病例阅读PPT课件.ppt

医学汉语,MedicalChinese,Contents内容,DigestiveSystem,absorptionaminoacidsamylaseanusappendixbilebilirubinbowel,吸收氨基酸淀粉酶肛门阑尾胆汁胆红素肠,canineteethcecumcoloncommonbileductdefecationdentindigestionduodenum,犬齿盲肠结肠胆总管排便牙本质消化十二指肠,DigestiveSystem,eliminationemulsificationenamelenzymeesophagusfattyacidsfecesgallbladder,排泄乳化珐琅质酶食道脂肪酸粪便胆囊,glucoseglycogenhydrochloricacidileumincisorinsulinjejunumlipase,葡萄糖糖原盐酸回肠切牙，门牙胰岛素空肠脂肪酶,DigestiveSystem,livermasticationmolarteethpalatepancreaspapillaeparotidglandperistalsis,肝脏咀嚼磨牙，臼齿颚胰腺舌乳头腮腺蠕动,pharynxportalveinproteasepulppyloricsphincterrectumrugaesaliva,咽门静脉蛋白酶牙髓幽门括约肌直肠胃褶皱唾液,DigestiveSystem,salivaryglandssigmoidcolonsphincterstomachtriglyceridesuvulavilli,唾液腺乙状结肠括约肌胃甘油三酯悬雍垂，小舌肠绒毛,DigestiveSystem,anorexiaascitesborborygmusconstipationdiarrheadysphagiaeructationflatus,厌食腹水肠鸣音便秘腹泻吞咽困难打嗝，嗳气胃肠气，屁,hematocheziajaundicemelenanauseasteatorrhea,便血黄疸黑便恶心，反胃脂肪泻,Symptoms,DigestiveSystem,aphthousstomatitisdentalcariesherpeticstomatitisoralleukoplakiaperiodontaldiseaseachalasiaesophagealvaricesgastriccarcinoma,口疮性口炎龋齿疱疹性口炎口腔白斑牙周病食道失弛症食管静脉曲张胃癌,herniapepticulceranalfistulacolonicpolyposiscolorectalcancerCrohndiseasediverticulosisdysentery,疝胃溃疡肛瘘结肠息肉直肠结肠癌克罗恩病憩室病痢疾,PathologicalConditions,DigestiveSystem,hemorrhoidsileusintussusceptionulcerativecolitisvolvuluscholelithiasiscirrhosispancreatitis,痔疮肠梗阻肠套叠溃疡性结肠炎肠扭转胆结石肝硬化胰腺炎,viralhepatitis,病毒性肝炎,PathologicalConditions,DigestiveSystem,liverfunctiontestsstoolculturehemocculttestbariumenemacholangiographyabdominalultrasonographymagneticresonanceimagingliverscan,肝功能检查gangongnengjiancha大便培养dabianpeiyang大便隐血试验dabianyinxueshiyan钡灌肠beiguanchang胆管造影danguanzaoying腹部超声fubuchaosheng磁共振cigongzhen肝扫描gansaomiao,LaboratoryTests,ClinicalProcedures,DigestiveSystem,gastricbypassgastrointestinalendoscopyliverbiopsynasogastricintubationparacentesisCTscan,胃旁路术weipanglushu胃肠内窥镜检查weichangneikuijing肝活组织检查ganzhuzhihuojian经鼻胃管插入术jingbiweiguancharu穿刺术chuancishu计算机断层扫描jisuanjiduancengsaomiao,LaboratoryTests,ClinicalProcedures,DigestiveSystem,GastricUlcerwithBleeding-melena,hematemesis,患者，男性，45岁，因“黑便3次，呕血1次”于2004年1月28日入院。Huanzhe,nanxing,sishiwusui,yin“heibiansanci,ouxueyici”yuerlinglingsinianyiyueershibariruyuan.,Casereading,胃溃疡伴出血-黑便、呕血Weikuiyangbanchuxueheibian、ouxue,A45-year-oldmanpresentedonJan.28,2004totheemergencydepartmentwithmelenaforthreetimesandvomitingofbloodforonetime.,DigestiveSystem,患者三天前饮酒后出现中上腹不适，解黑便一次，量约200g，当时不伴乏力，头晕，冷汗，心慌，患者未予重视。