Chapter17theabdomen

第17章腹部resumePingLiassociate

professorRheumatologyDept.ofChina-JapanUnionHospitalofJilinUniversity1331751166lipingzt@163.comReviewofSpecificSymptomsThemostcommonsymptomsofabdominaldiseaseareasfollows:腹部疾病最常見(jiàn)的癥狀如下：The

most:

(many,much的最高級(jí))最多的;最高程度的Whichofyouhasmadethemostmistakes?

你們當(dāng)中誰(shuí)錯(cuò)得最多?Most：多數(shù)的;大部分的Mostbirdscanfly.

多數(shù)的鳥(niǎo)會(huì)飛。The

most和most的區(qū)別PainNauseaandvomitingChange

in

bowel

movementsRectal

bleedingJaundiceAbdominal

distentionMassPruritus(itching)ReviewofSpecificSymptoms疼痛惡心和嘔吐排便習(xí)慣的改變直腸出血黃疸腹脹包塊搔癢癥painPainisprobablythemostimportantsymptomofabdominaldisease.疼痛是腹部疾病最重要的癥狀。Althoughabdominalneoplasiamaybepainless,mostabdominaldiseasemanifestsitselfwithsomeamountofpain.盡管腹部腫瘤可以是無(wú)痛性的，但是大部分腹部疾病表現(xiàn)出一定程度的疼痛。neoplasia[?ni?o?'ple???] neo-新的，現(xiàn)代的-plasia生長(zhǎng)、形成painless-less沒(méi)有、無(wú)manifestv.表現(xiàn)、指明manifestationn.臨床表現(xiàn)Feverisonemanifestationofcold.painPaincanresultfrommucosalirritation,smoothmusclespasm,peritonealirritation,capsularswelling,ordirectnervestimulation.疼痛可以是由于粘膜的刺激、平滑肌痙攣、腹膜刺激，包膜腫脹，或者直接的神經(jīng)刺激所引起。mucosal粘膜muco-粘的smoothmuscle平滑肌skeletalmuscle骨骼肌peritoneal腹膜的peri-周?chē)鷓ainAbdominalpainnecessitatesforspeedydiagnosisandtherapy.腹部疼痛需要迅速的診斷和治療。diagnosisn.診斷Thetwodoctorsmadedifferentdiagnosisofmydisease.diagnosev.診斷Thetestisusedtodiagnoseavarietyofdiseases. therapy治療近義詞：treatmenttherapy指更系統(tǒng)的診斷、治療treatment治療Physicaltherapyalternateswithchemical.理療和化療交替進(jìn)行。Theearlierthetreatmentisgiven,thebetterthepatient'schances. 病人越早接受治療，康復(fù)的可能性就越大。painWhenapatientcomplainsofabdominalpain,askthefollowingquestions:當(dāng)患者主訴腹痛時(shí)，應(yīng)該詢問(wèn)下列問(wèn)題：complain“抱怨”“訴苦”。指心中對(duì)人或事物不滿或身體感到不適或痛苦而對(duì)別人訴說(shuō)或抱怨,有時(shí)也可表示說(shuō)話者引起別人對(duì)此事的注意。用作不及物動(dòng)詞時(shí),其后可接of或about引起的短語(yǔ),of后常是訴苦的內(nèi)容,可為名詞或動(dòng)名詞,而about后則是對(duì)抱怨事物概括的陳述。當(dāng)表示“向…抱怨…”時(shí),要用complaintosbof〔about〕sth結(jié)構(gòu)。complain表示病人訴說(shuō)時(shí),不可說(shuō)complainabout〔against,at〕,應(yīng)說(shuō)complainof。Sheisalwayscomplainingofhertoothachetothedoctor.她老是跟大夫說(shuō)她牙痛。pain‘‘Whereisthepain?’’哪里疼痛？‘‘Hasthepainchangeditslocationsinceitstarted?’’從疼痛開(kāi)始后是否發(fā)生了疼痛位置的改變？‘‘Doyoufeelthepaininanyotherpartofyourbody?’’在你身體的其他部位是否也感覺(jué)疼痛？‘‘Howlonghaveyouhadthepain?’’疼痛持續(xù)多久了？‘‘Haveyouhadrecurrentepisodesofabdominalpain?’’腹痛是否間歇性發(fā)作？recurrent周期性、再發(fā)生re-又、再reinstall,re-extractionpain‘‘Didthepainstartsuddenly?’’疼痛是否突然發(fā)作？‘‘Canyoudescribethepain?Isitsharp?dull?burning?cramping?’’你是否能夠描述一下疼痛？它是刺痛？鈍痛？燒灼痛？絞痛？‘‘Isthepaincontinuous?Doesitcomeinwaves?’’疼痛是持續(xù)的嗎？它的強(qiáng)度是否有波動(dòng)？‘‘Hastherebeenanychangeintheseverityornatureofthepainsinceitbegan?’’從疼痛開(kāi)始發(fā)作，它的強(qiáng)度和性質(zhì)是否有任何變化？pain‘‘Whatmakesitworse?’’是什么使情況變得更糟糕？‘‘Whatmakesitbetter?’’是什么使情況變得更好？‘‘Isthepainassociatedwithnausea?vomiting?sweating?constipation?diarrhea?bloodystools?abdominaldistention?fever?chills?eating?’’疼痛是否伴隨惡心？嘔吐？出汗？便秘？腹瀉？血便？腹脹？發(fā)熱？寒戰(zhàn)？進(jìn)食？pain‘‘Haveyoueverhadgallstones?kidneystones?’’既往是否患膽石？腎結(jié)石？Ifthepatientisawoman,askthisquestion:如果患者是女性，還要詢問(wèn):‘‘Whenwasyourlastperiod?’’末次月經(jīng)是什么時(shí)間？period月經(jīng)期Doyougetpianbeforeorduringyourperiods？您在月經(jīng)前或月經(jīng)中有過(guò)疼痛嗎?painNotetheexacttimeatwhichthepainstartedandwhatthepatientwasdoingatthattime.注意疼痛開(kāi)始的準(zhǔn)確時(shí)間以及疼痛開(kāi)始時(shí)患者在做什么。Sudden,severepainawakeningapatientfromsleepmaybeassociatedwithacuteperforation,inflammation,ortorsionofanabdominalorgan.突然、嚴(yán)重的使患者從睡夢(mèng)中驚醒的疼痛可能是伴隨腹部器官的急性穿孔、炎癥、或扭轉(zhuǎn)。perforation穿孔Thispreventsbowelperforation.這樣可以防止腸道穿孔。inflammation炎癥Hehasaninflammationofthelungs.他得了肺炎。torsion扭轉(zhuǎn)Thisovaryisdarkandenlargedfromhemorrhagefollowingtorsion.卵巢扭轉(zhuǎn)造成出血而變黑變大。painAstoneinthebiliaryorrenaltractalsocausesintensepain.膽管或泌尿系統(tǒng)發(fā)生結(jié)石可引起劇烈的疼痛。biliary膽的、膽汁的Formanypersons,includingchildren,thebiliarytubingischokedwithgallstones.有許多人包括兒童，膽道都有膽石堵塞著。renal腎臟的Deathusuallyresultsfromhepaticorrenalfailure.常因肝臟或腎臟衰竭而導(dǎo)致死亡。近義詞：nephriticpainNoteacutenessofthepain.注意疼痛的劇烈程度。Acuteruptureofafallopiantubebyanectopicpregnancy,perforationofagastriculcer,peritonitis,andacutepancreatitiscausesuchseverepainthatfaintingmayresult.異位妊娠導(dǎo)致的急性輸卵管破裂、胃潰瘍穿孔、腹膜炎和急性胰腺炎導(dǎo)致嚴(yán)重的疼痛可以導(dǎo)致暈厥。rupure穿孔Hediedofaruptureofblood-vessels.他血管破裂而死。fallopiantube輸卵管gastriculcer胃潰瘍-itis炎癥peritonitis腹膜炎pancreatitis胰腺炎painItiscrucialtodeterminethelocationofthepainatitsonset,itslocalization,itscharacter,anditsradiation.確定疼痛的起始部位、定位、性質(zhì)和發(fā)射性是非常重要的。Commonly,whenanabdominalorganruptures,painisfelt‘‘a(chǎn)lloverthebelly,’’withoutlocalizationtoaspecificarea.當(dāng)腹部器官發(fā)生穿孔時(shí)，通常感覺(jué)疼痛“遍及全腹”,沒(méi)有特定區(qū)域的定位。Painarisingfromthesmallintestineiscommonlyfeltintheumbilicalorepigastricregions;forexample,painfromacuteappendicitisbeginsattheumbilicus.來(lái)源于小腸的疼痛通常位于臍部或上腹部；例如急性闌尾炎的疼痛起始于臍周。umbilical肚臍；epi-在.....之上；epigastric上腹部；appendicitis闌尾炎painAftertime,painmaybecomelocalizedtootherareas.經(jīng)過(guò)一段時(shí)間，疼痛可能定位到其他位置。Painfromacuteappendicitistravelsfromtheumbilicustotherightlowerquadrantinabout1to3hoursaftertheinitialevent.急性闌尾炎在發(fā)病的1-3小時(shí)后疼痛可以從臍部轉(zhuǎn)移到右下腹部。Paininthechestfollowedbyabdominalpainshouldraisethesuspicionofadissectingaortic

