病例阅读课件.ppt

1、医医 学学 汉汉 语语Medical ChineseContents 内容内容Vocabulary 词汇词汇1 Case reading 病例阅读病例阅读2 Situational dialogue 情景会话情景会话3 Digestive Systemabsorption amino acidsamylaseanusappendixbilebilirubinbowel吸收氨基酸淀粉酶肛门阑尾 胆汁胆红素肠canine teeth cecumcoloncommon bile ductdefecationdentindigestionduodenum犬齿盲肠结肠胆总管排便牙本质消化十二指肠 Dig

2、estive Systemelimination emulsificationenamelenzymeesophagusfatty acidsfecesgallbladder排泄乳化珐琅质酶食道脂肪酸粪便胆囊glucoseglycogenhydrochloric acidileumincisorinsulinjejunumlipase葡萄糖糖原盐酸回肠切牙，门牙胰岛素空肠脂肪酶 Digestive Systemlivermasticationmolar teethpalatepancreaspapillaeparotid glandperistalsis肝脏咀嚼磨牙，臼齿颚胰腺舌乳头腮腺蠕动p

3、harynxportal veinproteasepulppyloric sphincterrectumrugaesaliva咽门静脉蛋白酶牙髓幽门括约肌直肠胃褶皱唾液 Digestive Systemsalivary glandssigmoid colonsphincterstomachtriglyceridesuvulavilli唾液腺乙状结肠括约肌胃甘油三酯悬雍垂，小舌肠绒毛 Digestive Systemanorexiaascitesborborygmusconstipationdiarrheadysphagiaeructationflatus厌食腹水肠鸣音便秘腹泻吞咽困难打嗝，嗳气

4、胃肠气，屁hematocheziajaundicemelenanauseasteatorrhea便血黄疸黑便恶心，反胃脂肪泻Symptoms Digestive Systemaphthous stomatitisdental cariesherpetic stomatitisoral leukoplakiaperiodontal diseaseachalasiaesophageal varicesgastric carcinoma口疮性口炎龋齿疱疹性口炎口腔白斑牙周病食道失弛症食管静脉曲张胃癌herniapeptic ulceranal fistulacolonic polyposiscolo

5、rectal cancerCrohn diseasediverticulosisdysentery疝胃溃疡肛瘘结肠息肉直肠结肠癌克罗恩病憩室病痢疾Pathological Conditions Digestive Systemhemorrhoidsileusintussusceptionulcerative colitisvolvuluscholelithiasiscirrhosispancreatitis痔疮肠梗阻肠套叠溃疡性结肠炎肠扭转胆结石肝硬化胰腺炎viral hepatitis病毒性肝炎Pathological Conditions Digestive Systemliver fun

6、ction testsstool culturehemoccult testbarium enemacholangiographyabdominal ultrasonographymagnetic resonance imagingliver scan肝功能检查gan gong neng jian cha大便培养 da bian pei yang大便隐血试验da bian yin xue shiyan钡灌肠 bei guan chang胆管造影 dan guan zao ying腹部超声 fu bu chao sheng磁共振 ci gong zhen肝扫描 gan sao miaoLabor

7、atory Tests,Clinical Procedures Digestive Systemgastric bypassgastrointestinal endoscopyliver biopsynasogastric intubationparacentesisCT scan胃旁路术 wei pang lu shu胃肠内窥镜检查wei chang nei kui jing肝活组织检查 gan zhu zhi huo jian经鼻胃管插入术jing bi wei guan cha ru穿刺术 chuan ci shu计算机断层扫描ji suan ji duan ceng sao miaoL

8、aboratory Tests,Clinical Procedures Digestive SystemGastric Ulcer with Bleeding-melena,hematemesis患者，男性，45岁，因“黑便3次，呕血1次”于2004年1月28日入院。Huan zhe,nan xing,si shi wu sui,yin“hei bian san ci,ou xue yi ci”yu er ling ling si nian yi yue er shi ba ri ru yuan.Case reading 胃溃疡伴出血-黑便、呕血Wei kui yang ban chu xue

9、hei bian、ou xueA 45-year-old man presented on Jan.28,2004 to the emergency department with melena for three times and vomiting of blood for one time.Digestive System患者三天前饮酒后出现中上腹不适，解黑便一次，量约200g，当时不伴乏力，头晕，冷汗，心慌，患者未予重视。Huan zhe san tian qian yin jiu hou chu xian zhong shang fu bu shi,jie hei bian yi c