Huanzhesantianqianyinjiuhouchuxianzhongshangfubushi,jieheibianyici,liangyue200ke,dangshibubanfali,touyun,lenghan,xinhuang,huanzheweiyuzhongshi.,Casereading,Threedaysbefore,afterdrinkingsomealcohol,thepatientdevelopedmelenaofabout200gbutwithoutfatigue,dizziness,coldsweatorrapidheart-beat,sohedidntpaymuchattention.,DigestiveSystem,2天前呕吐咖啡色胃内容物1次，量约200ml，解柏油样便2次，约200g，同时伴有乏力，冷汗，心慌，急送我院急诊。Liangtianqianoutukafeiseweineirongwuyici,liangyue200haosheng,jiebaiyouyangbianliangci,yue200ke,tongshibanyoufali,lenghan,xinhuang,jisongwoyuanjizhen.,Casereading,Twodaysbefore,hesuddenlyvomitedcoffee-likefluidofabout200ml,followedbymelenatwice,withthetotalamountofabout200g.Hefeltfatigue,coldsweatandpalpitationandwassenttotheemergencydepartmentimmediately.,DigestiveSystem,测血压60/30mmHg,粪便隐血试验（+）。既往无肝炎病史，无肾衰史，无急性应激史，未服非甾体类消炎镇痛药。吸烟史20年，每天一包。无饮酒史，有一姐姐死于胃癌。Cexueyaliushidaosanshihaomigongzhu,fenbianyinxueshiyansigejia.Jiwangwuganyanbingshi,wushenshuaishi,wujixingyingjishi,weifufeizaitileixiaoyanzhentongyao.Xiyanshi20nian,meitianyibao.Wuyinjiushi,youyijiejiesiyuweiai.,Casereading,Hisbloodpressurewas60/30mmHgandthestooloccultbloodtestwas(+).Hehadnohistoryofhepatitis,renalfailure,acutestressorhistoryofNSAIDadministration.Hehad20-yearhistoryofsmokingonepackofcigarettesperday,anddenieduseofalcohol.Oneofhissistersdiedofgastriccarcinoma.,DigestiveSystem,入院体检：体温37.5oC,血压60/30mmHg,呼吸19次/分，心率102次/分。神志清晰，巩膜无黄染，贫血貌，未见肝掌，蜘蛛痣，浅表淋巴结未及肿大。Ruyuantijie:tiwei37.5sheshidu,xueyahaomigongzhu,Xinlv102cimeifen.Shenzhiqingxi,gongmowuhuangran,pinxuemao,weijianganzhang,zhizhuzhi,qianbiaolinbajieweijizhongda.,Casereading,Physicalexamination:T:37.5oC,BP:60/30mmHg,R:19/min,HR:102bpm.Conscious,nojaundiceofsclera,paleappearance,noliverpalm,nospiderangiomaonthechest,nopalpationofsuperficiallymphnodes.,DigestiveSystem,双肺听诊无异常。腹软，无压痛反跳痛，未及肿块，肝脾肋下未及。无移动性浊音，肠鸣音亢进。肛指阴性，下肢无水肿，神经系统体征（-）。Shuangfeitingzhenwuyichang;furuan,wuyatongfantiaotong,weijizhongkuai,ganpileixiaweiji.Wuyidongxingzhuoyin,changmingyinkangjin.Gangzhiyinxing,xiazhiwushuizhong,shenjingxitongtizhengyinxing.,Casereading,Bilaterallungauscultationnegative;abdomensoft,notendernessorreboundtenderness,nomasspalpated,liverandspleenarenotpalpatedbelowtheribcage,shiftingdullness(-),bowelsoundsactive,analdigitalexamination(-),noedemaoflowerlimbs,nervoussystem(-).,DigestiveSystem,Livercirrhosisandascites-fatigue,anorexia,abdominalswellingandoliguria,患者，男，57岁，因“乏力、纳差2个月，腹胀、少尿半月”于2003年1月20日入院。