aneurysm.繼發(fā)于胸痛的腹痛應(yīng)該警惕主動(dòng)脈瘤破裂的可能。aortic大動(dòng)脈的；aneurysm動(dòng)脈瘤painNotethenatureofthepain.注意疼痛的性質(zhì)。Paincausedbyaperforatedgastriculcerisoftendescribedas‘‘burning’’;dissectinganeurysmas‘‘tearing’’;intestinalobstructionas‘‘gripping’’;pyelonephritisas‘‘dull,aching’’;andbiliaryorrenalcolicas‘‘crampy,constricting.’’胃潰瘍穿孔引起的疼痛通常被描述為“燒灼感”；動(dòng)脈瘤破裂通常被描述為“撕裂樣”疼痛；小腸梗阻描述為“劇痛”；腎盂腎炎描述為“鈍痛”，膽道或腎臟疼痛描述為“痙攣性、壓榨性”。intestinal腸的；pyelonephritis[?pa??lo?n?'fra?t?s]腎盂腎炎；colic：疝氣、急腹痛描述疼痛：burning，tearing，gripping，dull，crampy，constrictingpainReferredpainoftenprovidesinsightastothecause.牽涉痛經(jīng)常能夠提供病因的線索。Referredpainisatermusedtodescribepainoriginatingintheinternalorgansbutdescribedbythepatientasbeinglocatedintheabdominalorchestwall,shoulder,jaw,orotherareassuppliedbythesomaticnerves.牽涉痛是指疼痛起源于內(nèi)部器官，但患者通常描述其定位于腹壁或胸壁、肩、下巴或其他體神經(jīng)支配區(qū)域。somatic身體的、軀體的painPainappearstooriginateinareassuppliedbythesomaticnervesenteringthespinalcordatthesamesegmentasthesensorynervesfromtheorganresponsibleforthepain.支配疼痛感覺(jué)起始區(qū)域的體神經(jīng)與支配疼痛真正起源器官的感覺(jué)神經(jīng)進(jìn)入脊髓的同一節(jié)段，這可能是引起牽涉痛的原因。Forexample,right-shoulderpainmayresultfromacutecholecystitis;testicularpainmayresultfromrenalcolicorfromappendicitis.例如，急性膽囊炎引起右肩痛，腎絞痛或闌尾炎引起睪丸痛。spinalcord脊髓；sensorynerves感覺(jué)神經(jīng)；cholecystitis膽囊炎；testicular睪丸的；painThecommonsitesforreferredpainareshowninFigure17-3.常見(jiàn)的牽涉痛部位見(jiàn)圖17-3。ThelocationsofpaininabdominaldiseasearesummarizedinTable17-2.腹部疾病的疼痛定位歸納于表17-2。Thetimeofoccurrenceandfactorsthataggravateoralleviatethesymptoms(e.g.,mealsordefecation)areparticularlyimportant.疼痛出現(xiàn)的時(shí)間和引起癥狀加重或減輕的因素（例如進(jìn)食或排便）尤其重要。aggravate：加重；alleviate：減輕painPeriodicepigastricpainoccurring1/2to1houraftereatingisaclassicsymptomofgastricpepticulcers.進(jìn)食后半小時(shí)到1小時(shí)出現(xiàn)周期性上腹痛是胃潰瘍的典型癥狀。Patientswithaduodenalpepticulcerhavepain2to3hoursaftereatingorbeforethenextmeal.患有十二指腸潰瘍疼痛多在進(jìn)食后2-3小時(shí)或下次進(jìn)餐前出現(xiàn)。gastricpepticulcers：消化性胃潰瘍duodenalpepticulcer：消化性十二指腸潰瘍patientswith:患有......painFoodtendstolessenthepain,especiallyinduodenalulcers.特別是十二指腸潰瘍，食物能夠減輕疼痛。Perforationofaduodenalulcertothepancreasmayproducebackache,simulatinganorthopedicproblem.十二指腸潰瘍穿孔至胰腺可以導(dǎo)致后背痛，看似矯形外科問(wèn)題。orthopedic[??θ?'pi?d?k] 整形外科painNocturnalpainisaclassicsymptomofduodenalpepticulcerdisease.十二指腸潰瘍的典型癥狀是夜間痛。Painaftereatingmayalsobeassociatedwithvasculardiseaseoftheabdominalviscera.腹部器官的血管類(lèi)疾病也可伴隨進(jìn)食后疼痛。nocturnal：夜間的viscera：['v?s?r?] 內(nèi)臟的painPatientswiththisconditionareolderandhavepostprandialpain,anorexia,andweightloss.這類(lèi)患者年齡較大，伴有餐后痛、厭食和消瘦。Thistriadisseeninabdominalanginaresultingfromobstructivevasculardiseaseintheceliacaxisorthesuperiormesentericartery.這一三聯(lián)癥見(jiàn)于腹腔干或腸系膜上動(dòng)脈的血管阻塞類(lèi)疾病引起的腹絞痛。post-:后面的；postprandial：餐后的anorexia：厭食癥triad：三個(gè)一組angina：[?n'd?a?n?]絞痛celiacaxis：腹腔干superiormesentericartery：腸系膜上動(dòng)脈painTable17-3summarizestheimportantmaneuversforamelioratingabdominalpain.表17-3是對(duì)改善腹痛重要方法的總結(jié)。NauseaandVomitingVomitingmaybecausedbysevereirritationoftheperitoneumresultingfromtheperforationofanabdominalorgan;fromobstructionofthebileduct,ureter,orintestine;orfromtoxins.引起嘔吐的原因可能是腹部器官穿孔造成對(duì)腹膜的嚴(yán)重刺激；膽管、輸尿管、小腸阻塞；或毒素刺激引起。Vomitingresultingfromaperforationisrarelymassive.穿孔引起的嘔吐很少是大量的。bileduct：膽管ureter：[j?'ri?t?] 輸尿管NauseaandVomitingObstructionofthebileductorothertubeproducesstretchingofthemuscularwall,resultinginepisodicvomitingthatoccursattheheightofthepain.膽管梗阻或其他管道的阻塞引起管道壁層肌肉緊張可導(dǎo)致嘔吐，嘔吐常發(fā)生在疼痛最劇烈時(shí)。Intestinalobstructionpreventstheintestinalcontentsfrompassingdistally;consequently,vomitingmayresultintheexpulsionofintestinalcontents.腸道梗阻阻礙腸內(nèi)容物經(jīng)腸道排出，隨即嘔吐導(dǎo)致腸內(nèi)容的排出。distally：['d?st?la?]遠(yuǎn)端expulsion：排出NauseaandVomitingToxinsgenerallycausepersistentvomiting.毒素通常引起持續(xù)性嘔吐。Notallabdominalemergenciescausevomiting.不是所有的腹部急癥都導(dǎo)致嘔吐。emergency：緊急事件emergencydepartment:急診科NauseaandVomitingIntraperitonealbleedingmayoccurintheabsenceofvomiting.腹腔內(nèi)的出血往往沒(méi)有嘔吐癥狀。Vomitingisfrequentlyalsocausedbyinflammationofintra-abdominalstructures,aswellasbyextra-abdominalconditions,includingdrugtoxicity,centralnervoussystemdisorders,myocardialinfarction,andpregnancy.嘔吐通常是腹腔內(nèi)結(jié)構(gòu)的炎癥引起，同時(shí)一些腹外情況也可引起嘔吐，它們包括藥物毒性反應(yīng)、中樞神經(jīng)系統(tǒng)疾病、心梗和懷孕。