10、i,liang yue 200 ke,dang shi bu ban fa li,tou yun,leng han,xin huang,huan zhe wei yu zhong shi.Case reading Three days before,after drinking some alcohol,the patient developed melena of about 200g but without fatigue,dizziness,cold sweat or rapid heart-beat,so he didnt pay much attention.Digestive Sy

11、stem2天前呕吐咖啡色胃内容物1次，量约200ml，解柏油样便2次，约200g，同时伴有乏力，冷汗，心慌，急送我院急诊。Liang tian qian ou tu ka fei se wei nei rong wu yi ci,liang yue 200 hao sheng,jie bai you yang bian liang ci,yue 200 ke,tong shi ban you fa li,leng han,xin huang,ji song wo yuan ji zhen.Case reading Two days before,he suddenly vomited coff

12、ee-like fluid of about 200ml,followed by melena twice,with the total amount of about 200g.He felt fatigue,cold sweat and palpitation and was sent to the emergency department immediately.Digestive System测血压60/30mmHg,粪便隐血试验（+）。既往无肝炎病史，无肾衰史，无急性应激史，未服非甾体类消炎镇痛药。吸烟史20年，每天一包。无饮酒史，有一姐姐死于胃癌。Ce xue ya liu shi

13、 dao san shi hao mi gong zhu,fen bian yin xue shi yan si ge jia.Ji wang wu gan yan bing shi,wu shen shuai shi,wu ji xing ying ji shi,wei fu fei zai ti lei xiao yan zhen tong yao.Xi yan shi 20 nian,mei tian yi bao.Wu yin jiu shi,you yi jie jie si yu wei ai.Case reading His blood pressure was 60/30mmH

14、g and the stool occult blood test was(+).He had no history of hepatitis,renal failure,acute stress or history of NSAID administration.He had 20-year history of smoking one pack of cigarettes per day,and denied use of alcohol.One of his sisters died of gastric carcinoma.Digestive System入院体检：体温37.5oC,

15、血压60/30mmHg,呼吸19次/分，心率102次/分。神志清晰，巩膜无黄染，贫血貌，未见肝掌，蜘蛛痣，浅表淋巴结未及肿大。Ru yuan ti jie:ti wei 37.5 she shi du,xue yahao mi gong zhu,Xin lv 102 ci mei fen.Shen zhi qing xi,gong mo wu huang ran,pin xue mao,wei jian gan zhang,zhi zhu zhi,qian biao lin ba jie wei ji zhong da.Case reading Physical examination:T:3

16、7.5oC,BP:60/30mmHg,R:19/min,HR:102bpm.Conscious,no jaundice of sclera,pale appearance,no liver palm,no spider angioma on the chest,no palpation of superficial lymph nodes.Digestive System双肺听诊无异常。腹软，无压痛反跳痛，未及肿块，肝脾肋下未及。无移动性浊音，肠鸣音亢进。肛指阴性，下肢无水肿，神经系统体征（-）。Shuang fei ting zhen wu yi chang;fu ruan,wu ya to

17、ng fan tiao tong,wei ji zhong kuai,gan pi lei xia wei ji.Wu yi dong xing zhuo yin,chang ming yin kang jin.Gang zhi yin xing,xia zhi wu shui zhong,shen jing xi tong ti zheng yin xing.Case reading Bilateral lung auscultation negative;abdomen soft,no tenderness or rebound tenderness,no mass palpated,li

18、ver and spleen are not palpated below the rib cage,shifting dullness(-),bowel sounds active,anal digital examination(-),no edema of lower limbs,nervous system(-).Digestive SystemLiver cirrhosis and ascites -fatigue,anorexia,abdominal swelling and oliguria患者，男，57岁，因“乏力、纳差2个月，腹胀、少尿半月”于2003年1月20日入院。Hua

19、n zhe,nan,wu shi qi sui,yin“fa li,na cha liang ge yue,fu zhang,shao niao ban yue”yu 2003nian1yue20ri ru yuan.Case reading 肝硬化腹水-乏力、纳差、腹胀、少尿Gan ying hua fu shuifa li,na cha,fu zhang,shao niaoA 57-year-old female patient was admitted on Jan.20th,2003 because of“fatigue and anorexia for 2 months,abdomi

