Chapter17theabdomen

第17章腹部resumePingLiassociate

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

most:

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

你們當中誰錯得最多?Most：多數的;大部分的Mostbirdscanfly.

多數的鳥會飛。The

most和most的區別PainNauseaandvomitingChange

in

bowel

movementsRectal

bleedingJaundiceAbdominal

distentionMassPruritus(itching)ReviewofSpecificSymptoms疼痛惡心和嘔吐排便習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痛性的，但是大部分腹部疾病表現出一定程度的疼痛。neoplasia[?ni?o?'ple???] neo-新的，現代的-plasia生長、形成painless-less沒有、無manifestv.表現、指明manifestationn.臨床表現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-周圍painAbdominalpainnecessitatesforspeedydiagnosisandtherapy.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指更系統的診斷、治療treatment治療Physicaltherapyalternateswithchemical.理療和化療交替進行。Theearlierthetreatmentisgiven,thebetterthepatient'schances. 病人越早接受治療，康復的可能性就越大。painWhenapatientcomplainsofabdominalpain,askthefollowingquestions:當患者主訴腹痛時，應該詢問下列問題：complain“抱怨”“訴苦”。指心中對人或事物不滿或身體感到不適或痛苦而對別人訴說或抱怨,有時也可表示說話者引起別人對此事的注意。用作不及物動詞時,其后可接of或about引起的短語,of后常是訴苦的內容,可為名詞或動名詞,而about后則是對抱怨事物概括的陳述。當表示“向…抱怨…”時,要用complaintosbof〔about〕sth結構。complain表示病人訴說時,不可說complainabout〔against,at〕,應說complainof。Sheisalwayscomplainingofhertoothachetothedoctor.她老是跟大夫說她牙痛。pain‘‘Whereisthepain?’’哪里疼痛？‘‘Hasthepainchangeditslocationsinceitstarted?’’從疼痛開始后是否發生了疼痛位置的改變？‘‘Doyoufeelthepaininanyotherpartofyourbody?’’在你身體的其他部位是否也感覺疼痛？‘‘Howlonghaveyouhadthepain?’’疼痛持續多久了？‘‘Haveyouhadrecurrentepisodesofabdominalpain?’’腹痛是否間歇性發作？recurrent周期性、再發生re-又、再reinstall,re-extractionpain‘‘Didthepainstartsuddenly?’’疼痛是否突然發作？‘‘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?’’疼痛是持續的嗎？它的強度是否有波動？‘‘Hastherebeenanychangeintheseverityornatureofthepainsinceitbegan?’’從疼痛開始發作，它的強度和性質是否有任何變化？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？發熱？寒戰？進食？pain‘‘Haveyoueverhadgallstones?kidneystones?’’既往是否患膽石？腎結石？Ifthepatientisawoman,askthisquestion:如果患者是女性，還要詢問:‘‘Whenwasyourlastperiod?’’末次月經是什么時間？period月經期Doyougetpianbeforeorduringyourperiods？您在月經前或月經中有過疼痛嗎?painNotetheexacttimeatwhichthepainstartedandwhatthepatientwasdoingatthattime.注意疼痛開始的準確時間以及疼痛開始時患者在做什么。Sudden,severepainawakeningapatientfromsleepmaybeassociatedwithacuteperforation,inflammation,ortorsionofanabdominalorgan.突然、嚴重的使患者從睡夢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。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Thisovaryisdarkandenlargedfromhemorrhagefollowingtorsion.卵巢扭轉造成出血而變黑變大。painAstoneinthebiliaryorrenaltractalsocausesintensepain.膽管或泌尿系統發生結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.異位妊娠導致的急性輸卵管破裂、胃潰瘍穿孔、腹膜炎和急性胰腺炎導致嚴重的疼痛可以導致暈厥。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、性質和發射性是非常重要的。Commonly,whenanabdominalorganruptures,painisfelt‘‘alloverthebelly,’’withoutlocalizationtoaspecificarea.當腹部器官發生穿孔時，通常感覺疼痛“遍及全腹”,沒有特定區域的定位。Painarisingfromthesmallintestineiscommonlyfeltintheumbilicalorepigastricregions;forexample,painfromacuteappendicitisbeginsattheumbilicus.來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.經過一段時間，疼痛可能定位到其他位置。Painfromacuteappendicitistravelsfromtheumbilicustotherightlowerquadrantinabout1to3hoursaftertheinitialevent.急性闌尾炎在發病的1-3小時后疼痛可以從臍部轉移到右下腹部。Paininthechestfollowedbyabdominalpainshouldraisethesuspicionofadissectingaortic

