医学英语第17章 腹部

Chapter17theabdomen

第17章腹部resumePingLiassociate

professorRheumatologyDept.ofChina-JapanUnionHospitalofJilinUniversity1331751166lipingzt@163.comReviewofSpecificSymptomsThemostcommonsymptomsofabdominaldiseaseareasfollows:腹部疾病最常见的症状如下：The

most:

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

你们当中谁错得最多?Most：多数的;大部分的Mostbirdscanfly.

多数的鸟会飞。The

most和most的区别PainNauseaandvomitingChange

in

bowel

movementsRectal

bleedingJaundiceAbdominal

distentionMassPruritus(itching)ReviewofSpecificSymptoms疼痛恶心和呕吐排便习惯的改变直肠出血黄疸腹胀包块搔痒症painPainisprobablythemostimportantsymptomofabdominaldisease.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程度的疼痛。neoplasia[ˌniːoʊ'pleɪʒə] neo-新的，现代的-plasia生长、形成painless-less没有、无manifestv.表现、指明manifestationn.临床表现Feverisonemanifestationofcold.painPaincanresultfrommucosalirritation,smoothmusclespasm,peritonealirritation,capsularswelling,ordirectnervestimulation.疼痛可以是由于粘膜的刺激、平滑肌痉挛、腹膜刺激，包膜肿胀，或者直接的神经刺激所引起。mucosal粘膜muco-粘的smoothmuscle平滑肌skeletalmuscle骨骼肌peritoneal腹膜的peri-周围painAbdominalpainnecessitatesforspeedydiagnosisandtherapy.腹部疼痛需要迅速的诊断和治疗。diagnosisn.诊断Thetwodoctorsmadedifferentdiagnosisofmydisease.diagnosev.诊断Thetestisusedtodiagnoseavarietyofdiseases. therapy治疗近义词：treatmenttherapy指更系统的诊断、治疗treatment治疗Physicaltherapyalternateswithchemical.理疗和化疗交替进行。Theearlierthetreatmentisgiven,thebetterthepatient'schances. 病人越早接受治疗，康复的可能性就越大。painWhenapatientcomplainsofabdominalpain,askthefollowingquestions:当患者主诉腹痛时，应该询问下列问题：complain“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complaintosbof〔about〕sth结构。complain表示病人诉说时,不可说complainabout〔against,at〕,应说complainof。Sheisalwayscomplainingofhertoothachetothedoctor.她老是跟大夫说她牙痛。pain‘‘Whereisthepain?’’哪里疼痛？‘‘Hasthepainchangeditslocationsinceitstarted?’’从疼痛开始后是否发生了疼痛位置的改变？‘‘Doyoufeelthepaininanyotherpartofyourbody?’’在你身体的其他部位是否也感觉疼痛？‘‘Howlonghaveyouhadthepain?’’疼痛持续多久了？‘‘Haveyouhadrecurrentepisodesofabdominalpain?’’腹痛是否间歇性发作？recurrent周期性、再发生re-又、再reinstall,re-extractionpain‘‘Didthepainstartsuddenly?’’疼痛是否突然发作？‘‘Canyoudescribethepain?Isitsharp?dull?burning?cramping?’’你是否能够描述一下疼痛？它是刺痛？钝痛？烧灼痛？绞痛？‘‘Isthepaincontinuous?Doesitcomeinwaves?’’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化？