Case of renal failure
[general information] female, 45 years old, farmers complained of menostaxis Yu Tian 20   in March 6th to present illness patients menstruation dark blood clot small, daily pad 4-5, 5 days, seventh days to start a small amount of fresh red, daily pad 2-3, starting twentieth days and lower abdomen pain with hemorrhage in 3 the day of vaginal, daily 6-7 piece of dark red blood. During the traditional Chinese medicine to eat. Infusion (specific unknown) poor results in recent days feel weak. History of the past 20 years. No history of hypertension, diabetes, hepatitis B history of tuberculosis without a history of 10 years. [personal history] no special hobby  without a family history of genetic history  years after menstruation history, menstrual cycle 25 days 5 day of the last menstrual period March 6th, menstruation volume of medium. [C] physical examination T:36.2; P:73 / min; R:19 / min; BP:190/100mmHg normal development, nutrient medium, language expression, active posture, physical cooperation. Sallow complexion anemia, body skin, mucous membrane elasticity difference with yellow dye, no bleeding and ecchymosis, superficial lymph nodes were palpable. Eyelid edema, conjunctival congestion, yellow sclera, bilateral isocoria round, sensitive to light reflex, ear appearance, nasal mucosa reddish, lips slightly dry, no cyanosis, pharyngeal tonsil swollen red. Neck soft, no resistance. The trachea is centered, the thyroid is not large, no vascular murmur. Thoracic symmetry, no deformity, no equal fremitus palpation, enhanced and weakened, lung percussion voiceless, double lung auscultation without rhonchi, no uplift before the heart, heart auscultation no organic disease. The abdomen flat, and no intestinal peristalsis, liver and spleen enlargement, bladder pain fall without pressing pain, left renal percussion pain. No lower limbs edema, dry stool, night urination 8 times / night amount. Gynecological examination.  auxiliary examination double kidney bladder and uterus accessories ultrasound showed no abnormalities, urinary protein + no more [treatment plan] please make bold discussion according to the situation, has abandoned the treatment the family situation is not good after the inspection results are given for three days.
Discussion one: a preliminary diagnosis: Uremia nephritis diagnosis basis: a 20 year history of anemia, sallow complexion, body skin, mucous membrane elasticity difference with jaundice, blood pressure 190/100, menstrual disorders, left renal hemorrhage, percussion pain, nocturia, urine protein + further examination: blood and urine routine, renal ultrasound, renal function determination renal biopsy. Treatment planning: diet, hypertension, dialysis, kidney transplantation.
Discussion two: the patient two prominent symptoms: 1, hemorrhage or bleeding; 2, frequent micturition, enuresis, anemia, eyelid edema, proteinuria, hypertension; 3, jaundice. 4, the basic rule of color Doppler ultrasound exclusion of abdominal tumors (part of the endometrial cancer need professional color identification); 5, past:: history of nephritis, hepatitis history. Based on 1, 2, 4, 5 to establish the diagnosis of renal failure. Jaundice is the main consideration of liver cells, it is suggested that liver function, if the obstruction, the need for cancer. Liver and kidney syndrome. Check the blood routine, liver and kidney function, electrolyte, blood ammonia, super hepatobiliary.
Discussion three: this case three characteristics: 1, menopause women, menstrual disorders, dripping not only 20 days after treatment, does not relieve symptoms. 2, in recent days feel weak, BP:190/100mmHg. 3, sallow complexion anemia, systemic skin, mucous yellow dye, eyelid edema, yellow sclera,sallow complexion in renal failure 4, night urination 8 times / night amount. 5, the 20 year history of nephritis and left renal left renal percussion pain. 6, urinary protein 4+ above symptoms seen in patients with renal failure. Blood for menses reasons: the platelet function of uremic toxin suppression is mainly adhesion and aggregation function is low, reduce, reduce the release of platelet factor third activity. The 10 year history of hepatitis B, liver and spleen enlargement, check liver function further, liver CT to exclude liver lesions. The blood for menses, uterine attachment B-ultrasound showed no abnormalities, due to gynecological examination of - menopausal patients further curettage, exclusion of endometrial carcinoma, cervical biopsy to exclude cervical Ca. further examination of liver, kidney function and tumor four.
Discussion four:10 years history of hepatitis B liver decompensation 2 nephritis 30 year history: decompensating: left renal percussion pain, eyelid edema, urinary protein BP:190/100mmHg 3 + + + +, menostaxis syndrome hemorrhage: 20 Yu Tian, 3 days of vaginal bleeding 4 is what stimulates the vesicouterine pouch: lower abdomen pain with,sallow complexion in renal failure.
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