intra-內(nèi)部的；extra-外部的NauseaandVomitingAskthefollowingquestionsifapatientcomplainsofnausea,vomiting,orboth:如果患者主訴惡心和/或嘔吐，應(yīng)該詢問(wèn)如下問(wèn)題：‘‘Howlonghaveyouhadnauseaorvomiting?’’“你惡心或嘔吐多久了？”‘‘Whatisthecolorofthevomit?’’“嘔吐物是什么顏色？”‘‘Isthereanyunusuallyfoulodortothevomitus?’’“嘔吐物是否有不同尋常的臭味？”foul：惡臭的odor：氣味NauseaandVomiting‘‘Howoftendoyouvomit?’’“多長(zhǎng)時(shí)間嘔吐一次？”‘‘Isvomitingrelatedtoeating?’’Ifyes,‘‘Howsoonaftereatingdoyouvomit?Doyouvomitonlyaftereatingcertainfoods?’’“嘔吐是否于進(jìn)食有關(guān)？”如果有關(guān)，“進(jìn)食后多久出現(xiàn)嘔吐？你是否只在進(jìn)食某種特定的食物后發(fā)生嘔吐？”‘‘Doyouhavenauseawithoutvomiting?’’“你是否只有惡心而不發(fā)生嘔吐？”Howoften：多久一次

