2017五年制医学英语-上届专外

ChapterChapterthe第17章吉林大 联谊医院风湿免疫associateRheumatologyDept.ofChina-JapanUnionHospitalofReviewofSpecificThemostcommonsymptomsofabdominaldiseaseareasThemost和mostThemost:(many,much的 Whichofyouhasmadethemostmistakes?当中谁错得最多Mostbirdscanfly.疼搔痒的改NauseaandChangeinRectalAbdominalPainisprobablythemostimportantsymptomof疼痛是腹部疾病最重要的症状Althoughabdominalneoplasiamaybepainless,mostabdominaldiseasemanifestsitselfwithsomeamountofpain.尽管腹部肿瘤可以是无痛性的，但是大部分腹部疾病表现出一定度的疼痛 新的，现代-生长、形-没有、n.临床表FeverisonemanifestationofPaincanresultfrommucosalirritation,smoothmusclespasm,peritonealirritation,capsularswelling,ordirectnerve疼疼痛可以是由于粘膜的刺激、平滑肌痉挛、腹膜刺激，包膜肿或者直接的神经刺激所引起smoothmuscleskeletalmuscle周 治近义词therapy指更系统treatment治Physicaltherapyalternateswith理疗和化疗交替进行Theearlierthetreatmentisgiven,thebetterthepatient's越早接受治疗，康复的可能性就越大、治Abdominalpainnecessitatesforspeedydiagnosis腹部疼痛需要迅速 和治疗Thetwodoctorsmadedifferentdiagnosisofmydisease. usedtodiagnoseavarietyof“抱怨”“诉苦”。指心中对人或事物不满或身体感到不适或痛苦而对别人诉说或抱怨“抱怨”“诉苦”。指心中对人或事物不满或身体感到不适或痛苦而对别人诉说或抱怨有时也可表示说话者引起别人对此事的注意。用作不及物动词时,其后可接of或about引起的短语,of后常是诉苦的内容,可为名词或动名词而about后则是对抱怨事物概括的陈述。当表示“向…抱怨…”时,要用complaintosb〔aboutsth结构表诉说plainabout〔 〕应plainofSheisalwayscomplainingofhertoothachetothedoctor.她老是跟大夫说Whenapatientcomplainsofabdominalpain,askfollowing当患者主诉腹痛时，应该询问下列问题‘‘Whereisthepain?’’‘‘Hasthepainchangeditslocationsinceitstarted?’’‘‘Doyoufeelthepaininanyotherpartofyourbody?’’‘‘Howlonghaveyouhadthe‘‘Haveyouhadrecurrentepisodesofabdominal周期性、再发 又、再reinstallre-‘‘Didthepainstartsuddenly?’’‘‘Canyoudescribethepain?Isitsharp?dull? 你是否能够描述一下疼痛？它是刺痛？钝痛？烧灼痛？绞痛‘‘Isthepaincontinuous?Doesitcomein疼痛是持续的吗？它的强度是否有波动‘‘Hastherebeenanychangeintheseverityornatureofthepainsinceitbegan?’’从疼痛开始发作，它的强度和性质是否有任何变‘‘Whatmakesitworse?’’‘‘Whatmakesitbetter?’’是什么使情况变得更‘‘Isthepainassociatedwithnausea?vomiting?sweating?constipation?diarrhea?bloodystools?abdominaldistention?fever?chills?eating?’’疼痛是否伴随 ？ ？出汗？便秘？腹泻？血便？腹胀？发热寒战？进食？‘‘Haveyoueverhadgallstones?kidneystones?’’ Ifthepatientisawoman,askthis‘‘Whenwasyourlastperiod?’’ 期Doyougetpianbeforeorduringyour您 前 中有过疼痛吗Notetheexacttimeatwhichthepainstartedandwhatthe ngatthat注意疼痛开始的准确时间以及疼痛开始时患者在做什么Sudden,severepainawakeningapatientfromsleepmaybeassociatedwithacuteperforation,inflammation,ortorsionofanabdominalorgan.