pain‘‘Whatmakesitworse?’’是什么使情况变得更糟糕？‘‘Whatmakesitbetter?’’是什么使情况变得更好？‘‘Isthepainassociatedwithnausea?vomiting?sweating?constipation?diarrhea?bloodystools?abdominaldistention?fever?chills?eating?’’疼痛是否伴随恶心？呕吐？出汗？便秘？腹泻？血便？腹胀？发热？寒战？进食？pain‘‘Haveyoueverhadgallstones?kidneystones?’’既往是否患胆石？肾结石？Ifthepatientisawoman,askthisquestion:如果患者是女性，还要询问:‘‘Whenwasyourlastperiod?’’末次月经是什么时间？period月经期Doyougetpianbeforeorduringyourperiods？您在月经前或月经中有过疼痛吗?painNotetheexacttimeatwhichthepainstartedandwhatthepatientwasdoingatthattime.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部器官的急性穿孔、炎症、或扭转。perforation穿孔Thispreventsbowelperforation.这样可以防止肠道穿孔。inflammation炎症Hehasaninflammationofthelungs.他得了肺炎。torsion扭转Thisovaryisdarkandenlargedfromhemorrhagefollowingtorsion.卵巢扭转造成出血而变黑变大。painAstoneinthebiliaryorrenaltractalsocausesintensepain.胆管或泌尿系统发生结石可引起剧烈的疼痛。biliary胆的、胆汁的Formanypersons,includingchildren,thebiliarytubingischokedwithgallstones.有许多人包括儿童，胆道都有胆石堵塞着。renal肾脏的Deathusuallyresultsfromhepaticorrenalfailure.常因肝脏或肾脏衰竭而导致死亡。近义词：nephriticpainNoteacutenessofthepain.注意疼痛的剧烈程度。Acuteruptureofafallopiantubebyanectopicpregnancy,perforationofagastriculcer,peritonitis,andacutepancreatitiscausesuchseverepainthatfaintingmayresult.异位妊娠导致的急性输卵管破裂、胃溃疡穿孔、腹膜炎和急性胰腺炎导致严重的疼痛可以导致晕厥。rupure穿孔Hediedofaruptureofblood-vessels.他血管破裂而死。fallopiantube输卵管gastriculcer胃溃疡-itis炎症peritonitis腹膜炎pancreatitis胰腺炎painItiscrucialtodeterminethelocationofthepainatitsonset,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的。Commonly,whenanabdominalorganruptures,painisfelt‘‘alloverthebelly,’’withoutlocalizationtoaspecificarea.当腹部器官发生穿孔时，通常感觉疼痛“遍及全腹”,没有特定区域的定位。Painarisingfromthesmallintestineiscommonlyfeltintheumbilicalorepigastricregions;forexample,painfromacuteappendicitisbeginsattheumbilicus.来源于小肠的疼痛通常位于脐部或上腹部；例如急性阑尾炎的疼痛起始于脐周。umbilical肚脐；epi-在.....之上；epigastric上腹部；appendicitis阑尾炎painAftertime,painmaybecomelocalizedtootherareas.经过一段时间，疼痛可能定位到其他位置。Painfromacuteappendicitistravelsfromtheumbilicustotherightlowerquadrantinabout1to3hoursaftertheinitialevent.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。Paininthechestfollowedbyabdominalpainshouldraisethesuspicionofadissectingaortic