aneurysm.繼發于胸痛的腹痛應該警惕主動脈瘤破裂的可能。aortic大動脈的；aneurysm動脈瘤painNotethenatureofthepain.注意疼痛的性質。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、下巴或其他體神經支配區域。somatic身體的、軀體的painPainappearstooriginateinareassuppliedbythesomaticnervesenteringthespinalcordatthesamesegmentasthesensorynervesfromtheorganresponsibleforthepain.支配疼痛感覺起始區域的體神經與支配疼痛真正起源器官的感覺神經進入脊髓的同一節段，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感覺神經；cholecystitis膽囊炎；testicular睪丸的；painThecommonsitesforreferredpainareshowninFigure17-3.常見的牽涉痛部位見圖17-3。ThelocationsofpaininabdominaldiseasearesummarizedinTable17-2.腹部疾病的疼痛定位歸納于表17-2。Thetimeofoccurrenceandfactorsthataggravateoralleviatethesymptoms(e.g.,mealsordefecation)areparticularlyimportant.疼痛出現的時間和引起癥狀加重或減輕的因素（例如進食或排便）尤其重要。aggravate：加重；alleviate：減輕painPeriodicepigastricpainoccurring1/2to1houraftereatingisaclassicsymptomofgastricpepticulcers.進食后半小時到1小時出現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食后2-3小時或下次進餐前出現。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致后背痛，看似矯形外科問題。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.腹部器官的血管類疾病也可伴隨進食后疼痛。nocturnal：夜間的viscera：['v?s?r?] 內臟的painPatientswiththisconditionareolderandhavepostprandialpain,anorexia,andweightloss.這類患者年齡較大，伴有餐后痛、厭食和消瘦。Thistriadisseeninabdominalanginaresultingfromobstructivevasculardiseaseintheceliacaxisorthesuperiormesentericartery.這一三聯癥見于腹腔干或腸系膜上動脈的血管阻塞類疾病引起的腹絞痛。post-:后面的；postprandial：餐后的anorexia：厭食癥triad：三個一組angina：[?n'd?a?n?]絞痛celiacaxis：腹腔干superiormesentericartery：腸系膜上動脈painTable17-3summarizestheimportantmaneuversforamelioratingabdominalpain.表17-3是對改善腹痛重要方法的總結。NauseaandVomitingVomitingmaybecausedbysevereirritationoftheperitoneumresultingfromtheperforationofanabdominalorgan;fromobstructionofthebileduct,ureter,orintestine;orfromtoxins.引起嘔吐的原因可能是腹部器官穿孔造成對腹膜的嚴重刺激；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致嘔吐，嘔吐常發生在疼痛最劇烈時。Intestinalobstructionpreventstheintestinalcontentsfrompassingdistally;consequently,vomitingmayresultintheexpulsionofintestinalcontents.腸道梗阻阻礙腸內容物經腸道排出，隨即嘔吐導致腸內容的排出。distally：['d?st?la?]遠端expulsion：排出NauseaandVomitingToxinsgenerallycausepersistentvomiting.毒素通常引起持續性嘔吐。Notallabdominalemergenciescausevomiting.不是所有的腹部急癥都導致嘔吐。emergency：緊急事件emergencydepartment:急診科NauseaandVomitingIntraperitonealbleedingmayoccurintheabsenceofvomiting.腹腔內的出血往往沒有嘔吐癥狀。Vomitingisfrequentlyalsocausedbyinflammationofintra-abdominalstructures,aswellasbyextra-abdominalconditions,includingdrugtoxicity,centralnervoussystemdisorders,myocardialinfarction,andpregnancy.嘔吐通常是腹腔內結構的炎癥引起，同時一些腹外情況也可引起嘔吐，它們包括藥物毒性反應、中樞神經系統疾病、心梗和懷孕。