20、nal swelling and oliguria for half a month”.Digestive System患者2月前无明显诱因下出现乏力，体力下降，由原来每餐2两降至1两,且伴有低热，自服感冒药后略有好转。Huan zhe liang yue qian wu ming xian you yin xia chu xian fa li,ti li xia jiang,you mei can er liang jiang zhi yi liang,qie ban you di re,zi fu gan mao yao hou lue you hao zhuang.Case readin

21、g Two months before,the patient began to feel fatigue,decreased tolerance of physical activities and anorexia without any identifiable causes.She used to eat 100g rice every meal,but now she could only eat 50g.She also had low-grade fever and felt better after taking anti-cold medications.Digestive

22、System半月前，患者出现腹胀，裤子腰围渐紧，尿量也渐减少，每日尿量约500ml，尿色黄。Ban yue qian,huan zhe chu xian fu zhang,ku zi yao wei jian jin,niao liang ye jian jian shao,mei ri niao liang yue 500 hao sheng,niao se huang.Case reading Half a month before,the patient began to feel abdominal swelling.Her pants waist belt became tight

23、for her.Urine volume decreased to 500ml everyday and the color was dark.Digestive System患者遂就诊于当地医院，行腹部B超检查，示肝硬化、脾肿大、大量腹水。患者20年前曾患过急性乙型肝炎，以后的几年中肝功能反复有异常。Huan zhe sui jiu zhen yu dang di yi yuan,xing fu bu bi chao jian cha,shi gan ying hua,pi zhong da,da liang fu shui.Huan zhe 20 nian qian ceng huan g

24、uo ji xing yi xing gan yan,yi hou de ji nian zhong gan gong neng fan fu you yi chang.Case reading Then the patient went to the district hospital nearby and took the abdominal ultrasound examination.The result showed she had liver cirrhosis,splenomegaly,and large volume of ascites.The patient had hep

25、atitis B 20 years ago.During the years after the acute infection,her liver function was abnormal intermittently.Digestive System患者无烟酒嗜好，已婚，育有一子、一女，女儿及丈夫身体健康，其子曾患乙肝。父亲死于肝癌，母亲仍健在。Huan zhe wu yin jiu shi hao,yi hun,yu you yi zi,yi nv,nv er ji zhang fu shen ti jian kang,qi zi ceng huan yi gan.Fu qin si

26、yu gan ai,mu qin reng jian zai.Case reading She had no habit of smoking and alcohol.She was married and had one son and one daughter.Her daughter and husband were both healthy.Her son had hepatitis B infection.Her father died of primary hepatic cancer.Her mother is still alive.Digestive System入院体检：体

27、温37.5oC,血压120/80mmHg,呼吸18次/分，心率100次/分。神清,慢性肝病面容，巩膜轻度黄染，肝掌（+），左颈部可见蜘蛛痣，浅表淋巴结未触及肿大。Ru yuan ti jian:ti wen 37.5 she shi du,xue ya.hao mi gong zhu,hu xi 18 ci mei fen,xin lv 100 ci mei fen.Shen qing,man xing gan bing mian rong,gong mo qing du huang ran,gan zhang,zuo jing bu ke jian zhi zhu zhi,qian biao

28、 lin ba jie wei chu ji zhong da.Case reading Physical examination:T:37.5oC,BP:120/80mmHg,R:18/min,HR:100bpm.Conscious,hepatic face,mild jaundice of sclera,liver palm(+),spider angioma on left neck,no palpation of superficial lymph nodes.Digestive System双肺呼吸音清，心界正常大小。腹部明显膨隆，未见腹壁静脉曲张，腹软，腹部无明显压痛，移动性杂音（

29、+）。肠鸣音正常。双下肢中度水肿，神经系统体征（-）。Shuang fei hu xi yin qing,xin jie zheng chang da xiao.Fu bu ming xian peng long,wei jian fu bu jing mai qu zhang,fu ruan,fu bu wu mian xian ya tong,yi dong xing za yin yi ge jia.Chang ming yin zheng chang.Shuang xia zhi zhong du shui zhong,shen jing xi tong ti zheng yin xi

30、ng.Case reading Lung auscultation negative,heart(-).Abdominal findings:obvious abdominal bulge(marked protuberance of the abdomen),no distention of abdominal wall veins,soft,no pain,shifting dullness(+),normal active intestinal sound,moderate edema of lower limbs,NS(-).Digestive System实习生：15床，现在您哪儿不