Huanzhe,nan,wushiqisui,yin“fali,nachalianggeyue,fuzhang,shaoniaobanyue”yu2003nian1yue20riruyuan.,Casereading,肝硬化腹水-乏力、纳差、腹胀、少尿Ganyinghuafushuifali,nacha,fuzhang,shaoniao,A57-year-oldfemalepatientwasadmittedonJan.20th,2003becauseof“fatigueandanorexiafor2months,abdominalswellingandoliguriaforhalfamonth”.,DigestiveSystem,患者2月前无明显诱因下出现乏力，体力下降，由原来每餐2两降至1两,且伴有低热，自服感冒药后略有好转。Huanzheliangyueqianwumingxianyouyinxiachuxianfali,tilixiajiang,youmeicanerliangjiangzhiyiliang,qiebanyoudire,zifuganmaoyaohoulueyouhaozhuang.,Casereading,Twomonthsbefore,thepatientbegantofeelfatigue,decreasedtoleranceofphysicalactivitiesandanorexiawithoutanyidentifiablecauses.Sheusedtoeat100griceeverymeal,butnowshecouldonlyeat50g.Shealsohadlow-gradefeverandfeltbetteraftertakinganti-coldmedications.,DigestiveSystem,半月前，患者出现腹胀，裤子腰围渐紧，尿量也渐减少，每日尿量约500ml，尿色黄。Banyueqian,huanzhechuxianfuzhang,kuziyaoweijianjin,niaoliangyejianjianshao,meiriniaoliangyue500haosheng,niaosehuang.,Casereading,Halfamonthbefore,thepatientbegantofeelabdominalswelling.Herpantswaistbeltbecametightforher.Urinevolumedecreasedto500mleverydayandthecolorwasdark.,DigestiveSystem,患者遂就诊于当地医院，行腹部B超检查，示肝硬化、脾肿大、大量腹水。患者20年前曾患过急性乙型肝炎，以后的几年中肝功能反复有异常。Huanzhesuijiuzhenyudangdiyiyuan,xingfububichaojiancha,shiganyinghua,pizhongda,daliangfushui.Huanzhe20nianqiancenghuanguojixingyixingganyan,yihoudejinianzhonggangongnengfanfuyouyichang.,Casereading,Thenthepatientwenttothedistricthospitalnearbyandtooktheabdominalultrasoundexamination.Theresultshowedshehadlivercirrhosis,splenomegaly,andlargevolumeofascites.ThepatienthadhepatitisB20yearsago.Duringtheyearsaftertheacuteinfection,herliverfunctionwasabnormalintermittently.,DigestiveSystem,患者无烟酒嗜好，已婚，育有一子、一女，女儿及丈夫身体健康，其子曾患乙肝。父亲死于肝癌，母亲仍健在。Huanzhewuyinjiushihao,yihun,yuyouyizi,yinv,nverjizhangfushentijiankang,qizicenghuanyigan.Fuqinsiyuganai,muqinrengjianzai.,Casereading,Shehadnohabitofsmokingandalcohol.Shewasmarriedandhadonesonandonedaughter.Herdaughterandhusbandwerebothhealthy.HersonhadhepatitisBinfection.Herfatherdiedofprimaryhepaticcancer.Hermotherisstillalive.,DigestiveSystem,入院体检：体温37.5oC,血压120/80mmHg,呼吸18次/分，心率100次/分。神清,慢性肝病面容，巩膜轻度黄染，肝掌（+），左颈部可见蜘蛛痣，浅表淋巴结未触及肿大。Ruyuantijian:tiwen37.5sheshidu,xueya.haomigongzhu,huxi18cimeifen,xinlv100cimeifen.Shenqing,manxingganbingmianrong,gongmoqingduhuangran,ganzhang,zuojingbukejianzhizhuzhi,qianbiaolinbajieweichujizhongda.,Casereading,Physicalexamination:T:37.5oC,BP:120/80mmHg,R:18/min,HR:100bpm.Conscious,hepaticface,mildjaundiceofsclera,liverpalm(+),spiderangiomaonleftneck,nopalpationofsuperficiallymphnodes.,DigestiveSystem,双肺呼吸音清，心界正常大小。