intra-內部的；extra-外部的NauseaandVomitingAskthefollowingquestionsifapatientcomplainsofnausea,vomiting,orboth:如果患者主訴惡心和/或嘔吐，應該詢問如下問題：‘‘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?’’“多長時間嘔吐一次？”‘‘Isvomitingrelatedtoeating?’’Ifyes,‘‘Howsoonaftereatingdoyouvomit?Doyouvomitonlyaftereatingcertainfoods?’’“嘔吐是否于進食有關？”如果有關，“進食后多久出現嘔吐？你是否只在進食某種特定的食物后發生嘔吐？”‘‘Doyouhavenauseawithoutvomiting?’’“你是否只有惡心而不發生嘔吐？”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？發熱？胸痛？”‘‘Haveyounoticedachangeinyourhearingability?’’“你是否注意到你的聽力有無改變？”‘‘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，應詢問：‘‘Whenwasyourlastperiod?’’“你的末次月經是什么時候？”Therelationshipofthepaintovomitingisimportantandmayhelpinprovidingthediagnosis.疼痛與嘔吐的關系非常重要，有可能有助于診斷。NauseaandVomitingInacuteappendicitis,painprecedesthevomitingusuallybyafewhours.急性闌尾炎時，疼痛通常在嘔吐前幾小時發生。Thecharacterofthevomitusmayaidindeterminingitscause.嘔吐物的特點可以幫助明確病因。Acutegastritiscausesthepatienttovomitstomachcontents.急性胃炎可導致患者嘔吐胃內容物。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。Intestinalobstructionoftencausesthepatienttoexpelbiliousvomitus,followedbyfeculent-smellingfluid.腸梗阻經常導致患者嘔吐膽汁樣物質，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.惡心無嘔吐通常是肝細胞疾病、懷孕和代謝疾病患者的常見癥狀。NauseamaybeassociatedwithahearinglossandtinnitusinpatientswithMe′nie`re’sdisease.惡心伴聽力喪失和耳鳴常提示美尼爾病。hepatocellularhepato-肝tinnitus：['t?n?t?s]耳鳴ChangeinBowelMovementsTakeacarefulhistoryofbowelhabits.注意采集排便習慣的詳細病史。Achangeinbowelmovementsnecessitatesfurtherelaboration.排便變化需要更詳盡的描述。Askthesequestionsofthepatientwithacuteonsetofdiarrhea:急性腹瀉患者需要詢問如下問題：bowelhabits：腸道排便習慣elaboration：詳細闡述acute：急性；chronic：慢性‘‘Howlonghaveyouhadthediarrhea?’’“你腹瀉多久了？”‘‘Howmanybowelmovementsdoyouhaveaday?’’“你一天排便多少次？”‘‘Didthediarrheastartsuddenly?’’“腹瀉是突然開始的嗎？”ChangeinBowelMovements‘‘Didthediarrheabeginafterameal?’’Ifyes,‘‘Whatdidyoueat?’’“腹瀉是一次進餐后開始的嗎？”如果是，“你當時吃了什么食物？”“‘‘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.進餐后急性發作的腹瀉提示急性感染或中毒。Waterystoolsareoftenassociatedwithinflammatoryprocessesofthesmallbowelandcolon.水樣便常提示小腸或結腸的炎癥過程。Shigellosisisadiseaseofthecolonthatproducesbloodydiarrhea.痢疾是一種伴發血樣便腹瀉的結腸疾病。ChangeinBowelMovementscolon：結腸Shigellosis：[???g?'lo?s?s] 志賀氏細菌性痢疾Amebiasisisalsoassociatedwithbloodydiarrhea.阿米巴病也伴發血樣便腹瀉。Thepatientwithchronicdiarrheashouldbeaskedthefollowing:慢性腹瀉的患者應詢問如下問題：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？”‘‘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?’’“腹瀉出現在進食后？”ChangeinBowelMovementsmucus：粘液的‘‘Whathappenswhenyoufast?Doyoustillhavediarrhea?’’“當你禁食后發生了什么情況？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間變得更加嚴重？”ChangeinBowelMovementsfast：齋戒、禁食‘‘Howisyourappetite?’’“你的食欲如何？”‘‘Hastherebeenanychangeinyourweight?’’“你的體重有無改變？”ChangeinBowelMovementsDiarrheaandconstipationfrequentlyalternateinpatientswithcoloncancerordiverticulitis.腹瀉和便秘交替出現常見于結腸癌或憩室炎患者。Loosebowelmovementsarecommonindiseasesoftheleftcolon,whereaswaterymovementsareseeninsevereinflammatoryboweldiseaseandprotein-losingenteropathies.腹瀉常見于左結腸疾病，而水樣便常見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致的。Patientswithulcerativecolitiscommonlyhavestoolmixedwithbloodandmucus.潰瘍性結腸炎患者通常大便中混有血和粘液。ChangeinBowelMovementscolitis：結腸炎Anyinflammatoryprocessofthesmallbowelorcoloncanmanifestwithbloodmixedwithstoolorundigestedfood.任何炎癥性小腸疾病或結腸疾病表現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是清晨頻繁腹瀉。Irritable：易怒的、急躁的ChangeinBowelMovementsPatientscomplainingofconstipationshouldbeaskedthesequestions:患者主訴便秘應該詢問下列問題：‘‘Howlonghaveyoubeenconstipated?’’“你發生便秘多久了？”‘‘Howoftendoyouhaveabowelmovement?’’“多長時間排便一次？”‘‘Whatisthesizeofyourstools?’’“大便條的長度是多少？”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？”‘‘Haveyounoticedachangeinthecaliberofthestool?’’“大便條的粗細是否發生了改變？”

