內(nèi)外科復(fù)習(xí)資料：外科學(xué)大題

1、外科名解+簡答+問答一、膽道疾?。艹龅臍v年題基本都出了，比較重要）1. 膽囊結(jié)石手術(shù)指征（06級問答）1）口服膽囊造影膽囊不顯影2）結(jié)石直徑超過2cm3）B超提示膽囊壁局限性增厚4）病程5年以上，年齡大于50歲的女性病人5）膽囊頸部嵌頓結(jié)石6）膽囊萎縮或瓷樣膽囊7）以往曾行膽囊造瘺術(shù)2. Reynolds五聯(lián)征（Reynolds pentad）（06級名解）Charcot triad plus shock and CNS inhibition, seen in AOSC.3. 陶土樣便（Argil like bowels）（如果名解英文，這個應(yīng)該不會考吧，太難翻譯了）膽汁缺乏所致的大便形狀改

2、變，呈陶土觀，常由阻黃疸引起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. 內(nèi)鏡鼻膽管引流術(shù)ENBDERCP下，經(jīng)鼻導(dǎo)管引流，常用于急性梗阻化膿性膽管炎（AOSC）6. 急性梗阻化膿性膽管炎AOSC臨床：1）多有膽道病史2）病起驟急，體溫驟升3）Reynolds五聯(lián)征：Charcot三聯(lián)征+休克+CNS抑制1) Histor

3、y of biliary tract disease2) Sudden attack, fever3) Reynolds pentad治療：1）目的：解除梗阻，膽道減壓，膽汁引流2）非手術(shù)治療：抗感染、抗水電紊亂、抗休克等3）手術(shù)治療：膽總管切開減壓術(shù)+T管引流4）緊急減壓引流：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綜合征(Mirizzi syndrome)Hartamn囊或頸部較大結(jié)石壓迫導(dǎo)致肝總管狹窄阻黃疸；膽囊膽管瘺炎癥，臨床表現(xiàn)為Charcot三聯(lián)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三聯(lián)征Abdominal pain, fever and jaundice9. 膽囊結(jié)石（gallbladder stone）臨床表現(xiàn)、診斷及治療臨床：1）胃腸道癥狀：消化不良，厭油2）膽絞痛：典型表現(xiàn)，尤夜間陣發(fā)，向肩背放射3）Mirizzi綜合征4）Murphy征5）其他：膽囊積液1) Intestinal symptoms2) Biliary colic3) Mirizzi syndrome4) Murphys sign5) Others: E

6、ffusion, pancreatitis, etc.診斷：1）結(jié)合病史、臨床2）B超：檢出率96%3）必要時CTMRI1) History2) BUS: 96%3) CT/MRI: if necessary治療：1）無癥狀者可不需要治療 2）有癥狀患者：腹腔鏡膽囊切除術(shù)或開腹膽囊切除術(shù) 3）對于部分患者應(yīng)在手術(shù)時行膽總管探查 4）不能耐受手術(shù)者可考慮溶石治療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. 肝外膽管結(jié)石手術(shù)原則（Surgery principle）手術(shù)原則去除病灶，取盡結(jié)石，解除梗阻，通暢引流Remove nidus; Deplete stone; Relieve obstruction; Biliary drainage二、闌尾疾病&腹外疝（非重點，闌尾記住兩個點就差不多了，一系歷年題貌似沒出過腹外疝的，熟悉三個名解就差不多了）1. McBurney點右髂前上棘、臍連線，中外1/3At 1/3 from right

8、ASIS to umbilicus.2. Lanz點左右髂前上棘連線，中右1/3At 1/3 from right ASIS to left ASIS.3. 結(jié)腸充氣實驗（Rovsing test）仰臥位，按壓左下腹降結(jié)腸，壓力傳導(dǎo)至肓腸和闌尾處，出現(xiàn)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)腸管壁為內(nèi)容

