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男,39岁。因乏力、右上腹部包块6个月,腹部肿胀伴黑便20天入院。6个月前出现乏力、消瘦,逐渐加重,并出现左上腹部包块,约在肋下5cm,质硬,边缘清,轻触痛。20天前出现腹部肿胀,迅速加重,伴数次成形黑便,并出现双下肢浮肿。体检:T38.5℃,P120次/分,R26次/分,BP15/8kPa。腹部明显膨隆,腹壁静脉显露,血流方向均向上。肝肋下未及,脾肋下约7cm,触痛明显,质韧,表面光滑,肝上界右锁骨中线第5肋间,脾上界左腋中线第7肋间,腹水征(+),双
Male, 39 years old. Because of weakness, right upper abdominal mass 6 months, abdominal swelling with black stool 20 days admission. 6 months ago, fatigue, weight loss, and gradually increased, and the left upper abdominal mass, about 5cm under the ribs, hard, clear edge, touch the pain. Twenty days before the abdomen swelling, rapid increase, with several times forming melena, and the emergence of lower extremity edema. Physical examination: T38.5 ℃, P120 beats / min, R26 beats / min, BP15 / 8kPa. Significant bulging abdomen, abdominal veins revealed that the direction of blood flow upward. Liver under the ribs and less, spleen ribs about 7cm, tenderness, quality tough, smooth surface, the upper right hepatic subclavian midline 5th intercostal spleen, upper left axillary midline 7th intercostal, ascites (+), double