aneurysm.继发于胸痛的腹痛应该警惕主动脉瘤破裂的可能。aortic大动脉的；aneurysm动脉瘤painNotethenatureofthepain.注意疼痛的性质。Paincausedbyaperforatedgastriculcerisoftendescribedas‘‘burning’’;dissectinganeurysmas‘‘tearing’’;intestinalobstructionas‘‘gripping’’;pyelonephritisas‘‘dull,aching’’;andbiliaryorrenalcolicas‘‘crampy,constricting.’’胃溃疡穿孔引起的疼痛通常被描述为“烧灼感”；动脉瘤破裂通常被描述为“撕裂样”疼痛；小肠梗阻描述为“剧痛”；肾盂肾炎描述为“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；colic：疝气、急腹痛描述疼痛：burning，tearing，gripping，dull，crampy，constrictingpainReferredpainoftenprovidesinsightastothecause.牵涉痛经常能够提供病因的线索。Referredpainisatermusedtodescribepainoriginatingintheinternalorgansbutdescribedbythepatientasbeinglocatedintheabdominalorchestwall,shoulder,jaw,orotherareassuppliedbythesomaticnerves.牵涉痛是指疼痛起源于内部器官，但患者通常描述其定位于腹壁或胸壁、肩、下巴或其他体神经支配区域。somatic身体的、躯体的painPainappearstooriginateinareassuppliedbythesomaticnervesenteringthespinalcordatthesamesegmentasthesensorynervesfromtheorganresponsibleforthepain.支配疼痛感觉起始区域的体神经与支配疼痛真正起源器官的感觉神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，肾绞痛或阑尾炎引起睾丸痛。spinalcord脊髓；sensorynerves感觉神经；cholecystitis胆囊炎；testicular睾丸的；painThecommonsitesforreferredpainareshowninFigure17-3.常见的牵涉痛部位见图17-3。ThelocationsofpaininabdominaldiseasearesummarizedinTable17-2.腹部疾病的疼痛定位归纳于表17-2。Thetimeofoccurrenceandfactorsthataggravateoralleviatethesymptoms(e.g.,mealsordefecation)areparticularlyimportant.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）尤其重要。aggravate：加重；alleviate：减轻painPeriodicepigastricpainoccurring1/2to1houraftereatingisaclassicsymptomofgastricpepticulcers.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。Patientswithaduodenalpepticulcerhavepain2to3hoursaftereatingorbeforethenextmeal.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。gastricpepticulcers：消化性胃溃疡duodenalpepticulcer：消化性十二指肠溃疡patientswith:患有......painFoodtendstolessenthepain,especiallyinduodenalulcers.特别是十二指肠溃疡，食物能够减轻疼痛。Perforationofaduodenalulcertothepancreasmayproducebackache,simulatinganorthopedicproblem.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。orthopedic[ɔːθə'piːdɪk] 整形外科painNocturnalpainisaclassicsymptomofduodenalpepticulcerdisease.十二指肠溃疡的典型症状是夜间痛。Painaftereatingmayalsobeassociatedwithvasculardiseaseoftheabdominalviscera.腹部器官的血管类疾病也可伴随进食后疼痛。nocturnal：夜间的viscera：['vɪsərə] 内脏的painPatientswiththisconditionareolderandhavepostprandialpain,anorexia,andweightloss.这类患者年龄较大，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的腹绞痛。post-:后面的；postprandial：餐后的anorexia：厌食症triad：三个一组angina：[æn'dʒaɪnə]绞痛celiacaxis：腹腔干superiormesentericartery：肠系膜上动脉painTable17-3summarizestheimportantmaneuversforamelioratingabdominalpain.表17-3是对改善腹痛重要方法的总结。NauseaandVomitingVomitingmaybecausedbysevereirritationoftheperitoneumresultingfromtheperforationofanabdominalorgan;fromobstructionofthebileduct,ureter,orintestine;orfromtoxins.引起呕吐的原因可能是腹部器官穿孔造成对腹膜的严重刺激；胆管、输尿管、小肠阻塞；或毒素刺激引起。Vomitingresultingfromaperforationisrarelymassive.穿孔引起的呕吐很少是大量的。bileduct：胆管ureter：[jʊ'riːtə] 输尿管NauseaandVomitingObstructionofthebileductorothertubeproducesstretchingofthemuscularwall,resultinginepisodicvomitingthatoccursattheheightofthepain.胆管梗阻或其他管道的阻塞引起管道壁层肌肉紧张可导致呕吐，呕吐常发生在疼痛最剧烈时。Intestinalobstructionpreventstheintestinalcontentsfrompassingdistally;consequently,vomitingmayresultintheexpulsionofintestinalcontents.肠道梗阻阻碍肠内容物经肠道排出，随即呕吐导致肠内容的排出。distally：['dɪstælaɪ]远端expulsion：排出NauseaandVomitingToxinsgenerallycausepersistentvomiting.毒素通常引起持续性呕吐。Notallabdominalemergenciescausevomiting.不是所有的腹部急症都导致呕吐。emergency：紧急事件emergencydepartment:急诊科NauseaandVomitingIntraperitonealbleedingmayoccurintheabsenceofvomiting.腹腔内的出血往往没有呕吐症状。Vomitingisfrequentlyalsocausedbyinflammationofintra-abdominalstructures,aswellasbyextra-abdominalconditions,includingdrugtoxicity,centralnervoussystemdisorders,myocardialinfarction,andpregnancy.呕吐通常是腹腔内结构的炎症引起，同时一些腹外情况也可引起呕吐，它们包括药物毒性反应、中枢神经系统疾病、心梗和怀孕。

