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Patient p.a. 46 yo, female complaints: heaviness, discomfort in the ruq, more pronounced in the evening, dry mouth, belching, headaches, weakness, episodes of increase in blood pressure up to 170/100 mm hg. Anamnesis. Considers himself sick about 5 years, when the above manifestations began to appear, was treated by udca for chronic hepatitis, markers of viral hepatitis b and c were negative. Over the last few years, body weight has increased. Last week worsening of state of health. He does not smoke and drink alcohol. Medical history: not working. Objectively: a condition of moderate severity. Increased body weight. Bmi = 36. Skin and visible mucous membranes are clear, pale, moist. Peripheral lymph nodes are not enlarged. Thyroid - not palpable. Vesicular breathing, no wheezing. Heart activity is rhythmic, the tones are clear. Bp 160/100 mm hg. Heart rate = pulse 90 bpm. Tongue is pink, moist, white with a touch of white. The abdomen is significantly enlarged due to subcutaneous fat, symmetrical, moderately painful in the epigastrium, the right ruq. Liver 15: 12: 10 cm by kurlov, margin soft, smooth, painless. Kerr, musset, chukhrienko's symptoms are negative. The spleen does not palpate. Pasternatsky's symptom is negative on both sides. Diuresis is the norm. Defecation - 1 t/day, n. Edema - not detected. Cbc: leukocytes - 7,9 * 109 / l, lymphocytes - 40,1 * 109 / l monocyte - 8.1 * 109 / l granulocyte - 51,8 * 109 / l, erythrocytes - 5,66 * 109 / l, hemoglobin - 176 g / l, platelets - 232 * 109 / l, esr - 4 mm / h ast 58 e / l, alt 81 o / l, thymol sample - 3.1, total bilirubin - 9.9 ?mol / l, direct - 3.3 ?mol / l, alkaline phosphatase -2500, ggtp - 88.1 you / l, creatinine - 89 ?mol / l, urea -4.5 mmol / l, uric acid - 344 ?mol / l, glucose - 5.36 mmol / l total. Cholesterol - 5.51 mmol / l, triglycerides - 2.63 mmol / l, ldl - 4.33 mmol / l, hdl - 1.0 mmol / l. Gfr (ckd-epi formula): 78 ml / min / 1.73m2 clinical analysis of urine: - 80 ml, rd - 1017, ph - 6,0 protein, sugar - no, mucus - little, leukocytes - 0-1 in sight, erythrocytes - no, epithelium: flat - many, transient - 0-1 in p / star. Cylinders - not found, oxalate salts - moderate, bacteria - no. Ecg: sinus rhythm, heart rate = 92 per min, lvh. Ultrasound of the heart: moderate lvh, aorta compacted, not enlarged. Ultrasound of the abdomen and kidney: enlarged liver, homogeneous, increased echogenicity. Portal vein - not dilated, choledoch - not dilated. The vascular pattern of the liver is smoothed. No pathological tumors were detected. Gallbladder is enlarged 10. 5x4 cm, wall up to 3 mm, choledoch is normal. The pancreas is not changed in size - 2.6 * 2.1 * 2.6 cm, parenchyma with increased echogenicity with foci of linear fibrosis. The duct is 0.1-0.2 mm. The spleen is not enlarged in size 12. 3x3.5 cm. Kidneys of normal shape, size and position, without features. In the left kidney cyst 12 mm. 1. Your must write preliminary diagnosis 2. Prescribe additional tests with imagine results. 3. According to all this information write final complete diagnosis (the main and coexistent). 4. Write ddx of the main disease at least with 3 another diseases. 5. Prescribe treatment. Describe in detail what medicines you are offering and why.


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