ChangeinBowelMovements‘‘Doyouhavemuchgas?’’“你是否有漲氣？”‘‘How’syourappetite?’’“食欲如何？”‘‘Hastherebeenanychangeinyourweight?’’“體重是否發生了變化？”Changeinthecaliberofthestoolissignificant.大便條粗細的變化是有意義的。ChangeinBowelMovements‘‘Pencil’’-diameterstoolsmayresultfromananaloradistalrectalcarcinoma.鉛筆粗細的大便可能是由肛門或直腸癌癥引起的。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于甲狀腺功能減退癥；adecreaseinweightmaybeassociatedwithcancerofthecolonorotherhypermetabolicconditions.體重降低可能見于結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]?甲狀腺機能減退hyper-：高的Hypermetabolic：高代謝Rectalbleedingmaybemanifestedbybrightredblood,bloodmixedwithstool,orblack,tarrystools.直腸出血可以表現為鮮紅色的血，便中混有血，或者黑色、柏油樣便。Brightredbloodperrectum,alsoknownashematochezia,canoccurfromcolonictumors,diverticulardisease,orulcerativecolitis.經直腸排出鮮紅色血，也稱為便血，見于結腸腫瘤、憩室疾病、或潰瘍性結腸炎。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.便中混有血見于潰瘍性結腸炎、腫瘤、或痔瘡。Askthepatientwhodescribesrectalbleedingthefollowingquestions:對于直腸出血的患者應詢問如下問題：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慣發生了變化？”‘‘Haveyounoticedapersistentsensationinyourrectumthatyouhavetomoveyourbowels,butyoucannot?’’“你是否持續感覺到不得不排便但卻排不出來？”Tenesmusisthepainful,continued,andineffectivestrainingatstool.里急后重是指在排便時疼痛的、持續而無效的用力。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部位的腫瘤所引起。Hemorrhoidalbleedingisacommoncauseofhematocheziaandstreakingofstoolwithblood.痔瘡出血是便血和大便帶血的常見原因。Lesion：[‘li??n]損害、損傷Anus：肛門