intra-内部的；extra-外部的NauseaandVomitingAskthefollowingquestionsifapatientcomplainsofnausea,vomiting,orboth:如果患者主诉恶心和/或呕吐，应该询问如下问题：‘‘Howlonghaveyouhadnauseaorvomiting?’’“你恶心或呕吐多久了？”‘‘Whatisthecolorofthevomit?’’“呕吐物是什么颜色？”‘‘Isthereanyunusuallyfoulodortothevomitus?’’“呕吐物是否有不同寻常的臭味？”foul：恶臭的odor：气味NauseaandVomiting‘‘Howoftendoyouvomit?’’“多长时间呕吐一次？”‘‘Isvomitingrelatedtoeating?’’Ifyes,‘‘Howsoonaftereatingdoyouvomit?Doyouvomitonlyaftereatingcertainfoods?’’“呕吐是否于进食有关？”如果有关，“进食后多久出现呕吐？你是否只在进食某种特定的食物后发生呕吐？”‘‘Doyouhavenauseawithoutvomiting?’’“你是否只有恶心而不发生呕吐？”Howoften：多久一次

Howoftendoyougotochurch?你隔多久去做一次礼拜?Howsoon：多快，多久以后

HowsooncanIbereleasedfromthehospital?什么时候才能出院?NauseaandVomiting‘‘Isthenauseaorvomitingassociatedwithabdominalpain?constipation?diarrhea?alossofappetite?achangeinthecolorofyourstools?achangeinthecolorofyoururine?fever?chestpain?’’“恶心或者呕吐是否伴随腹痛？便秘？腹泻？食欲减退？大便颜色改变？尿液颜色改变？发热？胸痛？”‘‘Haveyounoticedachangeinyourhearingability?’’“你是否注意到你的听力有无改变？”‘‘Haveyounoticedringinginyourears?’’“你是否存在耳鸣？”constipation：便秘；diarrhea：腹泻stools：粪便；urine：尿液NauseaandVomitingIfthepatientisawoman,askthisquestion:如果患者为女性，应询问：‘‘Whenwasyourlastperiod?’’“你的末次月经是什么时候？”Therelationshipofthepaintovomitingisimportantandmayhelpinprovidingthediagnosis.疼痛与呕吐的关系非常重要，有可能有助于诊断。NauseaandVomitingInacuteappendicitis,painprecedesthevomitingusuallybyafewhours.急性阑尾炎时，疼痛通常在呕吐前几小时发生。Thecharacterofthevomitusmayaidindeterminingitscause.呕吐物的特点可以帮助明确病因。Acutegastritiscausesthepatienttovomitstomachcontents.急性胃炎可导致患者呕吐胃内容物。gastritis-itis炎症；gastr-胃的NauseaandVomitingBiliarycolicproducesbilious,orgreenish-yellowvomitus.胆绞痛呕吐物为胆汁，或黄绿色物质。Intestinalobstructionoftencausesthepatienttoexpelbiliousvomitus,followedbyfeculent-smellingfluid.肠梗阻经常导致患者呕吐胆汁样物质，随即呕吐恶臭味液体。Feculentvomitusisusuallycausedbyintestinalobstruction.恶臭的呕吐物通常由肠梗阻引起。bilious：胆汁的feculent：['fekjʊlənt] 不洁的、肮脏的、臭的NauseaandVomitingNauseawithoutvomitingisacommonsymptominpatientswithhepatocellulardisease,pregnancy,andmetastaticdisease.恶心无呕吐通常是肝细胞疾病、怀孕和代谢疾病患者的常见症状。NauseamaybeassociatedwithahearinglossandtinnitusinpatientswithMe´nie`re’sdisease.恶心伴听力丧失和耳鸣常提示美尼尔病。hepatocellularhepato-肝tinnitus：['tɪnɪtəs]耳鸣ChangeinBowelMovementsTakeacarefulhistoryofbowelhabits.注意采集排便习惯的详细病史。Achangeinbowelmovementsnecessitatesfurtherelaboration.排便变化需要更详尽的描述。Askthesequestionsofthepatientwithacuteonsetofdiarrhea:急性腹泻患者需要询问如下问题：bowelhabits：肠道排便习惯elaboration：详细阐述acute：急性；chronic：慢性‘‘Howlonghaveyouhadthediarrhea?’’“你腹泻多久了？”‘‘Howmanybowelmovementsdoyouhaveaday?’’“你一天排便多少次？”‘‘Didthediarrheastartsuddenly?’’“腹泻是突然开始的吗？”ChangeinBowelMovements‘‘Didthediarrheabeginafterameal?’’Ifyes,‘‘Whatdidyoueat?’’“腹泻是一次进餐后开始的吗？”如果是，“你当时吃了什么食物？”“‘‘Arethestoolswatery?bloody?malodorous?’’“大便是水样的吗？血性的？恶臭的？”‘‘Isthediarrheaassociatedwithabdominalpain?lossofappetite?nausea?vomiting?’’