内外科复习资料：外科学大题

1、外科名解+简答+问答一、胆道疾病（能出的历年题基本都出了，比较重要）1. 胆囊结石手术指征（06级问答）1）口服胆囊造影胆囊不显影2）结石直径超过2cm3）B超提示胆囊壁局限性增厚4）病程5年以上，年龄大于50岁的女性病人5）胆囊颈部嵌顿结石6）胆囊萎缩或瓷样胆囊7）以往曾行胆囊造瘘术2. Reynolds五联征（Reynolds pentad）（06级名解）Charcot triad plus shock and CNS inhibition, seen in AOSC.3. 陶土样便（Argil like bowels）（如果名解英文，这个应该不会考吧，太难翻译了）胆汁缺乏所致的大便形状改

2、变，呈陶土观，常由阻黄疸引起4. Calot三角（Calot triangle）A triangle bounded by inferior border of the liver, cystic duct and common hepatic duct. The cystic artery runs through the triangle5. 内镜鼻胆管引流术ENBDERCP下，经鼻导管引流，常用于急性梗阻化脓性胆管炎（AOSC）6. 急性梗阻化脓性胆管炎AOSC临床：1）多有胆道病史2）病起骤急，体温骤升3）Reynolds五联征：Charcot三联征+休克+CNS抑制1) Histor

3、y of biliary tract disease2) Sudden attack, fever3) Reynolds pentad治疗：1）目的：解除梗阻，胆道减压，胆汁引流2）非手术治疗：抗感染、抗水电紊乱、抗休克等3）手术治疗：胆总管切开减压术+T管引流4）紧急减压引流：PTCD、ENBD1) Goal: Relieve obstruction, reduce pressure, biliary drainage2) Non-surgical treatment: Anti-infection, Correct fluid and electrolyte imbalance, Anti

4、-shock, etc.3) Surgical treatment: Open exploration and T tube placement4) Emergency biliary decompression: PTCD, ENBD7. Mirizzi综合征(Mirizzi syndrome)Hartamn囊或颈部较大结石压迫导致肝总管狭窄阻黄疸；胆囊胆管瘘炎症，临床表现为Charcot三联征 Association of recurrent cholecystitis, cholangitis and obstructive jaundice. It is caused by cysti

5、c duct stones resulting in constriction of the common bile duct8. Charcot三联征Abdominal pain, fever and jaundice9. 胆囊结石（gallbladder stone）临床表现、诊断及治疗临床：1）胃肠道症状：消化不良，厌油2）胆绞痛：典型表现，尤夜间阵发，向肩背放射3）Mirizzi综合征4）Murphy征5）其他：胆囊积液1) Intestinal symptoms2) Biliary colic3) Mirizzi syndrome4) Murphys sign5) Others: E

6、ffusion, pancreatitis, etc.诊断：1）结合病史、临床2）B超：检出率96%3）必要时CTMRI1) History2) BUS: 96%3) CT/MRI: if necessary治疗：1）无症状者可不需要治疗 2）有症状患者：腹腔镜胆囊切除术或开腹胆囊切除术 3）对于部分患者应在手术时行胆总管探查 4）不能耐受手术者可考虑溶石治疗1）Asymptomatic: in most cases treatment is not necessary2）Symptomatic: laparoscopic cholecystectomy (LC) or open cholec

7、ystectomy (OC) 3）Common bile duct exploration may be needed in some conditions10. 肝外胆管结石手术原则（Surgery principle）手术原则去除病灶，取尽结石，解除梗阻，通畅引流Remove nidus; Deplete stone; Relieve obstruction; Biliary drainage二、阑尾疾病&腹外疝（非重点，阑尾记住两个点就差不多了，一系历年题貌似没出过腹外疝的，熟悉三个名解就差不多了）1. McBurney点右髂前上棘、脐连线，中外1/3At 1/3 from right

8、ASIS to umbilicus.2. Lanz点左右髂前上棘连线，中右1/3At 1/3 from right ASIS to left ASIS.3. 结肠充气实验（Rovsing test）仰卧位，按压左下腹降结肠，压力传导至肓肠和阑尾处，出现右下腹部疼痛In supine position, when pressing the descending colon at left lower abdomen towards caecum and vermix, the right lower abdomen hurts. 4. Richter疝(Richter hernia)肠管壁为内容

