申論題

四、病例判讀：請依據題目所敘述之病史、臨床症狀及實驗室檢查結果判讀診斷下列病 例。（25 分） Dog：Eight-year-old Male Canine Bull Terrier. History：Intermittent vomit, anorexia and jaundice of three weeks’ duration. Physical examination：Scleral membranes are icteric and hepatomegaly is present. Initial assessment ： Vomiting and anorexia are nonspecific signs most commonly associated with hepatic, pancreatic, renal or intestinal disease. Presence of icterus and hepatomegaly suggests that liver is of particular interest. Hematology and chemistry profiles are warranted with particular emphasis on aforementioned organ systems. Laboratory data： Hematology：PCV＝32%, Hb＝11.1g/dL, RBC＝4.87×106/μL, Reticulocytes＝1.3%, WBC＝39,800/μL, Neutrophils（Band）＝400/μL, Neutrophils（Segmented）＝35,800/μL, Eosinophils＝0/μL, Lymphocytes＝2,400/μL, Monocytes＝1,200/μL. Serum biochemistry：BUN＝13.5 mg/dL, Creatinine＝0.6 mg/dL, Glucose＝85 mg/dL, T. bilirubin＝4.6 mg/dL, D. bilirubin＝3.9 mg/dL, Total protein＝7.0 g/dL, Albumin＝2.8 g/dL, ALT ＝ 449 U/L, ALP ＝ 800 U/L, Amylase ＝ 568 U/L, Sodium ＝ 146 mmol/L, Potassium ＝ 4.5 mmol/L, Chloride ＝ 120 mmol/L, Calcium ＝ 10.2 mg/dL, Phosphorus＝4.2 mg/dL, Cholesterol＝480 mg/dL, Triglyceride＝180 mg/dL. Urinalysis ： Color ： Orange, Turbidity ： Clear, Sp.gr ＝ 1.020, pH ＝ 6.5, Protein ： Negative, Glucose ： Negative, Ketone ： Negative, Bilirubin ＝ 4+, Occult blood ： Negative, Urine sediment examination：WBC：Negative, RBC：Negative, Epithelial cells：Negative, Bacteria：Negative, Casts：Negative, Crystals：Bilirubin.