突然、严重的使患者从睡梦中惊醒的疼痛可能是伴随腹 的性穿孔、炎症、或扭perforation穿Thispreventsbowelperforation.这样可以防止肠道穿inflammation炎Hehasaninflammationofthe 他得 torsion扭Thisovaryisdarkandenlargedfromhemorrhagefollowing扭转造 而变黑变大Astoneinthebiliaryorrenaltractalsocausesintense胆管或泌尿系统发 可引起剧烈的疼痛biliary胆的、胆汁For s,includingchildren,thebiliarytubingischokedwith有许多人包括儿童，胆道都有胆石堵塞着renal肾脏Deathusuallyresultsfromhepaticorrenal近义词常因肝脏或肾脏衰竭而近义词Noteacutenessofthe注意疼痛的剧烈程度Acuteruptureofafallopiantubebyanectopicpregnancy,perforationofagastriculcer,peritonitis,andacutepancreatitiscausesuchseverepainthatfaintingmayresult.异位妊娠导致的急 破裂、胃溃疡穿孔、腹膜炎和急性胰炎导致严重的疼痛可以导致晕厥rupurerupureHediedofaruptureofblood-vessels.fallopiangastricgastriculcer -itis炎症peritonitis腹膜炎pancreatitis胰腺炎Itiscrucialtodeterminethelocationofthepainatitsonset,itslocalization,itscharacter,anditsradiation.确定疼痛的起始部位、定位、性质和发射性是非常重要Commonly,whenanabdominalorganruptures,painisfeltoverthebelly,’’withoutlocalizationtoaspecific当腹 发生穿孔时，通常感觉疼痛“遍及全腹”,没有特定域的定Painarisingfromthesmallintestineiscommonlyfeltintheumbilicalorepigastricregions;forexample,painfromacuteappendicitisbeginsattheumbilicus.起始于脐周。 肚脐 在.....之上；epigastric上腹部；appendicitis阑尾Aftertime,pain elocalizedtoother经过一段时间，疼痛可能定位到其他位置Painfromacuteappendicitistravelsfromtheumbilicustotherightlowerquadrantinabout1to3hoursaftertheinitial急性阑尾炎在发病的1-3小时后疼痛可以从脐部转移到右下腹部Paininthechestfollowedbyabdominalpainshouldraisesuspicionofadissectingaortic继发于胸痛的腹痛应该警惕主动脉瘤破裂的可能aorticaortic大动脉的aneurysm动脉Notethenatureofthe注意疼痛的性Paincausedbyaperforatedgastriculcerisoftendescribedas‘‘burning’’;dissectinganeurysmas‘‘tearing’’;intestinalobstructionas‘‘grip ’’;pyelonephritisas‘‘dull,aching’’;andbiliaryorrenalcolicas‘‘crampy,被描述为“述为“钝痛”，胆道或肾脏疼痛描述为“痉挛性、压榨性”。intestinal肠的；pyelonephritis[ˌpaɪəloʊnɪ'fraɪtɪs]肾盂肾炎intestinal肠的；pyelonephritis[ˌpaɪəloʊnɪ'fraɪtɪs]肾盂肾炎colic：疝气、急腹Referredpainoftenprovidesinsightastothe牵涉痛经常能够提供病因的线索Referredpainisatermusedtodescribepainoriginatingintheinternalorgansbutdescribedbythepatientasbeinglocatedintheabdominalorchestwall,shoulder,jaw,orotherareas dbythesomaticnerves.牵涉痛是指疼 ，但患者通常描述其定位于腹壁胸壁、肩、下巴或其他体神经支配区域somaticsomatic身体的、躯体Painappearstooriginateinareas dbythesomaticnervesenteringthespinalcordatthesamesegmentasthesensorynervesfromtheorganresponsibleforthepain.