9、物的嵌顿疝Incarcerated hernia with the contents of intestines wall5. Littre疝(Littre hernia)内容物为Meckel憩室的嵌顿疝Incarcerated hernia with the contents of Meckel diverticulum6. 滑动性疝腹内脏器参与构成疝囊壁的难复性疝7. 斜疝直疝鉴别(Distinguish of indirect hernia and direct hernia)Indirect herniaDirect herniaAgeYouth and childrenEldersP

10、ositionInguinal canalScrotum availableHesselbachs triangleScrotum unavailableHold the internalringNo moreStill possibleIncarcerationCommonFewAppearancePyriform or Oval, with pedicleHemispheric, with broad baseHernial sac VS Spermatic cordAnteriorPosterioHernial neck VS Inferior epigastric arteryExte

11、riorInterior三、胃十二指肠疾病1. 胃的癌前病变(Gastric precancerous lesions)息肉、溃疡、萎缩性胃炎、残胃、胃粘膜巨大皱襞症Polypus, ulcer, atrophic gastritis, gastric stump, Mntrier disease2. 胃十二指肠溃疡穿孔的临床表现（Clinical Presentation of Acute Perforation）1）症状突然出现剧烈疼痛2）体征腹部柔韧感腹部反跳痛板状腹肠鸣音减弱或消失1) SyndromesInitial sudden onset of severe abdominal

12、pain 2) Physical signsa) Abdominal tenderness b) Abdominal rebound tendernessc) Tabulate venterd) Bowel sounds absent3. 胃大部切除术的并发症（8个以上）(Postgastrectomy syndromes)1）倾倒综合征早期倾倒综合征晚期倾倒综合征2）代谢障碍贫血脂肪吸收障碍缺钙：骨质疏松症、软骨病3）胃肠道重建输入袢综合征输出袢梗阻碱性反流性胃炎残窦综合症1）Dumping Syndromea) Early Dumpingb) Late Dumping2) Metaboli

13、c Disturbancesa) anemiab) impaired absorption of fatc) deficiencies in calcium 3) Gastric Reconstructiona) Afferent Loop Syndromeb) Efferent Loop Obstructionc) Alkaline Reflux Gastritisd) Retained Antrum Syndrome4. 早期胃癌（early gastric cancer, EGC）不看大小和是否淋巴转移，仅限粘膜（下层）的胃癌Gastric cancer of any sizes, lo

14、cated in mucosa, whether lymphatic metastasis or not5. 进展期胃癌(Advanced gastric cancer, AGC)浸润至浆肌层及浆膜外的胃癌Gastric cancer invaded muscular layer or out of serosa6. 胃溃疡手术指征1）经过短期（4-6周）内科治疗无效或愈合后复发者；2）年龄超过45岁得GU患者3）X线钡餐或胃镜证实为较大溃疡或高位溃疡4）不能排除或已证实为溃疡恶变者5）以往有一次急性穿孔或大出血病史，而溃疡仍为活动期者7. 残胃癌(Gastric stump cancer)良

15、性胃病经胃大部切除术后5年内残胃的癌变Canceration of the gastric remnant in five years after gastrectomy8. 进展期胃癌的Borrman病理分型(Borrman classification of AGC)型结节型；型溃疡型；型浸润型；型弥漫型（皮革胃）Type I: Nodular typeType II: Ulcerative typeType III: Infiltrating typeType IV: Diffuse type (linitis plastica)9. 消化性溃疡病因(Pathogeny of PU)1）

16、胃酸过高2）黏膜屏障受损：粘液HCO3磷脂屏障损伤；紧密连接受损；黏膜血流障碍3）HP感染4）非甾体类药物NSAIDs1) Hyperchlorhydria2) Damage of mucosa barrier3) H.pylori infection4) NSAIDs10. 瘢痕性幽门梗阻（胃出口梗阻）临床表现1）积累性呕吐，营养不良2）可吐宿食，馊味，无胆汁3）上腹隆起，胃型腹4）钡餐：24后仍有残留11. Krukenburgs tumor胃癌癌细胞脱落，种植于卵巢形成的肿瘤The tumor formed by implantation of gastric cancer cells

