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.

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