支配疼痛感觉起始区域的体神经与支配疼痛真 的感觉经进入脊髓的同一节段，这可能是引起牵涉痛的原因Forexample,right-shoulderpainmayresultfromacutecholecystitis;testicularpainmayresultfromrenalcolicorfromappendicitis.例如，急性胆囊炎引起右肩痛，肾绞痛或阑尾炎引 痛spinalspinalcord脊髓；sensorynerves感觉神经cholecystitis胆囊炎 的ThecommonsitesforreferredpainareshowninFigure17-常见的牵涉痛部位见图17-3Thelocationsofpain常见的牵涉痛部位见图17-3inTable17-腹腹部疾病的疼痛定位归纳于表17-2Thetimeofoccurrenceandfactorsthataggravateoralleviatesymptoms(e.g.,mealsordefecation)areparticularly疼痛出现的时间和引起症状加重或减轻的因素（例如进食或排便尤其重aggravateaggravate：加重；alleviate：减Periodicepigastricpainoccurring1/2to1houraftereatingaclassicsymptomofgastricpeptic进食后半小时到1小时出现周期性上腹痛是胃溃疡的典型症状进食后半小时到1小时出现周期性上腹痛是胃溃疡的典型症状患有十二指肠溃疡疼痛多在进食后2-3小时患有十二指肠溃疡疼痛多在进食后2-3小时或下次进餐前出现gastricpepticulcersgastricpepticulcers：消化性胃溃疡duodenalpepticulcer：消化性十二指肠溃疡patientswith:患有......Foodtendstolessenthepain,especiallyinduodenal特别是十二指肠溃疡，食物能够减轻疼痛Perforation特别是十二指肠溃疡，食物能够减轻疼痛十二指肠溃疡穿孔至胰十二指肠溃疡穿孔至胰腺可以导致后背痛，看似矫形外科问题orthopedicorthopedic[ɔːθə'piːdɪk]整形外nocturnal：nocturnal：夜间内脏Nocturnalpainisaclassicsymptomofduodenalpeptic十二指肠溃疡的典型症状是夜间痛Painaftereatingmayalsobeassociatedwithvasculardiseaseoftheabdominalviscera.腹 的血管类疾病也可伴随进食后疼痛Patientswiththisconditionareolderandhavepain,anorexia,andweight这类患 较大，伴有餐后痛、厌食和消瘦Thistriadisseeninabdominalanginaresultingfromobstructivevasculardiseaseintheceliacaxisorthesuperiormesentericartery.这一三联症见于腹腔干或肠系膜上动脉的血管阻塞类疾病引起绞痛postpost后面的；postprandial：餐后anorexia：厌食triad：三个一]celiacaxis：腹腔Table17-3summarizestheimportantmaneuversNauseaandVomitingmaybecausedbysevereirritationof resultingfromtheperforationofanabdominalorgan;fromobstructionofthebileduct,ureter,orintestine;orfromtoxins.引 的原因可能是腹 穿孔造成对腹膜的严重刺激；胆管输尿管、小肠阻塞；或毒素刺激引Vomitingresultingfromaperforationisrarely穿孔引起 很少是大量的ureter：[jʊ'riːtə]输尿NauseaandObstructionofthebileductorothertubeproducesstretchingofthemuscularwall,resultinginepisodicvomitingthatoccursattheheightofthepain. Intestinalobstructionpreventstheintestinalcontentsfrompassingdistally;consequently,vomitingmayresultintheexpulsionofintestinalcontents.肠道梗阻阻碍肠内容物经肠道排出，随 导致肠内容的排出distallydistally：['dɪstælaɪ]远expulsion：排emergency：紧急事emergency：紧急事科Toxinsgenerallycausepersistent毒素通常引起持续 Notallabdominalemergenciescause不是所有的腹部急症都导 NauseaandIntraperitonealbleedingmayoccurintheabsence腹腔内 往往没 症状Vomitingisfrequentlyalsocausedbyinflammationofintra-abdominalstructures,aswellasbyextra-abdominalconditions,includingdrugtoxicity,centralnervoussystemdisorders,myocardialinfarction,andpregnancy.