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RectalBleedingInquireaboutthepresenceofmelena.應了解黑便存在的情況。Ausefulwayofquestioningistoshowthepatienttheblacktubingonthestethoscopeandask,‘‘Haveyourbowelmovementseverbeenthiscolor?’’一種有效地詢問方法是向患者展示聽診器的黑管并問，“你的大便是否有過這種顏色？”Stethoscope：?[‘steθ?sko?p]?聽診器RectalBleedingIfaskeddirectlywhetherthebowelmovementshaveeverbeenblack,thepatientmayanswerintheaffirmative,equatingdark(normal)stoolswithblackstools.如果直接詢問患者是否有過黑色大便，患者的答復往往是肯定的，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詢問下列問題：‘‘Haveyoupassedmorethanoneblack,tarrystool?’’Ifyes,‘‘When?’’“是否排過多次黑色、柏油樣大便？”如果是，“什么時候？”‘‘Howlonghaveyoubeenhavingblack,tarrystools?’’“排黑色、柏油樣便多久了？”RectalBleeding‘‘Haveyounoticedfeelinglightheaded?’’“是否曾感覺頭昏眼花？”‘‘Haveyouhadanynauseaassociatedwiththesestools?anyvomiting?diarrhea?abdominalpain?sweating?’’“排便時是否伴有惡心？嘔吐？腹瀉？腹痛？出汗？”RectalBleedingLightheaded：頭昏眼花的Theanswerstothesequestionscanprovidesomeinformationregardingtheacutenessandtheamountofthehemorrhage.這些問題有助于提供關于出血的急性程度及出血量的相關信息。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.銀色便很少見但特異性的提示患者便中無尿膽原并伴有黑便，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.黃疸的出現是由于流入膽汁的結合型膽紅素減少引起的。Thiscanresultfromintrahepaticbiliaryobstruction,knownasmedicaljaundice,orfromextrahepaticbiliaryobstruction,knownassurgicaljaundice.黃疸的病因包括肝內膽管梗阻導致的內科黃疸，和肝外膽管梗阻導致的外科黃疸。Jaundiceconjugatedbilirubin：結合型膽紅素Intrahepatic：肝內的；extrahepatic：肝外的Intra-內的；extra-外的Inanypatientwithicterus,theexaminershouldsearchforcluesbyaskingthefollowingquestions:對于任何黃疸患者，檢查者應該詢問如下問題以尋找疾病線索：‘‘Howlonghaveyoubeenjaundiced?’’“黃疸發生多久了？”‘‘Didthejaundicedeveloprapidly?’’“黃疸是否發展迅速？”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？發熱？搔癢？體重減輕？”JaundiceDistaste：不喜歡、厭惡，dis-不Cigarettes：煙Chill：寒戰Itching：瘙癢‘‘Inthepastyearhaveyouhadanytransfusions?tattooing?inoculations?’’在過去一年里你是否曾經輸液？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藥物？”‘‘Doyoueatraw

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

you

traveled

abroad

in

the

past

year?”

If

yes,

“Where?Wereyouawarethatyoumayhaveconsumeduncleanwater?”“過去的一年中你是否出過國？”如果是，“你去過哪里？你是否知道你可能使用過不潔凈的水？”Jaundice‘‘Haveyoubeenjaundicedbefore?’’“既往是否有黃疸病史？”‘‘Hasyoururinechangedcolorsinceyounoticedthatyouwerejaundiced?’’“出現黃疸后，你的尿液顏色是否發生改變？”‘‘Whatisthecolorofyourstools?’’“大便是什么顏色?”Jaundice‘‘Doyouhaveanyfriendsorrelationswhoarealsojaundiced?’’“你是否有朋友或親屬也發生了黃疸？”‘‘Whattypeofworkdoyoudo?Whatothertypesofworkhaveyoudone?’’“你從事何種工作？你曾經從事過何種工作？”‘‘Whatareyourhobbies?’’“你的業余愛好是什么？”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