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第一篇 人体疾病第一章对人体的简要概述使我们对两个被认为是医学基础的不同学科有了初步认识,这两个学科就是解剖学与生理学。然而不把病理学包括进去,这种概述是不完整的,因为病理学是研究疾病引起的结构和功能变化的学科。实际上,现代对疾病的研究方法强调病理学与生理学的密切关系,并强调在治疗任何人体疾病时了解病理学与生理学基础的必要性。The brief survey of the human body in Chapter One has given us a glimpse into two different studies that are considered the fundamentals of medical sciences, namely anatomy and physiology. However, the picture is not complete without considering pathology, the science that deals with the structural and functional changes produced by the disease. In fact, the modern approach to the study of disorder emphasizes the close relationship of the pathological and physiological aspects and the need to understand the fundamentals of each in treating any body diseases. 那么什么是疾病呢?它可以被定义为正常机能或者部分机能遭受损害时的一种状态。每一种生物,无论植物还是动物,都会生病。例如,人类常常被微小的细菌感染,但是细菌又转而可能被更加微小的病毒感染。Then what is a disease? It may be defined as a condition that impairs the proper function of the body or of one of its parts. Every living thing, both plants and animals, can succumb to disease. People, for example, are often infected by tiny bacteria, but bacteria, in turn, can be infected by even more minute viruses. 世界上有数百种疾病,每一种都有其特定的症状和体征,这些都是医生诊断疾病的线索。症状是病人自己能觉察到的,比如,高烧、流血或者疼痛。而体征则是医生能够观察到的,比如,血管扩张或内器官肿大。Hundreds of different diseases exist. Each has its own particular set of symptoms and signs, clues that enable a physician to diagnose the problem. A symptom is something a patient can detect, such as fever, bleeding, or pain. A sign is something a doctor can detect, such as a swollen blood vessel or an enlarged internal body organ. 疾病可按不同的标准来分类。例如,流行病是感染某一地区许多人的疾病。 当它年复一年地发生在同一地区,就成了一种地方病。急性病发作快、病程短。例如,急性心脏病发作常常没有前兆,而且会很快致命。慢性病发病缓慢,但病程有时会长达数年。风湿热正是由于发病慢、病程长而成为一种慢性病。介于急性与慢性之间的另一种类型被称为亚急性。Diseases can be classified differently. For instance, an epidemic disease is one that strikes many persons in a community. When it strikes the same region year after year it is an endemic disease. An acute disease has a quick onset and runs a short course. An acute heart attack, for example, often hits without warning and can be quickly fatal. A chronic disease has a slow onset and runs a sometimes years-long course. The gradual onset and long course of rheumatic fever makes it a chronic ailment. Between the acute and chronic, another type is called subacute. 疾病也可以依其病原体来划分,例如,传染病指可以在人与人之间传播的疾病,如可通过咳嗽或打喷嚏造成的飞沫进行传播。极小的有机体,如细菌和真菌,可导致传染病。病毒和小虫子也可以。不论病原体是什么,只要它存活于受感染的人体内就能传染给别人。有时,一种致病菌侵入人体后,该人却没有显示患病的症状。于是无症状的病原携带者甚至在自己也不知情的情况下就把疾病传染给了他人。Diseases can also be classified by their causative agents. For instance, an infectious, or communicable, disease is the one that can be passed between persons such as by means of airborne droplets from a cough or sneeze. Tiny organisms such as bacteria and fungi can produce infectious diseases. So can viruses and tiny worms. Whatever the causative agent might be, it survives in the person it infects and is passed on to another. Sometimes, a disease-producing organism gets into a person who shows no symptoms of the disease. The asymptomatic carrier can then pass the disease on to someone else without even knowing he has it. 非传染性疾病是由身体机能失调引起的,这包括器官或组织退化、异常细胞生长以及异常的血液生成和血液循环。当然也包括胃、肠、内分泌系统和泌尿生殖系统的紊乱。一些疾病也可能由饮食不足、身体抵抗力下降或神经系统运行不良造成。Noninfectious diseases are caused by malfunctions of the body. These include organ or tissue degeneration, erratic cell growth, and faulty blood formation and flow. Also included are disturbances of the stomach and intestine, the endocrine system, and the urinary and reproductive systems. Some diseases can be caused by diet deficiencies, lapses in the bodys defense system, or a poorly operating nervous system. 