“腹泻是否伴有腹痛？食欲下降？恶心？呕吐？”ChangeinBowelMovementsmalodorous：恶臭的mal-坏的malnutrition，malfunctionTheacuteonsetofdiarrheaafteramealsuggestsanacuteinfectionortoxin.进餐后急性发作的腹泻提示急性感染或中毒。Waterystoolsareoftenassociatedwithinflammatoryprocessesofthesmallbowelandcolon.水样便常提示小肠或结肠的炎症过程。Shigellosisisadiseaseofthecolonthatproducesbloodydiarrhea.痢疾是一种伴发血样便腹泻的结肠疾病。ChangeinBowelMovementscolon：结肠Shigellosis：[ˌʃɪgə'loʊsɪs] 志贺氏细菌性痢疾Amebiasisisalsoassociatedwithbloodydiarrhea.阿米巴病也伴发血样便腹泻。Thepatientwithchronicdiarrheashouldbeaskedthefollowing:慢性腹泻的患者应询问如下问题：ChangeinBowelMovementsAmebiasis：['eɪmbiəsɪs] 阿米巴病‘‘Howlonghaveyouhaddiarrhea?’’“腹泻多久了？”‘‘Doyouhaveperiodsofdiarrheaalternatingwithconstipation?’’“腹泻是否与便秘交替出现？”‘‘Arethestoolswatery?loose?floating?malodorous?’’“大便呈水样？松散的？呈漂浮状？带有恶臭气味？”ChangeinBowelMovements‘‘Haveyounoticedbloodinthestools?mucus?undigestedfood?’’“你是否注意到便中带血？带粘液？含有未消化的食物？”‘‘Whatisthecolorofthestools?’’“大便是什么颜色的？”‘‘Howmanybowelmovementsdoyouhaveaday?’’“你每天排便几次？”‘‘Doesthediarrheaoccuraftereating?’’“腹泻出现在进食后？”ChangeinBowelMovementsmucus：粘液的‘‘Whathappenswhenyoufast?Doyoustillhavediarrhea?’’“当你禁食后发生了什么情况？你是否还存在腹泻？”‘‘Isthediarrheaassociatedwithabdominalpain?abdominaldistention?nausea?vomiting?’’“腹泻是否伴随腹痛？腹胀？恶心？呕吐？”‘‘Haveyounoticedthatthediarrheaisworseatcertaintimesoftheday?’’“你是否注意到腹泻在每天的固定时间变得更加严重？”ChangeinBowelMovementsfast：斋戒、禁食‘‘Howisyourappetite?’’“你的食欲如何？”‘‘Hastherebeenanychangeinyourweight?’’“你的体重有无改变？”ChangeinBowelMovementsDiarrheaandconstipationfrequentlyalternateinpatientswithcoloncancerordiverticulitis.腹泻和便秘交替出现常见于结肠癌或憩室炎患者。Loosebowelmovementsarecommonindiseasesoftheleftcolon,whereaswaterymovementsareseeninsevereinflammatoryboweldiseaseandprotein-losingenteropathies.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失性肠病。ChangeinBowelMovementsdiverticulitis：[ˌdaɪvərtɪkjʊ'laɪtɪs]憩室炎 Loosebowelmovements：腹泻Floatingstoolsmayresultfrommalabsorptionsyndromes.浮便是由于吸收不良综合征导致的。Patientswithulcerativecolitiscommonlyhavestoolmixedwithbloodandmucus.溃疡性结肠炎患者通常大便中混有血和粘液。ChangeinBowelMovementscolitis：结肠炎Anyinflammatoryprocessofthesmallbowelorcoloncanmanifestwithbloodmixedwithstoolorundigestedfood.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。Irritablebowelsyndromeclassicallyproducesmorediarrheainthemorning.肠激惹综合征典型的表现是清晨频繁腹泻。Irritable：易怒的、急躁的ChangeinBowelMovementsPatientscomplainingofconstipationshouldbeaskedthesequestions:患者主诉便秘应该询问下列问题：‘‘Howlonghaveyoubeenconstipated?’’“你发生便秘多久了？”‘‘Howoftendoyouhaveabowelmovement?’’“多长时间排便一次？”‘‘Whatisthesizeofyourstools?’’“大便条的长度是多少？”ChangeinBowelMovements‘‘Whatisthecolorofyourstools?’’“大便是什么颜色？”‘‘Isthestoolevermixedwithblood?mucus?’’“大便是否曾混有血？粘液？”‘‘Haveyounoticedperiodsofconstipationalternatingwithperiodsofdiarrhea?’’“腹泻和便秘是否交替出现？”‘‘Haveyounoticedachangeinthecaliberofthestool?’’“大便条的粗细是否发生了改变？”