17、on ovary四、肠梗阻（非重点，历年考得都比较少，顶多考个名解或简答）1. 动力性肠梗阻(Dynamic ileus)神经反射或毒素刺激引起的肠壁肌运动紊乱，无狭窄肠道，分麻痹性（术后为主）、痉挛性（常由铅中毒引起）2. 肠套叠(Intussusception)即肠管套入相连肠管，多“回肠入结肠”型，腹痛、腹块、血便One intestinal canal trapped into another intestinal canal, with the symptoms of abdominal pain, lump and bloody excrement3. 机械性肠梗阻(Mechani

18、cal ileus)各种原因引起的肠腔变窄，食物难以通过，由外压、内堵（粪石为主）、肠壁变（肿瘤、炎症）所致4. 血运性肠梗阻(Vascular ileus)肠系膜血管硬化或栓塞引起肠麻痹，可迅速肠坏死5. 绞窄性肠梗阻的临床表现(Strangulated ileus)痛吐胀闭+休克早快，X线有孤立肠袢1）痛：阵发加重，可有放射2）吐：呕吐早频，可有带血3）胀：局部隆起，腹膜刺激4）闭6. 肠梗阻治疗原则1）解除梗阻；2）纠正因肠梗阻引起的全身生理紊乱7. 肠扭转(Volvulus)沿系膜长轴旋转的闭袢型肠梗阻,为绞窄性，死亡率高达1040%五、肝脏疾病（应该会出一个简答或问答）1. Chil

19、d-pugh的定义以及B级的指标（英文）（06级简答）Child-pugh classification:Index123AccumulatedEncephalopathyNoneGrade 12Grade 34Child A6Child B 79Child C10AscitesNoneMildModerate of aboveBIL（mol/L）35355050ALB（g/L）35283528PT prolonged（s）13410102. 隐源性肝脓肿(Cryptogenic liver abscess)原因不明的肝脓肿，常抵抗力下降时发生，可能与肝内隐匿病变有关Occur with lo

20、w immunity, may be associated with latent liver disease3. 小肝癌和巨大肝癌的区别(Distinguish of MHCC, SHCC, LHCC and HHCC)微小肝癌2cm小肝癌5cm大肝癌10cm巨大肝癌MHCC2cmSHCC5cmLHCC10cmHHCC4. 肝癌的诊断和治疗 诊断：1）AFP：400g/L，持续8w排除妊娠、肝病活动期、生殖器胚源性肿瘤2）B超：直径2cm3）CT/MRI：直径1cm4）DSA：直径1cm5）穿刺活检Diagnosis：1) AFP 400g/L Lastingly, exclude preg

21、nancy, active liver diseases and embryonic tumors 2) BUS: Diameter 2cm 3) CT/MRI: Diameter 1cm 4) DSA: Diameter 1cm 5) Biospy治疗：1）手术治疗：规则切除不规则切除肝移植；适应征：总体良好病灶局限硬化尚轻代偿尚可（Child-Pugh AB级）；无其他器官严重损伤2）非手术治疗：栓塞化疗（TACE)、穿刺射频（RFA)、注纯酒精（PEI）、免疫治疗、中医治疗Treatment: 1) Surgery: regular & irregular resection, live

22、r transplantation2) Non-surgical treatment: TACE, RFA, PEI, Immunology therapy, Traditional Chinese medicine5. 原发性肝癌的临床表现1）早期无特异性2）肝区疼痛3）腹胀、恶心、呕吐4）体重下降、发热5）上消化道出血6）肝肿大7）黄疸8）腹水9）肝硬化体征：肝掌、蜘蛛痣、海蛇头等10）肝外转移症状1) No early symptoms2) Upper abdominal pain3) Abdominal distension, nausea, vomiting4) Weight los

23、s, fever5) Upper gastrointestinal bleeding6) Hepatomegaly7) Jaundice8) Ascites9) Signs of liver cirrhosis10) Extrahepatic metastatic symptoms6. 肝癌并发症上消化道出血、破裂、肝衰、感染、黄疸Upper gastrointestinal bleeding, hepatic rupture, hepatic failure, infection, jaundice六、甲状腺疾病&乳腺疾病（一个简答或名解）1. 甲状腺危象的临床表现及治疗（英文）（06级简答

24、）(Thyroid crisis)临床表现：1）多数发生于术后12-36h2）主要表现为高热和脉率快而弱3）神经症状：烦躁不安、谵妄，也为神志淡漠、嗜睡4）常有呕吐及水泻，以及全身红斑及低血压Symptoms & Signs:1) Occur after surgery in 12 36h2) High fever, rapid but weak pulse3) Neural symptoms: dysphoria, delirium OR apathetic, somnolence治疗：1）应用碘剂2）肾上腺皮质激素的应用 3）应用抗甲状腺药物 4）降低周围组织对甲状腺素的反应 5）应用镇静