腹部明显膨隆，未见腹壁静脉曲张，腹软，腹部无明显压痛，移动性杂音（+）。肠鸣音正常。双下肢中度水肿，神经系统体征（-）。Shuangfeihuxiyinqing,xinjiezhengchangdaxiao.Fubumingxianpenglong,weijianfubujingmaiquzhang,furuan,fubuwumianxianyatong,yidongxingzayinyigejia.Changmingyinzhengchang.Shuangxiazhizhongdushuizhong,shenjingxitongtizhengyinxing.,Casereading,Lungauscultationnegative,heart(-).Abdominalfindings:obviousabdominalbulge(markedprotuberanceoftheabdomen),nodistentionofabdominalwallveins,soft,nopain,shiftingdullness(+),normalactiveintestinalsound,moderateedemaoflowerlimbs,NS(-).,DigestiveSystem,实习生：15床，现在您哪儿不舒服？Shixisheng:shiwuchuang,xianzaininnaerbushufu病人：我肚子痛。Bingren:woduzitong.,Dialogue,Intern:BedNo.15,whichpartofyourbodyisnotfeelingwellnow?Patient:Myabdomenisaching.,DigestiveSystem,实：是上腹部吗？Shishangfubuma病：对。dui实：痛了多长时间了？Tongleduochangshijianle病：从前天晚上十点开始一直在痛congqiantianwanshangShidiankaishiyizhizaitong.,Dialogue,Intern:Isitattheepigastrium?Patient:Yes.Intern:Howlonghasitbeenlikethis?Patient:Itbeganfrom10Pmthedaybeforeyesterday,DigestiveSystem,实：您指指看，是哪儿痛？Nizhizhikan,shinaertong病：开始时是上腹部痛，后来是右侧腹部剧痛，就是这儿。Kaishishishishangfubutong,houlaishiyoucefubujvtong,jiushizheer.,Dialogue,I:Canyouindicatetheachingplacebypointatit?P:Thepainstartsattheepigastrium,andthenIfeelthesharppainattherightabdomen-here.,DigestiveSystem,实：您感觉是什么样的痛？Ninganjieshishenmeyangdetong病：持续地痛，越来越痛，像刀割一样。坐着痛，躺着也痛，痛死我了。Chixvditong,yuelaiyuetong,xiangdaogeyiyang,tangzheyetong,tongsiwole.,Dialogue,I:Whatkindofpainisit?P:Itsacontinuouspain.Anditbecomessharper,likebeingcutbyaknife.ItsallthesamewhetherImsittinguporlyingdown.Oh,itskillingme!,DigestiveSystem,实：其他地方也跟着痛吗？Qitadifangyegenzhetongma病：背部右侧也跟着痛，腰的右侧也不舒服。Beibuyouceyegenzhetong,yaodeyouceyebushufu.,Dialogue,I:Isanyotherpartofthebodyalsoaffected?P:Myrightbackaches,too.Andtherightlumbarregionfeelsuncomfortable.,DigestiveSystem,实：剧痛之后发冷吗？有没有发烧？Jutongzhihoufalengma?Youmeiyoufashao病：没发冷，但有点低烧。Meifaleng,danyoudiandishao.实：小便是什么颜色？Xiaobianshishenmeyanse?病：深黄色。Shenguangse.,Dialogue,I:Doyoufeelachillafterthesharppain?Doyouhavefever?P:Nochill,butIhavealowfever.I:Whatcolorisyoururine?P:Darkyellow.,DigestiveSystem,实：您还记得前天晚上吃什么了吗？Nihaijideqiantianwanshangchishenmelema病：记得。前天晚上，我们单位有个宴会，我吃了很多牛排、鸡肉和煎蛋。回家后就感觉不舒服，恶心，还吐了。,Dialogue,I:Doyourememberwhatyouhadeatenthenightbefore?P:Yes.Thatnight,Iatealotofbeefsteak,chickenandfriedeggsatourunitsdinnerparty.Ifeltunc