吐，它们包括药物毒性反应、中枢神经系统疾病、心梗和怀孕。 的； 外部NauseaandAskthefollowingquestionsifapatientcomplainsofvomiting,or ‘‘Howlonghaveyouhadnauseaorvomiting?’’ ‘‘Whatisthecolorofthe 物是什么颜色‘‘Isthereanyunusuallyfoulodortothe 物是否有不同寻常的臭味foulfoul：恶臭odor：气Nauseaand‘‘Howoftendoyou“多长时 一次‘‘Isvomitingrelatedtoeating?’’Ifyes,‘‘Howsoonaftereatingdoyouvomit?Doyouvomitonlyaftereatingcertainfoods?’’ 是否于进食有关？”如果有关，“进食后多久出 ？是否只在进食某种特定的食物后发 Howoften：多久一HowoftendoyougotochurchHowoften：多久一Howoftendoyougotochurch你隔多久去做一次礼拜Howsoon：多快，多久以HowsooncanIbereleasedfromthehospital?什么时候才能出院Nauseaand‘‘Isthenauseaorvomitingassociatedwithabdominalpain?constipation?diarrhea?alossofappetite?achangeinthecolorofyourstools?achangeinthecolorofyoururine?fever?chestpain?’’“ 或者 是否伴随腹痛？便秘？腹泻？食欲减退？大便颜改变？尿液颜色改变？发热？胸痛？”‘‘Haveyounoticedachangeinyourhearing“你是否注意到你 有无改变‘‘Haveyounoticedringinginyour“你是否存在耳鸣constipationconstipation：便秘；diarrhea：腹stools：粪便；urine：尿NauseaandIfthepatientisawoman,askthis如果患者为女性，应询问‘‘Whenwasyourlast“你的末 是什么时候Therelationshipofthepaintovomitingisimportantandhelpinprovidingthe疼痛 的关系非常重要，有可能有助 NauseaandInacuteappendicitis,painprecedesthevomitingusuallyafew急性阑尾炎时，疼痛通常 前几小时发生Thecharacterofthevomitusmayaidindeterminingits物的特点可以帮助明确病因Acutegastritiscausesthepatienttovomitstomach急性胃炎可导致患 胃内容物-itis炎症；gastr的、肮脏的、臭Biliarycolicproducesbilious,orgreenish-yellow胆绞 物为胆汁，或黄绿色物质Intestinalobstructionoftencausesthepatienttobiliousvomitus,followedbyfeculent-smelling Feculentvomitusisusuallycausedbyintestinalobstruction. NauseaandNauseawithoutvomitingisacommonsymptominpatientswithhepatocellulardisease,pregnancy,andmetastatic 通常是肝细胞疾病、怀孕和代谢疾病患者的常见症状NauseamaybeassociatedwithahearinglossandtinnitusinpatientswithMe´nie`re’sdisease. 丧失和耳鸣常提示美尼尔病hepato-肝tinnitus：['tɪnɪtəs]耳ChangeinBowelTakeacarefulhistoryofbowel注 排 的详细病史Achangeinbowelmovementsnecessitates排便变化需要更详尽的描述Askthesequestionsofthepatientwithacuteonset急性腹泻患者需要询问如下问题bowelhabitsbowelhabits：肠道排便ChangeinBowel“你腹泻多久‘‘Howlonghaveyou“你腹泻多久“你一天排便多少次‘‘Howmanybowelmovementsdo“你一天排便多少次“腹泻是突然开始的‘‘Did“腹泻是突然开始的ChangeinBowel‘‘Didthediarrheabeginafterameal?’’Ifyes,didyou“腹泻是一次进餐后开始的吗？”如果是，“你当时吃了什么物‘‘Arethestoolswatery?bloody?“大便是水样的吗？血性的？恶臭‘‘Isthediarrheaassociatedwithabdominalpain?lossofappetite?nausea?vomiting?’’