LP16

B, 65 ani
• MI- dureri epigastrice, astenie fizica
• AHC- fara
• APP – fara
 Obiectiv
• Constient, cooperant
• Tegumente si mucoase palide
• Subicter scleral
• Abdomen dureros spontan si la palpare in epigastru
• Splina cu pol palpabil in inspir profund
• TA=110/75mmHg, AV=87b/min,SO2=N
 Paraclinic
• HG – Hb=7g/dl, Ht=21%, L=3500/mmc, Plt=120000/mmc
VEM=110fl
FSP= macroovalocite, neutrofile hipersegmentate
• Vit B12=55pg/ml
• LDH=1780U/L
• BI=1,2mg/dl
• Sideremie = 100microg/dl
• AgHP -
• Suspiune diagnostica?
• Investigatii necesare pentru diagnostic?

• Diagnostic – neoplasm gastric.

Anemie megaloblastica secundara
B, 44 ani
• MI – arsuri retrosternale, jena la deglutitie, tuse iritativa
• APP – colecistectomie, dislipidemie
• Comportamente – fumator

• Simptomatologie debutat de aproximativ 3 luni si agravata in ultima

saptamana
 Obiectiv
• Obezitate gr I
• Cicatrice cheloida postcolecistectomie
• TA=120/86mmHG, AV=76/min ritmic
Paraclinic
• HG – Hb=12g/dl, L=N, PLT=N
• Profili lipidic – Col T=290mg/dl, TG=278mg/dl
• RX pulmonar N
• Echo abdominal – colecist absent
• EDS – eroziuni situate pe pliuri, <5mm. Hernie gastrica transhiatala.
*Complicaţii = ulcer esofagian, stenoz esofagiană benignă,
esofag Barrett, HDS, adenocarcinom