The task 11 Patient Z., 32 years old, plumber, entered the hospital with complaints of a sharp General weakness, post. aching pain in the right hypochondrium, icteric staining of the skin and sclera, dark unine and discolored feces, loss of appetite, nausea, pruritus. Sick for about two years. For no reason appeared icteric staining of the skin and eyes, darkened urine, discolored feces. Within a month he was treated at the clinic of infectious diseases in acute viral hepatitis. In the next 1.5 years was on a diet, refrain from drinking alcoholic beverages, feel a satisfactory, though he felt ar heaviness in the right hypochon drium, sometimes nausea. The deterioration is connected with violation of the food and alcohol. Gradually increasing the symptoms listed above, what was the reason for hospitalization. The examination found: yellowniess.of skin and sclera, spider neavy on the face, neck, chest and back, "liver" palm. The liver is palpated bellow a costaf arch for 4 sm, derse, the surfaceis smooth, edge sharp, the spleen is palpated bellow the costal arch for 3 cm, dense, painless. Laboratory researdh: Total Bilirubin 254 µmol1 (unconjugated - 115 mmol1, conjugated – 139 mmol1), total protein 52g1 (N 60-90 g1), albumin 25% (N 35-55%), globulins 48 % ( 15-30%), thymol test of 9.8 units (normally – 5 units), transaminases: aspartic acid 300 mmollhour (N 0-35 mmollhour), alaninova 570 mmol lhour (N 0-45 mmol1hour). The task: 1. Formulate and justify a presumptive diagnosis. List the main syndromes 2. What more research is needed. 3. List the possible complications. 4. What type of jaundice is characteristic for this disease? Describe its laboratory features.
2. I have already come from school. Now I am having dinner.
3. When did it stop raining? - It stopped raining two hours ago.
4. Did you sent him a telegram last week?
5. She has never driven a car before.
6. He has read the text and now he can retell it.
7. Jane wasn't at the cinema this week.
8. Don't you know who has opened the door?
9. Five years ago he was a typist.
10. When did he see you? - He saw me this week.
11. It's the best thing he has ever made.
12. Where have I put my bag? I can't find it.
13. Has somebody telephoned me? — Your mother telephoned you there times this morning.
14. I am happy. I have just received a telegram from my friend.
15. When did they move to a new flat? - They moved there last month.
2. John travelled around Europe last year. (Джон путешествовал вокруг Европы в году. (Past Perfect))
3. Have you ever lived in a foreign country? (Ты когда-либо жил в другой стране? (Past Perfect))
4. My friend know a lot because he has read a lot. (Мой друг много знает потому, что он много читал (Present Perfect))
5. She went home two days ago. (Она уехала домой два дня назад (Past Perfect))
1. When the police arrived (Past Perfect), the car had gone (Present Perfect). (Когда полиция прибыла, машина уже уехала)
2. George finished doing his homework at eight o'clock. (Джордж закончил делать своё домашнее задание в восемь часов) (Past Perfect)
3. When she got (Past Perfect) to the shop, it had closed (Present Perfect). (Когда она добралась до магазина, он уже закрылся.)
4. The train had left (Present Perfect) when he came (Past Perfect) to the station. (Поезд уехал, когда он пришёл на станцию.)
5. We had eaten (Present Perfect) everything by the time he arrived (Past Perfect) at the party. (Мы уже успели всё съесть к тому времени, когда он приехал на вечеринку)