 4 to 5 times / d. B-prompted massive ascites, hepatomegaly, fatty liver picture, biochemical examinations showed , Mycobacterium tuberculosis, anaerobic bacteria. rIP54.98g / L, GLU5.41n1n1oL. C1-110.4mmol / L, LDH339IU / L check abdominal CT, B super-fatty liver were prompt, early cirrhosis, ascites, to the large infusion of albumin, albumin levels but has been reviewed several times in the 27g / L level had a transient return to normal, no significant improvement in ascites. Serum protein electrophoresis: albumin 51.5%, a1 globulin 4.6%, globulin 7.3%, - / G 25.7%, the total albumin 54.39g / L, albumin 28.01g / L, a1 globulin 2.5g / L, l3 globulin 3.97 Author: 528000, Foshan City, Guangdong Province, Department of Gastroenterology, the First People's Hospital, g / L, - / globulin 13,98 g / L. 1 week after hospital patients who feel sharp pain with swelling of the left lower extremity, B ultrasound showed the left lower extremity superficial venous thrombosis,[link widoczny dla zalogowanych], but the inferior vena cava, hepatic portal vein was normal, after rehydration, infusion of albumin, the pain symptoms improved, but still mild swelling. Gastroscopy see flat erosive gastritis, no stomach, esophageal varices. Charles hormone series, head CT, pelvic CT were normal. Infusion in patients with a variety of hospital, allergy injections, facial symmetry discoid erythema occurs, symptomatic treatment by the anti-allergy, skin rash disappeared, there is still symmetry discoid facial erythema. 2 Discussion (1) young obese patients, women, acute onset, short duration, vomiting, abdominal pain as initial symptoms of gastrointestinal performance with massive ascites, abdominal plain film suggest low intestinal obstruction, liver function showed hypoproteinemia, the gastrointestinal decompression, anti-inflammatory, somatostatin, acid, intravenous protein, diuretic and other therapy, intestinal obstruction to improve, consider paralytic ileus, but no significant improvement in ascites, abdominal CT ruled out pancreatitis. (2) patients with no heart palpitations, shortness of breath, fever, weight loss and other symptoms. General search tips ascites effusion, ascites culture without bacterial growth, no abnormal urine, TB antibody (a), no abnormal blood lipid analysis, 12 tumors without exception, normal ECG, abdominal ultrasonography, the left lower extremity superficial venous thrombosis, but inferior vena cava, hepatic portal vein were normal, full abdominal and pelvic CT, B super no lesions, ascites, cardiac ascites consider tuberculous ascites, tumor ascites, renal ascites, Budd-Chiari syndrome may be caused by not significant, and the basic rule. (3) patients with no history of hepatitis, liver function prompted significant hypoproteinemia,[link widoczny dla zalogowanych], abdominal B-, CT prompted early cirrhosis, endoscopy showed chronic gastritis, blood was normal, liver fibrosis (a), the albumin 10g intravenously 2 times a day, diuretic therapy, review the albumin had a transient return to normal, but no significant improvement in ascites, the clinical diagnosis of early liver cirrhosis. Consider low protein induced liver cirrhosis with ascites is unlikely. (4) during hospitalization in patients with a variety of fluid replacement, allergy injections, groups of wind rash, the rash disappeared after anti-allergic, consider allergic constitution, facial symmetry of patients with discoid rash, patients with young women,[link widoczny dla zalogowanych], do not rule out autoimmune lupus erythematosus caused by gastrointestinal symptoms, massive ascites. Charles immune parameters ANA (+), ANA patterns: nucleolar type, ds-DNA (+), SSA (+), c30.49g / L, o40.07g / L, CH506.6IU/ml, the final diagnosis of systemic lupus erythematosus, Rheumatology transfer specialist treatment.