肿瘤学课件 血管肉瘤.pptVIP

Case Presentation- Sasha案例陈述 Presenting Complaint (April 1)现病史（4月1日） Pale mucus membranes 粘膜苍白 Acute Weakness 急性虚弱 Signalment 症状 Sasha is a 14 year old Fs mix/siberian husky dog 14岁母性混种/西伯利亚哈士奇 History 病史 Found in the backyard weak and unable to stand. 在后腕发现虚弱不能站立 Saha-on the ground, weak and ataxic upon rising. 躺在地上，虚弱，共济失调 Sasha presented nonambulatory with pale mucus membranes. 表现出粘膜苍白不能行走 Physical Exam ( Abnormalities) 体格检查（异常） GEN全身: Quiet, unresponsive. 全身，无反应 EEN眼、耳、鼻、咽喉: Ears cold to the touch 耳朵冰冷 MS: Nonambulatory 无法行走 CV心血管: HR心率=120, MM粘膜=pale, CRT血凝时间=3s. Weak pulses, no pulse deficits. 脉搏虚弱，无脉搏不条 RR呼吸速率: RR呼吸速率=30. Quiet breath sounds dorsally. Breath sounds auscultable ventrally. 背侧呼吸不清，腹侧呼吸尚可听诊 NE神经末稍: Miotic pupils, no PLR direct or consensual. 瞳孔缩小或没有直接的瞳孔光反射或交感性瞳孔光反射 GI/GU胃肠/泌尿生殖道: Splenic mass palpated. 触及脾有团块 Problem List 问题列表 Shock 休克 Pale mucus membranes 粘膜苍白 Splenic mass. 脾脏肿块 Emergency Treatment 紧急治疗 LRS -bolused. 乳酸林格氏溶液－快速注入 Clinically improved ,BAR. Able to rise and walk comfortably. 症状改善，四肢可站起，可轻松行走 Reason for the shock -hypovolemia secondary to internal hemorrhage. 休克原因－继发于内出血的血容量过低。 Diagnostic Plan 诊断计划 CBC 血常规 Chemistry panel 生化 Abdominal ultrasound 腹部超声 Abdominocentesis 腹腔穿刺术 Thoracic radiographs 胸部X光 Bloodwork 血液 CBC : HCT=33.6%, rare schistocytes. 少量的裂红细胞WBC=23,600, neut=20,532, bands=236. Post Fluids液体治疗后 : PCV=23%, TP=4.8. Chem: Na=145, K=4.3, Cl=104. Ca=9.2. Crea=0.9, BUN=38. Alb=2.6, Glob=2.9. DIC panel: PT凝血酶原时间, PTT部分凝血致活酶时间 WNL（正常）, Fibrinogen=265. 纤维蛋白原 Abdominal Ultrasound 腹部超声 revealed mild to moderate hemo abdomen and a large splenic mass. 显示出轻度到中度的血腹水，脾有大肿块 Abdominal Radiographs 腹部X光 Abdominocentesis 腹腔穿刺 peritoneal fluid: hemorrhagic exudate 腹水：血性渗出物 PCV -29% , TP of 5.7. (Peripheral外周血 PCV=23% (post-fluids液体治疗后), Peripheral TP=4.8 (post)). Thoracic radiographs 胸腔X光 Thoracic radiographs were unremarkable. 胸腔X光无异常 Assessment 估计 Internal hemorrhage. 内出血 Large splenic mass. 脾脏有大肿块 Assessmen