心理因素和社会因素也会引发残疾和疾病。这些疾病包括毒品成瘾、肥胖、营养不良和由污染造成的健康问题。Disability and illnesses can also be provoked by psychological and social factors. These ailments include drug addiction, obesity, malnutrition, and pollution-caused health problems. 而且,上千种乃至更多的遗传性出生缺陷由基因变异引起。由于小小的基因负责产生许多身体所需的化学物质,它们的缺失或者运行不良都会严重损害健康。影响人体化学反应的基因失调被称为先天性代谢失调,某些智力发育迟缓有遗传性。Furthermore, a thousand or more inheritable birth defects result from alternations in gene patterns. Since tiny genes are responsible for producing the many chemicals needed by the body, missing or improperly operating genes can seriously impair health. Genetic disorders that affect body chemistry are called inborn errors of metabolism. Some forms of mental retardation are hereditary. 病菌如何侵袭身体人类生活的世界里有许多其他生物为食物和繁衍而竞争。很多致病生物,即病原体,通常被广义地称为病菌,能侵入人体并利用其细胞和液体来满足自己的需求。一般来讲,身体防御系统能够抵抗这些入侵者。Humans live in a world where many other living things compete for food and places to breed. The pathogenic organisms, or pathogens, often broadly called germs that cause many diseases, are able to invade the human body and use its cells and fluids for their own needs. Ordinarily, the bodys defense system can ward off these invaders. 病原体能通过多种方式进入人体。一些病原体是被吸入人体的,如引起普通感冒、肺炎和结核病的病菌;有的是通过性接触进入人体的,如引起性病的病原体;还有的是通过受污染的食物、水或器皿进入人体,比如引起肝炎、霍乱和伤寒的病原体。Pathogenic organisms can enter the body in various ways. Somesuch as those that cause the common cold, pneumonia, and tuberculosisare breathed in. Otherssuch as those that cause venereal diseasesenter through sexual contact of human bodies. Still otherssuch as those that cause hepatitis, colitis, cholera, and typhoid feverget in the body through contaminated food, water or utensils. 昆虫作为媒介或者病原体携带者传播疾病。苍蝇能将病菌从人类的排泄物或其他腐烂的物质带到食物和饮料中;蚊子、虱子或其他媒介动物的叮咬也会将病菌传入人体。Insects can spread disease by acting as vectors, or carriers. Flies can carry germs from human waste or other tainted materials to food and beverages. Germs may also enter the body through the bite of a mosquito, louse, or other insect vector. 身体如何抵抗疾病作为第一条防线,健康的身体有许多物理屏障来抵御感染。覆盖在体表或者器官开口处的皮肤和粘膜能在很大程度上抵抗细菌或其他感染体的入侵。如果这些物理屏障遭到损坏或烧伤,身体对感染的抵抗力就会下降。在一些较轻的病情中,可能只会发生疖子和丘疹。在较重的情况下,身体的大面积区域则可能会被感染。As a first line of defense, a healthy body has a number of physical barriers against infection. The skin and mucous membranes covering the body or lining its openings offer considerable resistance to invasion by bacteria and other infectious organisms. If these physical barriers are injured or burned, infection resistance drops. In minor cases, only boils or pimples may develop. In major cases, however, large areas of the body might become infected. 呼吸道尤其容易受到感染。幸好,呼吸道内覆盖了能分泌粘液的细胞,它们能捕获微生物和尘埃。另外,呼吸道内覆有一层叫纤毛的细小绒毛,能象麦田里的小麦一样舞动,轻轻地将异物扫出呼吸道。另外,呼吸道内的异物还常通过擤鼻涕、咳嗽、打喷嚏和清嗓子而被排出。然而,反复感染、抽烟或其他原因会损坏呼吸道,使之容易受感染。Breathing passages are especially vulnerable to infection. Fortunately, they are lined with mucus-secreting cells that trap tiny organisms and dust particles. Also, minute hairs called cilia line the breathing passages, wave like a field of wheat, and gently sweep matter out of the respiratory tract. In addition, foreign matter in the breathing passages can often be ejected by nose blowing, coughing, sneezing, and throat clearing. Unfortunately, repeated infection, smoking and other causes can damage the respiratory passageways and make them more susceptible to infection.很多潜在的入侵者不能在体温(华氏98.6度或摄氏37度)下生存。即使能在这种温度下生存繁殖的病菌,在体温升高发烧时也会被杀灭。Many potential invaders cannot stand body temperature (98.6 oF or 37 oC). Even those that thrive at that temperature may be destroyed when the body assumes higher fever temperatures. 