ChangeinBowelMovements‘‘Doyouhavemuchgas?’’“你是否有涨气？”‘‘How’syourappetite?’’“食欲如何？”‘‘Hastherebeenanychangeinyourweight?’’“体重是否发生了变化？”Changeinthecaliberofthestoolissignificant.大便条粗细的变化是有意义的。ChangeinBowelMovements‘‘Pencil’’-diameterstoolsmayresultfromananaloradistalrectalcarcinoma.铅笔粗细的大便可能是由肛门或直肠癌症引起的。Achangeinthecolorofstoolsisimportant.大便颜色的变化非常重要。Asisdiscussedlater,palebrowntograystoolsindicateanabsenceofbile.正如下文将要讨论的，浅棕色至灰色的大便提示胆汁缺乏。ChangeinBowelMovementsThiscanresultfromanobstructiontobileflowfromthegallbladderorfromdecreasedproductionofbile.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。Weightchangesareimportantwiththesymptomofconstipation.体重改变是便秘重要的伴随症状。ChangeinBowelMovementsBile：胆汁gallbladder：胆囊Anincreaseinweightmayindicatedecreasedmetabolismseeninhypothyroidism;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肠癌症或其他高代谢情况。ChangeinBowelMovementsMetabolism：新陈代谢Hypo-：低的Hypothyroidism：‭[ˌhaɪpoʊ‘θaɪrɔɪdɪzəm]‬甲状腺机能减退hyper-：高的Hypermetabolic：高代谢Rectalbleedingmaybemanifestedbybrightredblood,bloodmixedwithstool,orblack,tarrystools.直肠出血可以表现为鲜红色的血，便中混有血，或者黑色、柏油样便。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。RectalBleedingRectal：直肠的Tarry：用柏油覆盖的rectum：直肠Hematochezia：[hemətə‘kiːzɪə]

便血hema-：血；hematuria，hematologyRectalBleedingBloodmixedwithstoolcanbetheresultofulcerativecolitis,diverticulardisease,tumors,orhemorrhoids.便中混有血见于溃疡性结肠炎、肿瘤、或痔疮。Askthepatientwhodescribesrectalbleedingthefollowingquestions:对于直肠出血的患者应询问如下问题：Hemorrhoids：[‘hemərɔɪdz]痔疮‘‘Howlonghaveyounoticedbrightredbloodinyourstools?’’“你注意到大便中有鲜红色血有多久了？”‘‘Isthebloodmixedwiththestool?’’