25、剂 6）静脉输入大量葡萄糖溶液 7）有心力衰竭加用洋地黄制剂Treatment:1) Idodine2) ACTH3) Antithyroid drugs, ATD4) Inhibit the effect of thyroxin5) Sedative6) Mass glucose solution7) Digitalis fof heart failure2. 湿疹样乳头癌(Pagets carcinoma of the breast)特殊的乳腺癌，即Pagets病，瘙痒糜烂溃疡，多于中老年，恶性程度低Special type of breast cancer; pruritus erosi

26、on ulcer; commonly in elders; low malignancy3. 酒窝征(Dimple sign)乳腺癌早期，累及Cooper韧带，韧带缩短，表面皮肤凹陷In early breast cancer, tumor involved the Cooper ligament. Skin sagged because of the short ligament.4. “橘皮样”改变(“Orange peel like” changes)乳腺癌癌块增大，堵塞皮下淋巴管，引起淋巴回流障碍，出现真皮水肿，呈“橘皮样”改变Tumor involved dermal lymphat

27、ics, blocked lymphatic circulation. Dermal edema appeared like orange peels.5. 炎性乳癌(Inflammatory breast carcinoma)特殊的乳腺癌，局部皮肤可呈炎症样表现，开始时比较局限，不久即扩展到乳房大部分皮肤，皮肤发红、水中、增厚、粗糙、表面温度升高，进展快，预后差Special type of breast cancer; inflammation; rapidly progress, bad prognosis6. 甲状腺肿手术指征（Indication of surgery）1）较大的结节

28、性甲状腺肿2）胸骨后甲状腺肿3）有压迫症状者4）结节性甲状腺肿继发功能亢进5）疑有恶变1) Large nodular goiter2) Retrosternal goiter3) Symptoms of oppression4) Nodular goiter with hyperthyroidism5) Suspicious canceration7. 甲亢手术指征（Surgical indication of hyperthyroidism）1）继发性甲亢及高功能腺瘤2）中度以上的原发性甲亢3）药物减量或停药后复发者4）不能坚持长期用药5）腺体较大有压迫症状6）妊娠早、中期的甲亢患者1)

29、Secondary hyperthyroidism and adnome thyroide hyperfunctionnel2) Moderate primary hyperthyroidism or above3) Recurrent after drug reduced or disused4) Cant tolerate long-term medical treatment5) Large gland with symptoms of oppression6) Early or mid trimester of pregnancy8. 甲亢手术并发症1）呼吸困难和窒息2）喉返及喉上神经

30、损伤3）甲状腺危象4）甲状腺功能减退5）甲状旁腺功能减退1) Dyspnea and apnea2) Injuries of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN)3) Thyroid crisis4) Hypothyroidism5) Hypoparathyroidism七、门脉高压症（一个简答）1. 经颈内静脉内门体分流术(Transjugular Intrahepatic Portosystenic Stent Shunt, TIPSS)经颈内静脉，入下腔静脉，入肝静脉，向门静脉穿刺并放入支架T

31、hrough jugular vein postcava hepatic vein, put a stent between hepatic vein and portal vein.2. 门静脉和腔静脉之间的交通支(Communicating branches between portal vein and vena cava)1）食管下段胃底支2）直肠下端肛管支3）前腹壁支4）腹膜后支1) Lower esophageal-Gastric branches2) Rectum bottom-Anal tube branches3) Anterior abdominal branches4)

32、Retroperitoneal branches3. 门脉高压治疗（针对并发症）(Treatment of portal hypertension)1）食管静脉曲张破裂出血（EVB）：手术治疗：断流术、分流术非手术治疗：a）输血输液防休克 b）血管加压素 c）内镜治疗 d）三腔二囊管 e）TIPSS2）巨脾：可单纯脾切3）腹水：穿刺+白蛋白；TIPSS、腹水颈内静脉转流术；肝移植1) Esophageal varices bleeding (EVB):Surgical treatment: Devascularization and shuntNon-surgical treatment: a