外耳道里的蜡质和泪管里的眼泪能减缓一些细菌的生长速度,而胃酸也能毁掉某种吞食进去的病菌。Wax in the outer ear canals and tears from eye ducts can slow the growth of some bacteria. And stomach acid can destroy certain swallowed germs.身体的第二条防线是血液和淋巴。某些白细胞群聚集在被感染区,通过形成脓肿使感染限于局部。如果脓块不破裂,里面的脓不排出,感染很可能会扩大。发生这种情况时,感染首先被该区域的淋巴腺阻挡。例如,手上的感染向上传到手臂时,手臂上会出现红痕,腋窝淋巴腺肿胀,有触痛感。如果感染得不到控制,将会导致血液中毒。The bodys second line of defense is in the blood and lymph. Certain white blood cells flock to infected areas and try to localize the infection by forming pus-filled abscesses. Unless the abscess breaks and allows the pus to drain, the infection is likely to spread. When this happens, the infection is first blocked by local lymph glands. For example, an infection in the hand travels up the arm, producing red streaks and swollen, tender lymph glands in the armpit. Unless the infection is brought under control, it will result in blood poisoning. Phagocytes are located at various sites to minimize infection. One type in the spleen and liver keeps the blood clean. Others in such high-risk areas as the walls of the bronchi and the intestines remove certain bacteria and shattered cells.位于身体不同部位的吞噬细胞能最大程度地减少感染。肝和脾内的吞噬细胞能保持血液清洁。位于支气管壁和肠壁等高危区域的吞噬细胞能清除某些细菌和破碎的细胞。第二篇 诊断与预后诊断 在大多数临床就诊过程中,病人会向医生提出一些基本的问题,例如:“我怎么了?”、“我的病是什么原因引起的?”这些问题促使医生做出诊断,即确定生病的原因。诊断包括病史、身体检查和实验室检查。In most clinical encounters, the patient presents basic questions to the doctor: Whats wrong with me? What is causing my illness? These questions set the stage for making a diagnosis, i.e. determining the cause of an illness. And a diagnosis is accomplished with history, physical examination and laboratory testing.疾病的诊断过程由采集病人的病史开始,医生向病人询问当前和过去所患的疾病、家族病史、生活习惯等等。下表是一个标准病历应包含的内容。The process of diagnosing a disease begins with the persons health history. The physician asks the patient questions on both present and past illnesses, family history of disease, habits and so on. The following table presents typical contents of a standard medical history.病人的一般情况年龄、性别、民族、职业和生育情况(适用于女性)主诉用四到五个字,最好是引用患者的自述,陈述就诊的目的及病痛的持续时间。偶尔也可将患者的请求作为主诉,如:“我需要注射流感疫苗”。患者的其他医生姓名、地址、电话号码以与患者的关系现病史 每种主要症状,包括什么症状、发生部位、发生时间、轻重程度、时间 经过、症状好转或加重的影响因素、既往诊治情况及可能缩小诊断范围 相关的问题既往史既往疾病及住院情况、免疫情况、用药情况、过敏史、饮酒、吸烟及有无药物成瘾等社会及职业史描述患者日常生活中典型的一天以及目前疾病对其生活的影响;患者可获得的社会支持(来自家庭、朋友或同事)及职业史家族史家族中的遗传病史,家族成员的寿命及死亡原因各系统的评估主要器官系统的系统性评估:皮肤、造血系统(包括淋巴结),头、眼、耳、鼻、口、喉、颈、乳房、呼吸系统、心血管系统、胃肠道系统、泌尿生殖系统、肌肉骨骼系统、神经系统、内分泌系统和精神系统Description of patientAge, gender, race, occupation and parity (for woman)Chief complaintFour or five words, preferably quoting the patient, stating the purpose of the visit and the duration of the complaint. Occasionally the patient states a request instead of a complaint such as I need a flu shot.Other physicians involved in the patients careName, address, telephone number, and relationship to the patientHistory of the present illnessFor each major symptom, what, where, when, how much, chronological course, what makes the symptom better or worse, past medical care, questions to narrow diagnostic possibilitiesPast medical historyPrevious illnesses and hospitalizations, immunizations, medications the patient takes, allergies, and alcohol, tobacco and drug habitsSocial and occupational historyDescription of a typical day in the patients life and how the present illness affects it, social supports (family, friends, and colleagues) available to the patient, and occupational historyFamily historyHistory of genetically related diseases in the patients family and longevity and cause of death of family membersReview of systemsSystematic review of major organ systems: skin, hematopoietic system (including lymph nodes), head, eyes, ears, nose, mouth, throat, neck, breasts, and respiratory, cardiovascular, gastrointestinal, genitourinary, musculoskeletal, nervous, endocrine and psychiatric systems询问病史之后是全面的身体检查,内容包括测量身高、体重和血压,对心肺听诊,检查眼、耳和口腔。