中医病例讨论培训课件.ppt

一.辩证导引TodaywewilldiscusstheTCMcaseofa36-year-oldman。今天我们要讨论的是3６岁男性中医病例.2/28/20251

二.病史陈述Firstofall,Iwouldliketopresentthecase.首先，我为大家介绍此病例2/28/20252

二.病史陈述Todaywewilldiscussthecaseofa36-year-oldmanwithrecurrentepigastricpainforfivemonths.今天我们要讨论的是一位近五个月以来上腹疼痛的36岁男性病例。2/28/20253

二.病史陈述Fivemonthsago,thepatientfeltepigastricpain.Atthattime,theamylaselevelswas349Uperliter.Thewhite-cellcountandtheresultsoftestsofliverfunctionwerenormal.thepaincontinued,andtheamylaselevelsdidnotreturntonormal.五个月前,病人感到上腹疼痛.淀粉酶水平是349单位每升.白细胞数目和肝功能正常.疼痛继续.淀粉酶水平一直不正常.2/28/20254

二.病史陈述Twelveweeksago,hewasadministrationofprednisone(20mgtwicedaily).Thepatient’spainresolved.Thepatienthadlost5.5kginweightduringrecentweeks.12周前,病人使用了强的松20毫克,每天两次.最近几周病人体重下降5.5公斤.2/28/20255

二.病史陈述Sixteenweeksbeforeadmission，anendoscopicexaminationshoweddiffuseattenuationofthecommonbileductandfocalnarrowingattheoriginofthelefthepaticduct入院前16周,内窥镜显示胆管变薄,左侧胆管变狭窄.2/28/20256

二.病史陈述buttheintrahepaticductswerenotoptimallydistended.Thesamedayanuppergastrointestinalendoscopicexaminationshowedabnormalitiesintheentirepancreas，但是肝内胆管无扩张.同一天的胃肠内窥镜显示胰腺的畸形.2/28/20257

二.病史陈述Hehadatendencytowardconstipationandurinaryfrequency.Hehadhadnorecentepisodesofnausea,vomiting,ordiarrhea.Hispaternalgrandmotherhaddiedof“stomachcancer,”buttherewasnofamilyhistoryofpancreatitis.最近他有便秘和尿频现象.没有头晕恶心,呕吐,腹泻的现象.他的曾祖母死于胃癌,没有胰腺炎家族史.2/28/20258

二.病史陈述Physicalexamination(体格检查):T36.7℃,HR83bpm,BP115/75mmHg;Normaldevelopment,normalnourishment,unpalpationofsuperficiallymphnode,normalbreathsoundofthelung,HR83bpm,regular.Slightlypalpationalpaininepigastricabdomen,nopalpationalpaininotherregion,withoutanyreflectpain.Noedemainthelowextremities.发育正常，营养良好，浅表淋巴结未及，双肺呼吸音正常，心率83bpm，律齐。中上腹轻压痛，无反跳痛，其余部位无压痛，双下肢无水肿。2/28/20259

二.病史陈