Howoftendoyougotochurch?你隔多久去做一次禮拜?Howsoon：多快，多久以后

HowsooncanIbereleasedfromthehospital?什么時(shí)候才能出院?NauseaandVomiting‘‘Isthenauseaorvomitingassociatedwithabdominalpain?constipation?diarrhea?alossofappetite?achangeinthecolorofyourstools?achangeinthecolorofyoururine?fever?chestpain?’’“惡心或者嘔吐是否伴隨腹痛？便秘？腹瀉？食欲減退？大便顏色改變？尿液顏色改變？發(fā)熱？胸痛？”‘‘Haveyounoticedachangeinyourhearingability?’’“你是否注意到你的聽(tīng)力有無(wú)改變？”‘‘Haveyounoticedringinginyourears?’’“你是否存在耳鳴？”constipation：便秘；diarrhea：腹瀉stools：糞便；urine：尿液NauseaandVomitingIfthepatientisawoman,askthisquestion:如果患者為女性，應(yīng)詢問(wèn)：‘‘Whenwasyourlastperiod?’’“你的末次月經(jīng)是什么時(shí)候？”Therelationshipofthepaintovomitingisimportantandmayhelpinprovidingthediagnosis.疼痛與嘔吐的關(guān)系非常重要，有可能有助于診斷。NauseaandVomitingInacuteappendicitis,painprecedesthevomitingusuallybyafewhours.急性闌尾炎時(shí)，疼痛通常在嘔吐前幾小時(shí)發(fā)生。Thecharacterofthevomitusmayaidindeterminingitscause.嘔吐物的特點(diǎn)可以幫助明確病因。Acutegastritiscausesthepatienttovomitstomachcontents.急性胃炎可導(dǎo)致患者嘔吐胃內(nèi)容物。gastritis-itis炎癥；gastr-胃的NauseaandVomitingBiliarycolicproducesbilious,orgreenish-yellowvomitus.膽絞痛嘔吐物為膽汁，或黃綠色物質(zhì)。Intestinalobstructionoftencausesthepatienttoexpelbiliousvomitus,followedbyfeculent-smellingfluid.腸梗阻經(jīng)常導(dǎo)致患者嘔吐膽汁樣物質(zhì)，隨即嘔吐惡臭味液體。Feculentvomitusisusuallycausedbyintestinalobstruction.惡臭的嘔吐物通常由腸梗阻引起。bilious：膽汁的feculent：['fekj?l?nt] 不潔的、骯臟的、臭的NauseaandVomitingNauseawithoutvomitingisacommonsymptominpatientswithhepatocellulardisease,pregnancy,andmetastaticdisease.惡心無(wú)嘔吐通常是肝細(xì)胞疾病、懷孕和代謝疾病患者的常見(jiàn)癥狀。NauseamaybeassociatedwithahearinglossandtinnitusinpatientswithMe′nie`re’sdisease.惡心伴聽(tīng)力喪失和耳鳴常提示美尼爾病。hepatocellularhepato-肝tinnitus：['t?n?t?s]耳鳴ChangeinBowelMovementsTakeacarefulhistoryofbowelhabits.注意采集排便習(xí)慣的詳細(xì)病史。Achangeinbowelmovementsnecessitatesfurtherelaboration.排便變化需要更詳盡的描述。Askthesequestionsofthepatientwithacuteonsetofdiarrhea:急性腹瀉患者需要詢問(wèn)如下問(wèn)題：bowelhabits：腸道排便習(xí)慣elaboration：詳細(xì)闡述acute：急性；chronic：慢性‘‘Howlonghaveyouhadthediarrhea?’’“你腹瀉多久了？”‘‘Howmanybowelmovementsdoyouhaveaday?’’“你一天排便多少次？”‘‘Didthediarrheastartsuddenly?’’“腹瀉是突然開(kāi)始的嗎？”ChangeinBowelMovements‘‘Didthediarrheabeginafterameal?’’Ifyes,‘‘Whatdidyoueat?’’“腹瀉是一次進(jìn)餐后開(kāi)始的嗎？”如果是，“你當(dāng)時(shí)吃了什么食物？”“‘‘Arethestoolswatery?bloody?malodorous?’’“大便是水樣的嗎？血性的？惡臭的？”‘‘Isthediarrheaassociatedwithabdominalpain?lossofappetite?nausea?vomiting?’’“腹瀉是否伴有腹痛？食欲下降？惡心？嘔吐？”ChangeinBowelMovementsmalodorous：惡臭的mal-壞的malnutrition，malfunctionTheacuteonsetofdiarrheaafteramealsuggestsanacuteinfectionortoxin.進(jìn)餐后急性發(fā)作的腹瀉提示急性感染或中毒。Waterystoolsareoftenassociatedwithinflammatoryprocessesofthesmallbowelandcolon.水樣便常提示小腸或結(jié)腸的炎癥過(guò)程。