中国全科医生（Chinese general practitioner）.docVIP

中国全科医生（Chinese general practitioner） Brief history The patient, male, aged 64 years, was admitted to the hospital for 1 years, with abdominal distension and edema of the lower extremities for 6 years, and rash for 9 months. The patient was examined 6 years ago and found that the liver and spleen were large and asymptomatic. Abdominal distension, abdominal circumference increased 1 years ago, lower extremity edema, no fever, anorexia, fatigue, jaundice, dyspnea and volume of urine, outside the hospital ultrasound showed liver splenomegaly, ascites, diuretics improved. 9 months ago there was a red rash all over the body with obvious itching. Since the onset of the patient, the general situation may be, physical and weight did not drop significantly. Diagnosis and treatment analysis The reason of ascites is portal hypertension In elderly men, asymptomatic liver and spleen are largely concealed, and ascites occurs 5 years later. The most common cause of cirrhosis ascites, tuberculous peritonitis and malignant tumor, usually need to calculate the serum ascites albumin gradient (SAAG), SAAG more than 11 g/L showed portal hypertension on ascites (cirrhosis, Budd Chiari syndrome, constrictive pericarditis), or consider other disease (due to inflammation and tumor). In this case, the course of disease is long, the progress is slow, the patient is generally in good condition, without the symptoms of low fever, fatigue, night sweats, weight loss and so on. The clinical manifestations do not support tuberculosis and malignant tumors. An itching rash that is unknown and may be associated with a primary disease or as a drug or other allergen. Liver cirrhosis complicated with pruritus should be considered in primary biliary cirrhosis, but the disease is common in women and has jaundice, which is not in accordance with this case. Past history: 1 years of traditional Chinese medicine such as 37 for joint pain, 50 years for smoking, 10 for a day, and a small amount of alcohol. The pa