“腹泻是否伴有腹痛？食欲下降 malodorousmalodorous：恶臭mal-坏的ChangeinBowelTheacuteonsetofdiarrheaafteramealsuggestsaninfectionor进餐后急性发作的腹泻提示 染 Waterystoolsareoftenassociatedwithinflammatoryprocessesofthesmallbowelandcolon.水样便常提示小肠或结肠的炎症过Shigellosisisadiseaseofthecolonthatproduces痢疾是一种伴发血样便腹泻的结肠疾病coloncolon：结Shigellosis：[ˌʃɪgə'loʊsɪs]志贺氏细菌性痢ChangeinBowel阿米巴病也伴发血样便腹泻Amebiasis阿米巴病也伴发血样便腹泻Thepatientwithchronicdiarrheashouldbeasked慢慢性腹泻的患者应询问如下问题 阿米巴ChangeinBowel“腹泻多久了‘‘Howlonghave“腹泻多久了‘‘Doyouhaveperiodsofdiarrheaalternating“腹泻“腹泻是否与便秘交替出现“大便呈水样？松散的？呈漂浮状？带“大便呈水样？松散的？呈漂浮状？带有恶臭气ChangeinBowel‘‘Haveyounoticedbloodinthestools?undigested“你是否注意到便中带血？带粘液？含“你是否注意到便中带血？带粘液？含有未消化的食物“大便是什么颜色的‘‘Howmanybowelmovementsdo“大便是什么颜色的“腹泻出现在进食后mucus：粘液“腹泻出现在进食后mucus：粘液“你每天排便几次ChangeinBowel‘‘Whathappenswhenyoufast?Doyoustill“当你禁食后发生了什么情况？你是否还存在腹‘‘Isthediarrheaassociatedwithabdominalpain?abdominaldistention?nausea?vomiting?’’“腹泻是否伴随腹痛？腹胀 ‘‘Haveyounoticedthatthediarrheaisworseattimesofthe“你是否注意到腹泻在每天的固定时间变得更加严重fastfast：斋戒、禁ChangeinBowel“你的食欲如‘‘How“你的食欲如“你的体重有无改变‘‘Hastherebeenany“你的体重有无改变ChangeinBowelDiarrheaandconstipationfrequentlyalternateinwithcoloncanceror腹泻和便秘交替出现常见于结腹泻和便秘交替出现常见于结肠癌或憩室炎患者腹腹泻常见于左结肠疾病，而水样便常见于炎症性肠病和蛋白丢肠病Loosebowelmovements：腹泻ChangeinBowelFloatingstoolsmayresultfrommalabsorption浮便是由于吸收不良综合征导致的浮便是由于吸收不良综合征导致的withbloodand溃疡溃疡性结肠炎患者通常大便中混有血和粘colitis：结肠ChangeinBowelAnyinflammatoryprocessofthesmallbowelorcolonmanifestwithbloodmixedwithstoolorundigested肠激惹综合征典型的表现是清晨频繁腹泻肠激惹综合征典型的表现是清晨频繁腹泻Irritable：易怒的、急躁任何炎症性小肠疾病或结肠疾病表现为大便混有血或未消化的食物ChangeinBowelPatientscomplainingofconstipationshouldbeasked患者患者主诉便秘应该询问下列问题“你发生便秘多久了‘‘How“你发生便秘多久了“多长时间排便一次‘‘Howoftendo“多长时间排便一次“大便条的长度是多‘‘Whatis“大便条的长度是多ChangeinBowel‘‘Whatisthecolorofyour“大便是什么颜色‘‘Isthestoolever“大便是什么颜色“大便是否曾混有血‘‘Haveyounoticed“大便是否曾混有血periodsof“腹泻和便秘是否交‘‘Haveyounoticedachangein“腹泻和便秘是否交““大便条的粗细是否发生了改变ChangeinBowel‘‘Doyouhavemuch“你是否有涨“你是否有涨气“食欲如何‘‘Hastherebeenanychange“食欲如何“体重是否发生了变Changeinthecaliber“体重是否发生了变大大便条粗细的变化是有意义的ChangeinBowel‘‘Pencil’’-diameterstoolsmayresultfrom orarectal铅笔粗细的大便可能是 或直 引起的Achangeinthecolorofstoolsis大便颜色的变化非常重要Asisdiscussedlater,palebrowntograystoolsindicateabsenceof正如下文将要讨论的，浅棕色至灰色的大便提示胆汁缺乏ChangeinBowelThiscanresultfromanobstructiontobileflowfromgallbladderorfromdecreasedproductionof体重改变是便秘重要的伴随症状Bilegallbladder这体重改变是便秘重要的伴随症状Bilegallbladder这可能是由于胆汁从胆囊流出通道梗阻或胆汁产生减少所致ChangeinBowelAnincreaseinweightmayindicatedecreasedseenin体重增加提示新陈代谢减慢见于甲状腺功能减退症adecreaseinweightmaybeassociatedwithcancerofthecolonorotherhypermetabolicconditions.