Shigellosisisadiseaseofthecolonthatproducesbloodydiarrhea.痢疾是一種伴發(fā)血樣便腹瀉的結(jié)腸疾病。ChangeinBowelMovementscolon：結(jié)腸Shigellosis：[???g?'lo?s?s] 志賀氏細(xì)菌性痢疾Amebiasisisalsoassociatedwithbloodydiarrhea.阿米巴病也伴發(fā)血樣便腹瀉。Thepatientwithchronicdiarrheashouldbeaskedthefollowing:慢性腹瀉的患者應(yīng)詢問(wèn)如下問(wèn)題：ChangeinBowelMovementsAmebiasis：['e?mbi?s?s] 阿米巴病‘‘Howlonghaveyouhaddiarrhea?’’“腹瀉多久了？”‘‘Doyouhaveperiodsofdiarrheaalternatingwithconstipation?’’“腹瀉是否與便秘交替出現(xiàn)？”‘‘Arethestoolswatery?loose?floating?malodorous?’’“大便呈水樣？松散的？呈漂浮狀？帶有惡臭氣味？”ChangeinBowelMovements‘‘Haveyounoticedbloodinthestools?mucus?undigestedfood?’’“你是否注意到便中帶血？帶粘液？含有未消化的食物？”‘‘Whatisthecolorofthestools?’’“大便是什么顏色的？”‘‘Howmanybowelmovementsdoyouhaveaday?’’“你每天排便幾次？”‘‘Doesthediarrheaoccuraftereating?’’“腹瀉出現(xiàn)在進(jìn)食后？”ChangeinBowelMovementsmucus：粘液的‘‘Whathappenswhenyoufast?Doyoustillhavediarrhea?’’“當(dāng)你禁食后發(fā)生了什么情況？你是否還存在腹瀉？”‘‘Isthediarrheaassociatedwithabdominalpain?abdominaldistention?nausea?vomiting?’’“腹瀉是否伴隨腹痛？腹脹？惡心？嘔吐？”‘‘Haveyounoticedthatthediarrheaisworseatcertaintimesoftheday?’’“你是否注意到腹瀉在每天的固定時(shí)間變得更加嚴(yán)重？”ChangeinBowelMovementsfast：齋戒、禁食‘‘Howisyourappetite?’’“你的食欲如何？”‘‘Hastherebeenanychangeinyourweight?’’“你的體重有無(wú)改變？”ChangeinBowelMovementsDiarrheaandconstipationfrequentlyalternateinpatientswithcoloncancerordiverticulitis.腹瀉和便秘交替出現(xiàn)常見(jiàn)于結(jié)腸癌或憩室炎患者。Loosebowelmovementsarecommonindiseasesoftheleftcolon,whereaswaterymovementsareseeninsevereinflammatoryboweldiseaseandprotein-losingenteropathies.腹瀉常見(jiàn)于左結(jié)腸疾病，而水樣便常見(jiàn)于炎癥性腸病和蛋白丟失性腸病。ChangeinBowelMovementsdiverticulitis：[?da?v?rt?kj?'la?t?s]憩室炎 Loosebowelmovements：腹瀉Floatingstoolsmayresultfrommalabsorptionsyndromes.浮便是由于吸收不良綜合征導(dǎo)致的。Patientswithulcerativecolitiscommonlyhavestoolmixedwithbloodandmucus.潰瘍性結(jié)腸炎患者通常大便中混有血和粘液。ChangeinBowelMovementscolitis：結(jié)腸炎Anyinflammatoryprocessofthesmallbowelorcoloncanmanifestwithbloodmixedwithstoolorundigestedfood.任何炎癥性小腸疾病或結(jié)腸疾病表現(xiàn)為大便混有血或未消化的食物。Irritablebowelsyndromeclassicallyproducesmorediarrheainthemorning.腸激惹綜合征典型的表現(xiàn)是清晨頻繁腹瀉。Irritable：易怒的、急躁的ChangeinBowelMovementsPatientscomplainingofconstipationshouldbeaskedthesequestions:患者主訴便秘應(yīng)該詢問(wèn)下列問(wèn)題：‘‘Howlonghaveyoubeenconstipated?’’“你發(fā)生便秘多久了？”‘‘Howoftendoyouhaveabowelmovement?’’“多長(zhǎng)時(shí)間排便一次？”‘‘Whatisthesizeofyourstools?’’“大便條的長(zhǎng)度是多少？”ChangeinBowelMovements‘‘Whatisthecolorofyourstools?’’“大便是什么顏色？”‘‘Isthestoolevermixedwithblood?mucus?’’“大便是否曾混有血？粘液？”‘‘Haveyounoticedperiodsofconstipationalternatingwithperiodsofdiarrhea?’’“腹瀉和便秘是否交替出現(xiàn)？”‘‘Haveyounoticedachangeinthecaliberofthestool?’’“大便條的粗細(xì)是否發(fā)生了改變？”

