試題詳解

14. 你的病人懷孕已26周，因近期皮膚發癢，甚至癢到影響睡眠而來求醫。她祇有服用vitamin 及folic acid，未服用任何藥物。身體診察發現皮膚有抓痕，沒有petechiae或ecchymoses。病人意識清楚，生命徵象正常，沒有發燒。有mildly icteric sclera。腹部敲診無shifting dullness。抽血檢驗結果如下：Hb=12.0 (≧10.8); WBC=4800 (≧4000), platelet=280K (≧130K), PT (INR)=1.1 (0.8-1.1), Bilirubin (T)=3.8 mg/dL (≦1.0), Bilirubin {D}=3.2 mg/dL (≦0.3), ALT=38 (≦ 41), AST=29 (≦31), ALP (Alkaline phosphatase)=330 (≦104), GGT=400 (≦52), Albumin=3.5 g/dL (≧3.5)。超音波檢查子宮及胎兒正常。最可能之診斷為下列那一項？
(A) HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome
(B) Acute fatty liver of pregnancy
(C) Intrahepatic cholestasis of pregnancy
(D) Hyperemesis gravidarum
(E) Drug-induced liver injury