“血液是混在大便中吗？”‘‘Aretherestreaksofbloodonthesurfaceofthestool?’’“大便表面是否有血液？”RectalBleedingStreaks：条纹‘‘Haveyounoticedachangeinyourbowelhabits?’’“你是否注意到你的排便习惯发生了变化？”‘‘Haveyounoticedapersistentsensationinyourrectumthatyouhavetomoveyourbowels,butyoucannot?’’“你是否持续感觉到不得不排便但却排不出来？”Tenesmusisthepainful,continued,andineffectivestrainingatstool.里急后重是指在排便时疼痛的、持续而无效的用力。RectalBleedingTenesmus：[tɪ‘nezməs]里急后重RectalBleedingItiscausedbyinflammationoraspace-occupyinglesionsuchasatumoratthedistalrectumoranus.它是由炎症或空间占位损害如直肠末端或肛门部位的肿瘤所引起。Hemorrhoidalbleedingisacommoncauseofhematocheziaandstreakingofstoolwithblood.痔疮出血是便血和大便带血的常见原因。Lesion：[‘liːʒn]损害、损伤Anus：肛门

Hemorrhoidal：痔疮的hematochezia：[hemətə‘kiːzɪə]便血Melenaisablack,tarrystoolthatresultsfrombleedingabovethefirstsectionoftheduodenum,withpartialdigestionofthehemoglobin.黑便是指由于十二指肠以上部位出血使血红蛋白仅部分消化导致黑色的柏油样大便。Melena：[mə'liːnə]黑便duodenum：[ˌduːə‘diːnəm]十二指肠Hemoglobin：血红蛋白Hemo-血；-globin球蛋白RectalBleedingInquireaboutthepresenceofmelena.应了解黑便存在的情况。Ausefulwayofquestioningistoshowthepatienttheblacktubingonthestethoscopeandask,‘‘Haveyourbowelmovementseverbeenthiscolor?’’一种有效地询问方法是向患者展示听诊器的黑管并问，“你的大便是否有过这种颜色？”Stethoscope：‭[‘steθəskoʊp]‬听诊器RectalBleedingIfaskeddirectlywhetherthebowelmovementshaveeverbeenblack,thepatientmayanswerintheaffirmative,equatingdark(normal)stoolswithblackstools.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。RectalBleedingAffirmative：肯定的Equating：等同于；～

withAskthesequestionsofapatientwhodescribesmelena:如果患者描述有黑便应询问下列问题：‘‘Haveyoupassedmorethanoneblack,tarrystool?’’Ifyes,‘‘When?’’“是否排过多次黑色、柏油样大便？”如果是，“什么时候？”‘‘Howlonghaveyoubeenhavingblack,tarrystools?’’“排黑色、柏油样便多久了？”RectalBleeding‘‘Haveyounoticedfeelinglightheaded?’’“是否曾感觉头昏眼花？”‘‘Haveyouhadanynauseaassociatedwiththesestools?anyvomiting?diarrhea?abdominalpain?sweating?’’“排便时是否伴有恶心？呕吐？腹泻？腹痛？出汗？”RectalBleedingLightheaded：头昏眼花的Theanswerstothesequestionscanprovidesomeinformationregardingtheacutenessandtheamountofthehemorrhage.这些问题有助于提供关于出血的急性程度及出血量的相关信息。Lightheadedness,nausea,anddiaphoresisareseenwithrapidgastrointestinalbleedingandhypotension.头昏、恶心和出汗提示快速胃肠道出血和低血压。RectalBleedingRegarding：关于，同aboutHemorrhage：hemo-Diaphoresis:[ˌdaɪəfə‘riːsɪs]出汗Gastrointestinal：gastro-胃的,

intestinal肠的Thepresenceofsilver-coloredstoolsisrarebutpathognomonicofacholicstoolswithmelena,aconditionresultingfromcanceroftheampullaofVaterintheduodenum.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，提示十二指肠泛特氏壶腹癌。Thecancerproducesbiliaryobstruction,andthecancerousfrondsaresloughed,causingmelena.这种癌症导致胆道梗阻，且癌叶的脱落引起黑便。