ChangeinBowelMovements‘‘Doyouhavemuchgas?’’“你是否有漲氣？”‘‘How’syourappetite?’’“食欲如何？”‘‘Hastherebeenanychangeinyourweight?’’“體重是否發(fā)生了變化？”Changeinthecaliberofthestoolissignificant.大便條粗細(xì)的變化是有意義的。ChangeinBowelMovements‘‘Pencil’’-diameterstoolsmayresultfromananaloradistalrectalcarcinoma.鉛筆粗細(xì)的大便可能是由肛門(mén)或直腸癌癥引起的。Achangeinthecolorofstoolsisimportant.大便顏色的變化非常重要。Asisdiscussedlater,palebrowntograystoolsindicateanabsenceofbile.正如下文將要討論的，淺棕色至灰色的大便提示膽汁缺乏。ChangeinBowelMovementsThiscanresultfromanobstructiontobileflowfromthegallbladderorfromdecreasedproductionofbile.這可能是由于膽汁從膽囊流出通道梗阻或膽汁產(chǎn)生減少所致。Weightchangesareimportantwiththesymptomofconstipation.體重改變是便秘重要的伴隨癥狀。ChangeinBowelMovementsBile：膽汁gallbladder：膽囊Anincreaseinweightmayindicatedecreasedmetabolismseeninhypothyroidism;體重增加提示新陳代謝減慢見(jiàn)于甲狀腺功能減退癥；adecreaseinweightmaybeassociatedwithcancerofthecolonorotherhypermetabolicconditions.體重降低可能見(jiàn)于結(jié)腸癌癥或其他高代謝情況。ChangeinBowelMovementsMetabolism：新陳代謝Hypo-：低的Hypothyroidism：?[?ha?po?‘θa?r??d?z?m]?甲狀腺機(jī)能減退hyper-：高的Hypermetabolic：高代謝Rectalbleedingmaybemanifestedbybrightredblood,bloodmixedwithstool,orblack,tarrystools.直腸出血可以表現(xiàn)為鮮紅色的血，便中混有血，或者黑色、柏油樣便。Brightredbloodperrectum,alsoknownashematochezia,canoccurfromcolonictumors,diverticulardisease,orulcerativecolitis.經(jīng)直腸排出鮮紅色血，也稱(chēng)為便血，見(jiàn)于結(jié)腸腫瘤、憩室疾病、或潰瘍性結(jié)腸炎。RectalBleedingRectal：直腸的Tarry：用柏油覆蓋的rectum：直腸Hematochezia：[hem?t?‘ki?z??]