体重降低可能见于结 或其他高代谢情况Hypothyroidism：[ˌhaɪpoʊ‘θaɪrɔɪdɪzəmHypermetabolicRectalRectalbleedingmaybemanifestedbybrightredbloodmixedwithstool,orblack,tarry直 可以表现为鲜红色的血，便中混有血，或者黑色、柏油便Brightredbloodperrectum,alsoknownashematochezia,canoccurfromcolonictumors,diverticulardisease,orulcerativecolitis.经直肠排出鲜红色血，也称为便血，见于结肠肿瘤、憩室疾病、或溃疡性结肠炎。RectalRectal：直肠的]hema-：血RectalBloodmixedwithstoolcanbetheresultofulcerativediverticulardisease,tumors,or便中混有血见于溃疡性结肠炎、肿瘤、或痔疮Askthepatientwhodescribesrectalbleedingthefollowing对于直 的患者应询问如下问题HemorrhoidsHemorrhoids：[‘hemərɔɪdzRectal‘‘Howlonghaveyounoticedbrightredbloodinyour“你注意到大便中有鲜红色血有多久了“你注意到大便中有鲜红色血有多久了“血液是混在大便中‘‘Aretherestreaksofbloodonthesurfaceofthe““大便表面是否有血StreaksRectal‘‘Haveyounoticedachangeinyourbowel“你是否注意到你的排 发生了变化‘‘Haveyounoticeda sationinyourrectumyouhavetomoveyourbowels,butyou“你是否持续感觉到不得不排便但却排不出来Tenesmusisthepainful,continued,andineffectiveat里急后重是指在排便时疼痛的、持续而无效的用力RectalItiscausedbyinflammationoraspace-occupyingsuchasatumoratthedistalrectumor它是由炎症或空间占位损害如直肠末端 部位的肿瘤所引起Hemorrhoidalbleedingisacommoncauseofhematocheziaandstreakingofstoolwithblood.痔 是便血和大便带血的常见原因LesionLesion：[‘liːʒn损害、损伤]RectalMelenaisablack,tarrystoolthatresultsfrombleedingabovethefirstsectionoftheduodenum,withpartialdigestionofthehemoglobin.黑便是指由于十二指肠以上部 使血红蛋白仅部分消化导致色的柏油样大便MelenaMelena：[mə'liːnə]黑便duodenum：[ˌduːə‘diːnəm十二指肠Hemo-血；-globinRectalInquireaboutthepresenceof应了解黑便存在的情况Ausefulwayofquestioningistoshow应了解黑便存在的情况一一种有效地询问方法是向患者展示听诊器的黑管并问，“你的大是否有过这种颜色Stethoscope：[‘steθəskoʊp]RectalIfaskeddirectlywhetherthebowelmovementshaveeverbeenblack,thepatientmayanswerintheaffirmative,equatingdark(normal)stoolswithblackstools.如果如果直接询问患者是否有过黑色大便，患者的答复往往是肯定的他们把正常暗色的大便等同于黑便Affirmative：肯定Equating：等同于；～RectalAskthesequestionsofapatientwhodescribes如果患者描述有黑便应询问下列问题‘‘Haveyoupassedmore如果患者描述有黑便应询问下列问题“是否排过多次黑色、柏油样大便？”如果是，“什么“是否排过多次黑色、柏油样大便？”如果是，“什么时候““排黑色、柏油样便Rectal‘‘Haveyounoticedfeeling“是否曾感觉头昏眼‘‘Haveyouhadanynauseaassociatedwiththesestools?vomiting?diarrhea?abdominalpain?“排便时是否伴 ？腹泻？腹痛？