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
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

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

Explorari paraclinice :

ST

-sdr.colestatic:bilirubina totala 1,59mg/dl

-ecogr.abd.:ficat hiperreflectiv
-fibroscan :explicarea metodei ,indicatii
-EKG:T negativ avL, V1; supradenivelare

(D.D.: diselectrolitemii)
-Rad.toracica: -hiperinfl. pulmonara
- sinus cardio-frenic obtuz
(aderente pleuro-pericardice)
- fibronoduli calcari hil dr.
-Spirometrie: scaderea FEV1 80%
-markeri virali abs.

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 18g 1cps/zi inhalator
(mecanism de actiune, contraindicatii,
precautii)

Tratament :

2.Pantoprazol 40 mg /zi 4-6 sapt.

+Amoxicilina 2g +Claritromicina 1g(daca H.P.
+)
3.Regim igieno-dietetic
4.Hepatoprotectoare
Complicatii:
-cord pulmonar cronic
-neoplasm bronhopulmonar ,esofagian
-ciroza hepatica
Particularitati :asociere alcool+tuberculostatice si
aparitia unei afectari hepatice persistenta, fara
tendinte evolutive spre activa, in pofida consumului
sustinut de alcool