便血hema-：血；hematuria，hematologyRectalBleedingBloodmixedwithstoolcanbetheresultofulcerativecolitis,diverticulardisease,tumors,orhemorrhoids.便中混有血見(jiàn)于潰瘍性結(jié)腸炎、腫瘤、或痔瘡。Askthepatientwhodescribesrectalbleedingthefollowingquestions:對(duì)于直腸出血的患者應(yīng)詢問(wèn)如下問(wèn)題：Hemorrhoids：[‘hem?r??dz]痔瘡‘‘Howlonghaveyounoticedbrightredbloodinyourstools?’’“你注意到大便中有鮮紅色血有多久了？”‘‘Isthebloodmixedwiththestool?’’

“血液是混在大便中嗎？”‘‘Aretherestreaksofbloodonthesurfaceofthestool?’’“大便表面是否有血液？”RectalBleedingStreaks：條紋‘‘Haveyounoticedachangeinyourbowelhabits?’’“你是否注意到你的排便習(xí)慣發(fā)生了變化？”‘‘Haveyounoticedapersistentsensationinyourrectumthatyouhavetomoveyourbowels,butyoucannot?’’“你是否持續(xù)感覺(jué)到不得不排便但卻排不出來(lái)？”Tenesmusisthepainful,continued,andineffectivestrainingatstool.里急后重是指在排便時(shí)疼痛的、持續(xù)而無(wú)效的用力。RectalBleedingTenesmus：[t?‘nezm?s]里急后重RectalBleedingItiscausedbyinflammationoraspace-occupyinglesionsuchasatumoratthedistalrectumoranus.它是由炎癥或空間占位損害如直腸末端或肛門(mén)部位的腫瘤所引起。Hemorrhoidalbleedingisacommoncauseofhematocheziaandstreakingofstoolwithblood.痔瘡出血是便血和大便帶血的常見(jiàn)原因。Lesion：[‘li??n]損害、損傷Anus：肛門(mén)

Hemorrhoidal：痔瘡的hematochezia：[hem?t?‘ki?z??]便血Melenaisablack,tarrystoolthatresultsfrombleedingabovethefirstsectionoftheduodenum,withpartialdigestionofthehemoglobin.黑便是指由于十二指腸以上部位出血使血紅蛋白僅部分消化導(dǎo)致黑色的柏油樣大便。Melena：[m?'li?n?]黑便duodenum：[?du??‘di?n?m]十二指腸Hemoglobin：血紅蛋白Hemo-血；-globin球蛋白R(shí)ectalBleedingInquireaboutthepresenceofmelena.應(yīng)了解黑便存在的情況。Ausefulwayofquestioningistoshowthepatienttheblacktubingonthestethoscopeandask,‘‘Haveyourbowelmovementseverbeenthiscolor?’’一種有效地詢問(wèn)方法是向患者展示聽(tīng)診器的黑管并問(wèn)，“你的大便是否有過(guò)這種顏色？”Stethoscope：?[‘steθ?sko?p]?聽(tīng)診器RectalBleedingIfaskeddirectlywhetherthebowelmovementshaveeverbeenblack,thepatientmayanswerintheaffirmative,equatingdark(normal)stoolswithblackstools.如果直接詢問(wèn)患者是否有過(guò)黑色大便，患者的答復(fù)往往是肯定的，他們把正常暗色的大便等同于黑便。RectalBleedingAffirmative：肯定的Equating：等同于；～

withAskthesequestionsofapatientwhodescribesmelena:如果患者描述有黑便應(yīng)詢問(wèn)下列問(wèn)題：‘‘Haveyoupassedmorethanoneblack,tarrystool?’’Ifyes,‘‘When?’’“是否排過(guò)多次黑色、柏油樣大便？”如果是，“什么時(shí)候？”‘‘Howlonghaveyoubeenhavingblack,tarrystools?’’“排黑色、柏油樣便多久了？”RectalBleeding‘‘Haveyounoticedfeelinglightheaded?’’“是否曾感覺(jué)頭昏眼花？”‘‘Haveyouhadanynauseaassociatedwiththesestools?anyvomiting?diarrhea?abdominalpain?sweating?’’“排便時(shí)是否伴有惡心？嘔吐？腹瀉？腹痛？出汗？”RectalBleedingLightheaded：頭昏眼花的Theanswerstothesequestionscanprovidesomeinformationregardingtheacutenessandtheamountofthehemorrhage.這些問(wèn)題有助于提供關(guān)于出血的急性程度及出血量的相關(guān)信息。Lightheadedness,nausea,anddiaphoresisareseenwithrapidgastrointestinalbleedingandhypotension.頭昏、惡心和出汗提示快速胃腸道出血和低血壓。RectalBleedingRegarding：關(guān)于，同aboutHemorrhage：hemo-Diaphoresis:[?da??f?‘ri?s?s]出汗Gastrointestinal：gastro-胃的,

intestinal腸的Thepresenceofsilver-coloredstoolsisrarebutpathognomonicofacholicstoolswithmelena,aconditionresultingfromcanceroftheampullaofVaterintheduodenum.銀色便很少見(jiàn)但特異性的提示患者便中無(wú)尿膽原并伴有黑便，提示十二指腸泛特氏壺腹癌。Thecancerproducesbiliaryobstruction,andthecancerousfrondsaresloughed,causingmelena.這種癌癥導(dǎo)致膽道梗阻，且癌葉的脫落引起黑便。

