[医学]华中科大同济医院泌外2011毕业考试翻译.doc

总论：名词解释：（每题5分）低渗性缺水失血性休克多系统器官衰竭急性蜂窝织炎问答：（每题15分）1 简述感染性休克的治疗2 试述外科手术病人营养状况的判定方法泌外：名词解释：（每题5分）急性肾功能衰竭肾自截压力性尿失禁尿三杯试验问答：（每题15分）1 简述膀胱肿瘤的分期以及诊断方法2 简述肾输尿管结石的手术治疗原则翻译： Hematuria can be associated with multiple medical and surgical problems, ranging from minor incidental findings to urologic neoplasm. The finding of blood in the urine prompts the need for a more thorough evaluation. Blood in the urine can originate from any site along the urinary tract. Gross blood or clots in the urine generally prompt a patient to seek medical attention, and painless gross hematuria requires a complete urologic work-up: urinalysis, culture, cytology, upper tract imaging, and cystoscopy. Patients with gross hematuria have about five times the number of life-threatening conditions when compared with patients with microscopic hematuria. Evaluating microscopic hematuria is more controversial. Evaluations of microscopic hematuria have resulted in the discovery of significant disease in 3.4 to 56% of individuals and in the discovery of malignancy in 0 to 26% of individuals. These wide ranges reflect differences in age and sex of patient populations. Hematuria is a sign of potentially lifethreatening disease and deserves evaluation.Evaluation begins with a complete urologic history and physical examination. In addition, a serum creatinine should be drawn on those referred for hematuria. Frequency, urgency, dysuria, urethral discharge, and suprapubic or perineal pain suggests an inflammatory or infectious process. The clinician should look for a family history of stones, renal disease, or sickle cell anemia. Patients may give a history of recent trauma, vigorous exercise, sexual activity, or menstruation, suggesting a benign etiology. Glomerulonephritis is generally preceded by a recent upper respiratory tract infection associated with acute onset of hypertension and edema. Several medications may induce a chemical cystitis, papillary necrosis, or allergic nephritis and hematuria. A description of accompanying pain may help to localize the bleeding site. Consider total painless gross hematuria to be of neoplastic origin until proven otherwise. Blood that appears at the onset of micturition and then clears frequently originates from the prostate, seminal vesicles, or urethra. Blood originating from the bladder trigone, vesicle neck, or posterior urethra appears at the end of urination. Hematuria throughout urination suggests vesical, ureteral, or renal pathology. Patients with risk factors for significant disease should be identified and treated as high risk. These risk factors include a smoking history, an occupational exposure to chemicals or dyes (benzenes or aromatic amines), a history of gross hematuria, age 40 years, a previous urologic history, a history of irritative voiding symptoms, a history of urinary tract infection, a history of analgesic abuse, and a history of pelvic irradiation or cyclophosphamide usage.When hematuria is suspected, one must perform a urinalysis on a clean-catch, midstream, fresh urine specimen. Patients should avoid strenuous exercise or instrumentation for at least 48 hours prior to giving a sample. In addition, trauma, sexual activity, menstruation, and viral illness may result in positive results. Repeat urinalysis should be performed, and, if normal, additional evaluation is not necessary. In females, the labia should be separated and, in uncircumcised males, the foreskin retracted to avoid contamination. If there is evidence of contamination, a new specimen should be obtained and consideration given to a catheterized specimen. When dipstick is positive for blood, a microscopic evaluation for blood cells must be performed. Various studies have reported that between 13 and 21% of healthy individuals have some degree of hematuria. In 1926, Addis reported microscopic examination of overnight urine specimens from presumably healthy medical students and found red blood cells in 40 of 60 specimens. The 95 to 98% confidence limits for hematuria in a healthy population are reported as under 3 red blood cells per high-power field (RBC/HPF). The recommended definition of microscopic hematuria is 3 RBC/HPF on microscopic evaluation of the urinary sediment from two of three properly collected urinalysis specimens. Risk factors for significant urologic disease must be considered when deciding whether or not to evaluate those with 3 RBC/HPF without evidence of infection, then work-up should continue.Hematuria in the presence of proteinuria or red cell casts suggests glomerular disease and warrants renal consultation. A total protein excretion of 1 g/24 h would be unlikely without parenchymal disease or gross hematuria.17 Further, the presence of a high proportion of dysmorphic red blood cells or renal insufficiency should prompt further medical evaluation.All patients who have been previously defined as “high risk” need to undergo cystoscopy and cytologic evaluation. Cytology can be obtained from a voided specimen or from a bladder wash at the time of cystoscopy. For low-risk patientsthose who are asymptomatic and without risk factors for transitional cell carcinoma urine cytology or cystoscopy may be performed. Cystoscopy is required for all those with positive or atypical or suspicious cytology. Cystoscopy in low-risk patients has very low yield ( 1%). Currently, there are insufficient data to recommend the routine use of voided urinary markers.Upper urinary tract imaging is essential for full evaluation of the renal parenchyma and elvicaliceal system. Evaluation may consist of an intravenous urography (IVU), ultrasonography (US), computed tomography (CT) scan, or magnetic resonance imaging (MRI). In patients with normal renal function and without contraindication to contrast dye, IVU or CT urography should be considered as the initial imaging modality.6 If IVU is performed, physicians should be aware of its limi