31、舒服？Shi xi sheng:shi wu chuang,xian zai nin na er bu shu fu病人：我肚子痛。Bing ren:wo du zi tong.Dialogue Intern:Bed No.15,which part of your body is not feeling well now?Patient:My abdomen is aching.Digestive System实：是上腹部吗？Shi shang fu bu ma病：对。dui实：痛了多长时间了？Tong le duo chang shi jian le 病：从前天晚上十点开始一直在痛 con

32、g qian tian wan shangShi dian kai shi yi zhi zai tong.Dialogue Intern:Is it at the epigastrium?Patient:Yes.Intern:How long has it been like this?Patient:It began from 10 Pm the day before yesterday Digestive System实：您指指看，是哪儿痛？Ni zhi zhi kan,shi na er tong病：开始时是上腹部痛，后来是右侧腹部剧痛，就是这儿。Kai shi shi shi sha

33、ng fu bu tong,hou lai shi you ce fu bu jv tong,jiu shi zhe er.Dialogue I:Can you indicate the aching place by point at it?P:The pain starts at the epigastrium,and then I feel the sharp pain at the right abdomen-here.Digestive System实：您感觉是什么样的痛？Nin gan jie shi shen me yang de tong病：持续地痛，越来越痛，像刀割一样。坐着

34、痛，躺着也痛，痛死我了。Chi xv di tong,yue lai yue tong,xiang dao ge yi yang,tang zhe ye tong,tong si wo le.Dialogue I:What kind of pain is it?P:Its a continuous pain.And it becomes sharper,like being cut by a knife.Its all the same whether Im sitting up or lying down.Oh,its killing me!Digestive System实：其他地方也跟着

35、痛吗？Qi ta di fang ye gen zhe tong ma病：背部右侧也跟着痛，腰的右侧也不舒服。Bei bu you ce ye gen zhe tong,yao de you ce ye bu shu fu.Dialogue I:Is any other part of the body also affected?P:My right back aches,too.And the right lumbar region feels uncomfortable.Digestive System实：剧痛之后发冷吗？有没有发烧？Ju tong zhi hou fa leng ma?

36、You mei you fa shao病：没发冷，但有点低烧。Mei fa leng,dan you dian di shao.实：小便是什么颜色？Xiao bian shi shen me yan se?病：深黄色。Shen guang se.Dialogue I:Do you feel a chill after the sharp pain?Do you have fever?P:No chill,but I have a low fever.I:What color is your urine?P:Dark yellow.Digestive System实：您还记得前天晚上吃什么了吗？

37、Ni hai ji de qian tian wan shang chi shen me le ma病：记得。前天晚上，我们单位有个宴会，我吃了很多牛排、鸡肉和煎蛋。回家后就感觉不舒服，恶心，还吐了。Dialogue I:Do you remember what you had eaten the night before?P:Yes.That night,I ate a lot of beefsteak,chicken and fried eggs at our units dinner party.I felt uncomfortable and sick after getting ho

38、me,and I even threw up.Digestive System实：一共吐了几次？Yi gong tu le ji ci?病：四五次吧。Si wu ci ba.实：吐的是什么东西？有没有血或绿色的东西？Tu de shishen me dongxi?Youmeiyou xue huo lvse de dongxi病：吐的主要是喝的和吃的东西，没有血和绿色的东西。Tu de zhuyao shi hede he chide dongxi,meiyou xue he lvse de dongxiDialogue I:How many times have you vomited al

39、together?P:About 4 or 5 times.I:What stuff have you thrown up?Is there any blood or green stuff?P:No.No blood or green stuff.Mainly what I had drunk and eaten.Digestive System实：您以前有过这样的腹痛吗？Nin yi qian you guo zhe yang de fu tong ma?病：有过。这样的痛已经有八年多了，每年都发作一两次。You guo.Zhe yang de tong yi jing you ba ni

40、an duo le,mei nian dou fa zuo yi liang ci.Dialogue I:Have you had such abdominal pain before?P:Yes.I have been attacked by such aches for 8 years now,once or twice a year.Digestive System实：请您想一想，每次发作都是在吃了太多油腻的东西以后吗？Qing nin xiang yi xiang,mei ci fa zuo dou shi zai chi le tai duo you ni de dong xi yi

41、 hou ma病：多数是这样。有时工作太累或者旅游玩儿的太累也会发病。Duo shu shi zhe yang.You shi gong zuo tai lei huo zhe lv you wan er de tai lei ye hui fa bing.Dialogue I:Please try to recall.Were you attacked each time after eating too much greasy stuff?P:Mostly.It sometimes also happens as a result of tiredness after working too hard or touring for too long