33、) Transfusion, antishockb) Vasopressinc) Endoscopic therapyd) Sengstaken-Blakemore tubee) TIPSS2) Splenomegaly: Simple splenctomy3) Ascites: a) Abdominocentesis + ALB supplementb) TIPSS, ascites-jugular bypass(查不到，自己猜的)c) Hepatictransplantation4. 门脉高压临床表现1）脾肿大/脾亢2）EVB3）海蛇头4）门脉高压性胃炎5）腹水6）肝性脑病1) Splen

34、omegaly/Hypersplenism2) EVB3) Portal hypertensive gastritis/gastropathy4) Ascites5) Hepatic encephalopathy5. 布-加氏综合征(Budd-Chiari syndrome, B-CS)肝静脉、肝段下腔静脉狭窄，引起回流受阻所致的肝后型门高症为主的综合征A syndrome of posthepatic portal hypertension caused by stenosis of hepatic veins and hepatic inferior vena cava八、胰腺疾病（名解或

35、简答）1. 胰头癌的治疗（Treatment of pancreatic cancer）1）根治手术胰十二指肠切除术胆囊空肠吻合术胆总管空肠吻合术胃空肠吻合术2）化疗3）放疗4）基因治疗5）免疫治疗1) Radical resection is the only effective therapy optiona) Pancreatoduodenectomyb) Cholecystojejunostomyc) Choledochojejunostomyd) Gastrojejunostomy2) Chemotherapy3) Radiotherapty4) Gene therapy5) Imm

36、notherapy2. Whipple三联征(Whipple triad)清晨空腹低血糖+持续血糖2.8mmol/L+摄入葡萄糖即缓1) Hypoglycemia symptom after fasting or work2) glucose 2.8mmol/L3) Symptom relieves after administration of glucose by oral or vein3急性胰腺炎的临床表现1）腹痛2）恶心、呕吐3）腹胀4）腹部柔韧感、反跳痛、肌紧张5）发热、黄疸6）Gray-turner征、Cullen征7）多器官功能障碍综合症（MODS）1) Abdominal p

37、ain2) Nausea, vomiting3) Distension 4) Tenderness, rebound tenderness, muscular regard5) Fever，jaundice， 6) Gray-Turner sign: flank ecchymoses Cullen sign: periumbilical ecchymoses 7) MODS4. 急性胰腺炎局部并发症1）胰腺坏死a）感染性坏死b）无菌性坏死2）胰腺脓肿3）胰腺假性囊肿1) Pancreatic necrosisa) Infective pancreatic necrosisb) Sterile

38、pancreatic necrosis2) Pancreatic abscess3) Pancreatic pseudocyst5. 胰腺炎的病因（至少6种）胆源性（炎症、结石、梗阻）、酗酒、暴饮暴食、高血脂、药源性、感染（腮腺炎病毒）、自免疫Biliary, Alcohol, Craputence, Hyperlipidaemia, Drugs, Infection, Autoimmunology6. 胰腺假性囊肿(Pancreatic pseudocyst)发病率10-20%，急性胰腺炎后形成的由纤维组织或肉芽组织包裹的胰液积聚，可由体格检查及影像学检查诊断，呈圆形或椭圆形，界限清楚。1)

39、 Peripancreatic fluid collections occur in 10-20 % of patients2) Those persisting beyond the phase of acute inflammation become pancreatic pseudocysts3) Collection surrounded by fibrous tissue or granula tissue4) Diagnosed by PE or image test 5) Round or ellipse6) Clear cyst wall7. 急性胰腺炎治疗（参考内科）(Tre

40、atment of AP)治疗原则： 1）减轻和控制胰腺本身炎症 2）阻断和防止并发症发生 3）全身支持疗法和治疗并发症Principle of treatment1) Lighten and control the inflammation of pancreas2) Block up and prevent the complication3) Systemic supportive therapy and treat the complication重症急性胰腺炎治疗：（内科版，应该不会算错）1) 监护Monitor：禁食+ICU2) 液体复苏3) 预防感染4) 营养支持5) 抑制胰腺外分泌和胰酶活性：生长抑素、加贝脂6) 预防和治疗肠道衰竭7) 内镜治疗：ERCP,EST8) 中医中药9)手术治疗1) Monitor: Fasting and ICU2) Fluid recovery3) Prevent infection4) Nutrient support5) Inhibit external secretion and pancreatin activity6) Prevent and treat intestin