RectalBleedingPathognomonic：特殊病癥的、特異的Acholic：無(wú)膽汁的；a-

=not

cholic膽汁的Ampulla：壺腹Frond：蕨葉Slough：蛻皮JaundiceThepresenceofjaundice(icterus)mustalerttheexaminerthatthereiseitherliverparenchymaldiseaseoranobstructiontobileflow.存在黃疸提醒檢查者患者或者存在肝細(xì)胞疾病或者存在膽汁排出梗阻。Jaundice:黃疸Icterus：[‘?kt?r?s]黃疸parenchymal：?[p?‘r??k?m?l]?薄壁組織的Thepresenceoficterus,orjaundice,resultsfromadecreasedexcretionofconjugatedbilirubinintothebile.黃疸的出現(xiàn)是由于流入膽汁的結(jié)合型膽紅素減少引起的。Thiscanresultfromintrahepaticbiliaryobstruction,knownasmedicaljaundice,orfromextrahepaticbiliaryobstruction,knownassurgicaljaundice.黃疸的病因包括肝內(nèi)膽管梗阻導(dǎo)致的內(nèi)科黃疸，和肝外膽管梗阻導(dǎo)致的外科黃疸。Jaundiceconjugatedbilirubin：結(jié)合型膽紅素Intrahepatic：肝內(nèi)的；extrahepatic：肝外的Intra-內(nèi)的；extra-外的Inanypatientwithicterus,theexaminershouldsearchforcluesbyaskingthefollowingquestions:對(duì)于任何黃疸患者，檢查者應(yīng)該詢問(wèn)如下問(wèn)題以尋找疾病線索：‘‘Howlonghaveyoubeenjaundiced?’’“黃疸發(fā)生多久了？”‘‘Didthejaundicedeveloprapidly?’’“黃疸是否發(fā)展迅速？”Jaundice‘‘Isthejaundiceassociatedwithabdominalpain?lossofappetite?nausea?vomiting?distasteforcigarettes?’’“黃疸是否伴有腹痛？食欲減退？惡心？嘔吐？討厭香煙？”‘‘Isthejaundiceassociatedwithchills?fever?itching?weightloss?’’“黃疸是否伴有寒戰(zhàn)？發(fā)熱？搔癢？體重減輕？”JaundiceDistaste：不喜歡、厭惡，dis-不Cigarettes：煙Chill：寒戰(zhàn)Itching：瘙癢‘‘Inthepastyearhaveyouhadanytransfusions?tattooing?inoculations?’’在過(guò)去一年里你是否曾經(jīng)輸液？紋身？接種疫苗？JaundiceTransfusion：輸液Tattooing：紋身Inoculation：接種疫苗‘‘Doyouuseanyrecreationaldrugs?’’Ifyes,‘‘Doyouuseanydrugsintravenously?’’“你是否使用消遣性毒品？”如果是，“你是否靜脈注射這類(lèi)藥物？”‘‘Doyoueatraw

shellfish?oysters?’’“你是否使用生的貝類(lèi)食品？牡蠣？”Jaundicerecreationaldrugs：消遣性毒品Raw：未加工的，生的Shellfish：貝類(lèi)食品Oysters：牡蠣“Have

you

traveled

abroad

in

the

past

year?”

If

yes,

“Where?Wereyouawarethatyoumayhaveconsumeduncleanwater?”“過(guò)去的一年中你是否出過(guò)國(guó)？”如果是，“你去過(guò)哪里？你是否知道你可能使用過(guò)不潔凈的水？”Jaundice‘‘Haveyoubeenjaundicedbefore?’’“既往是否有黃疸病史？”‘‘Hasyoururinechangedcolorsinceyounoticedthatyouwerejaundiced?’’“出現(xiàn)黃疸后，你的尿液顏色是否發(fā)生改變？”‘‘Whatisthecolorofyourstools?’’“大便是什么顏色?”Jaundice‘‘Doyouhaveanyfriendsorrelationswhoarealsojaundiced?’’“你是否有朋友或親屬也發(fā)生了黃疸？”‘‘Whattypeofworkdoyoudo?Whatothertypesofworkhaveyoudone?’’“你從事何種工作？你曾經(jīng)從事過(guò)何種工作？”‘‘Whatareyourhobbies?’’“你的業(yè)余愛(ài)好是什么？”JaundiceViralhepatitisisassociatedwithnausea,vomiting,alossofappetite,andanaversiontosmoking.病毒性肝炎伴有惡心、嘔吐、食欲減退、和討厭吸煙。HepatitisAhasafecal-oralrouteoftransmissionandanincubationperiodof2to6weeks.甲型肝炎是通過(guò)糞—口途徑傳播，潛伏期是2-6周。Jaundiceaversion：憎恨、厭惡Hepatitis：肝炎；hepat：肝的；-itis炎癥Fecal：排泄物Transmission：傳播Incu