听力和视力检查有时在常规身体检查中进行。反射检查是简单的神经传导检查,有好几项,包括用橡皮锤在某些部位(如膝盖)敲打。Asking the patients medical history is followed by the general physical examination which includes measuring height and weight, and taking blood pressure; listening to the heart and lungs with a stethoscope; and examining eyes, ears, and mouth. Tests of hearing and vision are sometimes performed in routine physical examinations. Reflex tests are simple tests of nerve conduction that involve, among several other tests, tapping with a rubber hammer in areas such as the knee. 由于体液常常揭示了关于疾病性质的重要信息,所以实验室检查对于确诊疾病起着非常重要的作用。血液检查能判断病人是否贫血,即正常红细胞数量不足,判断病人是否有感染或血液病如白血病。血液分析还能显示是否有营养不良和其他疾病。葡萄糖耐糖试验用于诊断糖尿病,通过检测血糖水平来测量胰岛素的活性。Since body fluids often reveal important information about the nature of the disorder, laboratory testing plays an important role in determining the patients disease. Blood tests can determine whether the person has anemiathat is, an insufficient amount of healthy red blood cellsinfection, or a blood disease, such as leukemia. Blood analysis can also uncover nutritional deficiencies and other disorders. The glucose-tolerance test, which is used to diagnose diabetes, measures insulin activity by monitoring the level of glucose, or sugar, in the blood. 尿液检查用于检测其中是否有葡萄糖、细菌、蛋白质及其他物质。尿液中存在葡萄糖有时是由糖尿病引起的。尿液中有细菌表明肾脏或膀胱有感染,尿液中存在蛋白质可能源于某种肾脏疾病。粪便样品检查旨在寻找致病微生物和便血,便血是肠道病的一个常见症状。Urine is also tested for glucose as well as for bacteria, protein, and other materials. Glucose in the urine is sometimes caused by diabetes. Bacteria in the urine can indicate a kidney or bladder infection, and the presence of protein may result from a kidney disorder. A stool sample is tested for disease-causing microorganisms and for blood, which is often a symptom of intestinal disease.当怀疑有神经系统病变时,常常通过脊液检查来发现微生物和其他不正常成分。鼻腔和喉部的粘液检查常常可用于确定引起呼吸道感染的微生物。Spinal fluid is examined for microorganisms and other unusual contents when a nervous system disorder is suspected. Mucus from the nose and throat can be tested to identify the organisms responsible for respiratory infections.活检是指从人体的某个器官或部位采集组织样品,然后把该样品切成非常薄的切片,用特殊的染料染色,再置于显微镜下观察,以发现细胞的病变。A sample of tissue can be taken from an organ or any other part of the body by a process called biopsy. The tissue is then sliced into very thin sections, stained with special dyes, and studied under the microscope to discover abnormalities in the cells.放射照片(即X光照片)被用来检查身体的各个部位。比如,胸片有助于诊断肿瘤、肺炎和结核。X光片也可以显示骨折和肌肉骨骼系统的其他疾病。Radiographs, or x-ray photographs, are used to examine various parts of the body. A chest x- ray, for example, can help diagnose tumors, pneumonia, and tuberculosis. X-rays can also show bone fractures and other conditions of the musculoskeletal system. 计算机断层扫描(CT)扫描仪是一种特别的X射线相机,它可以获得硬组织和软组织的高清图像。通过每次对身体组织的一个断层进行扫描照相,CT扫描仪可以检测到非常小的肿瘤和其他疾病。Computed tomography (CT) scanners are specialized X-ray cameras that take highly detailed images of hard and soft tissues. By picturing one layer of the bodys tissues at a time, CT scanners can detect very small tumors and other disorders.核磁共振(即磁共振成像)是一种无副作用、无创的检查方法,运用强磁场下的无线电波来对患者进行检查,并生成脑、心脏、肝脏及其他器官的薄层可视图像。由此产生的对比度高、具有不同色调的图像可以发现肿瘤、缺血组织及斑块。