出汗Lightheaded：头昏眼花RectalTheanswerstothesequestionscanprovidesomeinformationregardingtheacutenessandtheamountofthe这些问题有助于提供关 的急性程度 量的相关信息Lightheadedness,nausea,anddiaphoresisareseenrapidgastrointestinalbleedingand头昏 和出汗提示快速胃肠 和低血压Diaphoresis:[ˌdaɪəfə‘riːsɪs]出汗Gastrointestinal：gastro-胃的intestinal肠的RectalThepresenceofsilver-coloredstoolsisrarebutpathognomonicofacholicstoolswithmelena,aconditionresultingfromcanceroftheampullaofVaterinthe银色便很少见但特异性的提示患者便中无尿胆原并伴有黑便，提十二指肠泛特 癌Thecancerproducesbiliaryobstruction,andthefrondsaresloughed,causingPathognomonic：特殊病症的、特异的Acholic：无胆汁的；anotcholic胆汁的FrondSlough这 导Pathognomonic：特殊病症的、特异的Acholic：无胆汁的；anotcholic胆汁的FrondSloughThepresenceofjaundice(icterus)mustalerttheexaminerthatthereiseitherliverparenchymaldiseaseoranobstructiontobileflow.存存在黄疸提醒检查者患者或者存在肝细胞疾病或者存在胆汁排出阻Jaundice:Jaundice:Icterus：[‘ɪktərəs]parenchymal：[pə‘rəŋkəməl]Thepresenceoficterus,orjaundice,resultsfromdecreasedexcretionofconjugatedbilirubinintothe黄疸的出现是由于流入胆汁的结合型胆红素减黄疸的出现是由于流入胆汁的结合型胆红素减少引起的黄疸黄疸的病因包括肝内胆管梗阻导致的内科黄疸，和肝外胆管梗阻致的外科黄疸conjugatedbilirubin：结合型胆红素Intra-内的；extra-外的Inanypatientwithicterus,theexaminershouldsearchcluesbyaskingthefollowing对于任何黄疸患者，检查者应该询问对于任何黄疸患者，检查者应该询问如下问题以寻找疾病线索：“黄疸发生多久“黄疸“黄疸发生多久“黄疸是否发展迅‘‘Isthejaundiceassociatedwithabdominalpain?lossappetite?nausea?vomiting?distastefor“黄疸是否伴有腹痛？食欲减退 ？讨厌香烟‘‘Isthejaundiceassociatedwithchills?fever?itching?weightloss?’’“黄疸是否伴有寒战？发热？搔痒？体重减DisDistaste：不喜欢、厌恶，dis‘‘Inthepastyearhaveyouhadanytransfusions?在过去一年里你是否曾经输液？纹身？接 ‘‘Doyouuseanyrecreationaldrugs?’’Ifyes,‘‘Doyouanydrugs“你是否使用消遣 ？”如果是，“你是否静脉注射这类物‘‘Doyoueatraw fish?“你是否使用生的贝类食品？牡recreationalrecreationaldrugs：消遣性 fish“Haveyoutraveledabroadinthepastyear?”Ifyes,“Where?Wereyouawarethatyoumayhaveconsumedunclean“过去的一年中你是否出过国？”如果是，“你去过哪里？你是知道你可能使用 净的水‘‘Haveyoubeenjaundiced“既往是否有黄疸病‘‘Hasyoururinechangedcolor“既往是否有黄疸病were“出现黄疸后，你的尿液颜色是否发“出现黄疸后，你的尿液颜色是否发生改变““大便是什么颜色‘‘Doyouhaveanyfriendsorrelationswhoare“你是否有朋友或亲属也发生了黄‘‘Whattypeofworkdoyoudo?Whatothertypesofworkhaveyoudone?’’“你从事何种工作？你曾经从事过何种工作‘‘Whatareyour“你的业 是什么Viralhepatitisisassociatedwithnausea,vomiting,alossofappetite,anda siontosmoking.性肝炎伴 、食欲减退、和讨厌吸烟HepatitisAhasafecal-oralrouteoftransmissionandincubationperiodof2to6甲型肝炎是通过粪—口途 ，潜伏期是2-6周aversionaversionHepatitis：肝炎；hepat：肝的；-itisItmaybelinkedtoingestionofraw 它可能与摄入生的贝类食物有关HepatitisBisblood-borneandhasanincubationperiodofto6乙型肝炎是血 ，潜伏期为1-6个