RectalBleedingPathognomonic：特殊病症的、特异的Acholic：无胆汁的；a-

=not

cholic胆汁的Ampulla：壶腹Frond：蕨叶Slough：蜕皮JaundiceThepresenceofjaundice(icterus)mustalerttheexaminerthatthereiseitherliverparenchymaldiseaseoranobstructiontobileflow.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梗阻。Jaundice:黄疸Icterus：[‘ɪktərəs]黄疸parenchymal：‭[pə‘rəŋkəməl]‬薄壁组织的Thepresenceoficterus,orjaundice,resultsfromadecreasedexcretionofconjugatedbilirubinintothebile.黄疸的出现是由于流入胆汁的结合型胆红素减少引起的。Thiscanresultfromintrahepaticbiliaryobstruction,knownasmedicaljaundice,orfromextrahepaticbiliaryobstruction,knownassurgicaljaundice.黄疸的病因包括肝内胆管梗阻导致的内科黄疸，和肝外胆管梗阻导致的外科黄疸。Jaundiceconjugatedbilirubin：结合型胆红素Intrahepatic：肝内的；extrahepatic：肝外的Intra-内的；extra-外的Inanypatientwithicterus,theexaminershouldsearchforcluesbyaskingthefollowingquestions: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：‘‘Howlonghaveyoubeenjaundiced?’’“黄疸发生多久了？”‘‘Didthejaundicedeveloprapidly?’’“黄疸是否发展迅速？”Jaundice‘‘Isthejaundiceassociatedwithabdominalpain?lossofappetite?nausea?vomiting?distasteforcigarettes?’’“黄疸是否伴有腹痛？食欲减退？恶心？呕吐？讨厌香烟？”‘‘Isthejaundiceassociatedwithchills?fever?itching?weightloss?’’“黄疸是否伴有寒战？发热？搔痒？体重减轻？”JaundiceDistaste：不喜欢、厌恶，dis-不Cigarettes：烟Chill：寒战Itching：瘙痒‘‘Inthepastyearhaveyouhadanytransfusions?tattooing?inoculations?’’在过去一年里你是否曾经输液？纹身？接种疫苗？JaundiceTransfusion：输液Tattooing：纹身Inoculation：接种疫苗‘‘Doyouuseanyrecreationaldrugs?’’Ifyes,‘‘Doyouuseanydrugsintravenously?’’“你是否使用消遣性毒品？”如果是，“你是否静脉注射这类药物？”‘‘Doyoueatraw

shellfish?oysters?’’“你是否使用生的贝类食品？牡蛎？”Jaundicerecreationaldrugs：消遣性毒品Raw：未加工的，生的Shellfish：贝类食品Oysters：牡蛎“Have

you

traveled

abroad

in

the

past

year?”

If

yes,

“Where?Wereyouawarethatyoumayhaveconsumeduncleanwater?”“过去的一年中你是否出过国？”如果是，“你去过哪里？你是否知道你可能使用过不洁净的水？”Jaundice‘‘Haveyoubeenjaundicedbefore?’’“既往是否有黄疸病史？”‘‘Hasyoururinechangedcolorsinceyounoticedthatyouwerejaundiced?’’“出现黄疸后，你的尿液颜色是否发生改变？”‘‘Whatisthecolorofyourstools?’’“大便是什么颜色?”Jaundice‘‘Doyouhaveanyfriendsorrelationswhoarealsojaundiced?’’“你是否有朋友或亲属也发生了黄疸？”‘‘Whattypeofworkdoyoudo?Whatothertypesofworkhaveyoudone?’’“你从事何种工作？你曾经从事过何种工作？”‘‘Whatareyourhobbies?’’“你的业余爱好是什么？”JaundiceViralhepatitisisassociatedwithnausea,vomiting,alossofappetite,andanaversiontosmoking.病毒性肝炎伴有恶心、呕吐、食欲减退、和讨厌吸烟。HepatitisAhasafecal-oralrouteoftransmissionandanincubationperiodof2to6weeks.甲型肝炎是通过粪—口途径传播，潜伏期是2-6周。Jaundiceaversion：憎恨、厌恶Hepatitis：肝炎；hepat：肝的；-itis炎症Fecal：排泄物Transmission：传播Incu