Nuclear magnetic resonance, or magnetic resonance imaging, is a hazard-free, non-invasive method that uses radio waves in the presence of a strong magnetic field to probe a patient and generate visual images of thin slices of the brain, heart, liver, and other organs. The high-contrast, variable-toned images that result can uncover tumors, blood-starved tissues, and plaques. 超声检查对于检测肺部和腹腔肿瘤很有效,它使用超高频声波来形成内部器官的电视图像。由于超声波无任何辐射,有时用于确定妊娠期胎儿的大小和位置。Ultrasonography is useful in locating tumors of the lung and abdominal cavity. It employs ultra-high frequency sound waves to form television images of internal organs. Because it produces no radiation, ultrasound is sometimes used during pregnancy to determine the size and position of the fetus. 心肌和神经系统产生的电脉冲可以通过特殊设备测量出来。心电图可用于诊断某些心脏疾病,将电极贴在胸口,就可以记录病人在休息或活动时的心脏电活动,如在跑步机上行走时的心脏电活动。脑电图通过连接在头部的电极测量大脑电活动,可检测大脑中的某一区域是否存在波动,如发生癫痫时。肌电图记录肌肉神经的活动,它对于诊断诸如多发性硬化症的退行性神经疾病很有帮助。Both the heart muscle and the nervous system produce electrical impulses that can be measured with special machines. The electrocardiograph is useful for diagnosing certain heart conditions. With electrodes taped to a persons chest, the electrical activity of the heart can be recorded while the patient is either resting or performing some activity, such as walking on a treadmill. The electroencephalogram measures the electrical activity of the brain through electrodes attached to the head. This test detects whether there is an area of irritability in the brain, which, for example, occurs in epilepsy. The electromyogram (EMG) records the activity of nerves in muscles. The EMG is helpful in diagnosing degenerative nerve disorders such as multiple sclerosis.肺功能检查主要检测肺和呼吸道的呼吸能力,通过向一根与肺量计相连的管道呼气就可以获得有关呼吸功能的信息。Tests of pulmonary function measure the breathing capacity of the lungs and airways. By exhaling into a tube connected to a machine called a spirometer, information is obtained on respiratory functions.光纤技术使医生能够看到以前只能通过手术才可看到的部位,光纤仪器主要是细如发丝的玻璃纤维,可以进入细小区域,并且深入体腔。光纤技术可用于检查结肠和肺部支气管。Fiber optic technology has allowed physicians to see parts of the body that previously could be seen only by performing surgery. Fiber optic tools are essentially hair-thin glass fibers that can enter small areas and can be moved deep into the body cavities. Fiber optic technology can be used to examine the colon and the bronchial tubes in the lung. 盆腔检查用于评估女性的生殖整体健康情况,巴氏涂片可检测宫颈癌。乳房检查能够发现可能是癌症的肿块。乳房X线照相术使用特殊的X射线产生乳房的软组织图像,是一种检测肿瘤的更可靠的方法。A pelvic examination is performed to assess the general reproductive health of a woman. The pap smear is a test for cancer of the cervix. A breast examination can detect lumps that may indicate cancer. Mammography, a procedure that involves using special x-rays to produce an image of the soft tissues of the breast, is a much more reliable way to detect tumors.皮试用于诊断过敏,心理测试用于诊断学习和精神障碍。Skin tests are used to diagnose hypersensitivity conditions, or allergies. Psychological tests are used to diagnose learning and mental disorders. 预后 医生可能会遇到另一类问题,如:“你觉得我的病能康复吗?”或“你能使我病情好转吗?”。病人是在询问他们的预后,即关于其疾病的可能性结果的预测。事实上,对于很多患者来说,预后是他们最关心的问题。A physician may encounter another type of questions, such as “Do you think I can get recovered from my condition?” or “Can you help me to stay well?” The patient is asking their prognosis, the forecast of the probable results of his/her disease. In fact, for a great many patients, the prognosis is their biggest concern.因此,将诊断结果告诉病人并与病人讨论治疗过程是非常重要的。如果病情很可能治愈并无后遗症,那么安慰一下患者就行了。然而,最难讨论的预后是关于那些致命性疾病的,尤其是众多癌症。即使是不好的预后,大多数患者也想知道,但在多大程度上告知病人情况主要是由病人而不是医生来决定,医生有责任让病人意识到讨论预后与否将取决于病人的意愿。详细的讨论最好在随访时进行,即在双方有机会相互了解之后。最高明的医生在告知病人事实时也会给予希望,帮助病人走出震惊、否定、抑郁的复杂情绪,并最

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