9、物的嵌頓疝Incarcerated hernia with the contents of intestines wall5. Littre疝(Littre hernia)內(nèi)容物為Meckel憩室的嵌頓疝Incarcerated hernia with the contents of Meckel diverticulum6. 滑動性疝腹內(nèi)臟器參與構(gòu)成疝囊壁的難復(fù)性疝7. 斜疝直疝鑒別(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、胃十二指腸疾病1. 胃的癌前病變(Gastric precancerous lesions)息肉、潰瘍、萎縮性胃炎、殘胃、胃粘膜巨大皺襞癥Polypus, ulcer, atrophic gastritis, gastric stump, Mntrier disease2. 胃十二指腸潰瘍穿孔的臨床表現(xiàn)（Clinical Presentation of Acute Perforation）1）癥狀突然出現(xiàn)劇烈疼痛2）體征腹部柔韌感腹部反跳痛板狀腹腸鳴音減弱或消失1) SyndromesInitial sudden onset of severe abdominal

12、pain 2) Physical signsa) Abdominal tenderness b) Abdominal rebound tendernessc) Tabulate venterd) Bowel sounds absent3. 胃大部切除術(shù)的并發(fā)癥（8個以上）(Postgastrectomy syndromes)1）傾倒綜合征早期傾倒綜合征晚期傾倒綜合征2）代謝障礙貧血脂肪吸收障礙缺鈣：骨質(zhì)疏松癥、軟骨病3）胃腸道重建輸入袢綜合征輸出袢梗阻堿性反流性胃炎殘竇綜合癥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轉(zhuǎn)移，僅限粘膜（下層）的胃癌Gastric cancer of any sizes, lo

14、cated in mucosa, whether lymphatic metastasis or not5. 進(jìn)展期胃癌(Advanced gastric cancer, AGC)浸潤至漿肌層及漿膜外的胃癌Gastric cancer invaded muscular layer or out of serosa6. 胃潰瘍手術(shù)指征1）經(jīng)過短期（4-6周）內(nèi)科治療無效或愈合后復(fù)發(fā)者；2）年齡超過45歲得GU患者3）X線鋇餐或胃鏡證實為較大潰瘍或高位潰瘍4）不能排除或已證實為潰瘍惡變者5）以往有一次急性穿孔或大出血病史，而潰瘍?nèi)詾榛顒悠谡?. 殘胃癌(Gastric stump cancer)良

15、性胃病經(jīng)胃大部切除術(shù)后5年內(nèi)殘胃的癌變Canceration of the gastric remnant in five years after gastrectomy8. 進(jìn)展期胃癌的Borrman病理分型(Borrman classification of AGC)型結(jié)節(jié)型；型潰瘍型；型浸潤型；型彌漫型（皮革胃）Type I: Nodular typeType II: Ulcerative typeType III: Infiltrating typeType IV: Diffuse type (linitis plastica)9. 消化性潰瘍病因(Pathogeny of PU)1）

16、胃酸過高2）黏膜屏障受損：粘液HCO3磷脂屏障損傷；緊密連接受損；黏膜血流障礙3）HP感染4）非甾體類藥物NSAIDs1) Hyperchlorhydria2) Damage of mucosa barrier3) H.pylori infection4) NSAIDs10. 瘢痕性幽門梗阻（胃出口梗阻）臨床表現(xiàn)1）積累性嘔吐，營養(yǎng)不良2）可吐宿食，餿味，無膽汁3）上腹隆起，胃型腹4）鋇餐：24后仍有殘留11. Krukenburgs tumor胃癌癌細(xì)胞脫落，種植于卵巢形成的腫瘤The tumor formed by implantation of gastric cancer cells

17、on ovary四、腸梗阻（非重點，歷年考得都比較少，頂多考個名解或簡答）1. 動力性腸梗阻(Dynamic ileus)神經(jīng)反射或毒素刺激引起的腸壁肌運動紊亂，無狹窄腸道，分麻痹性（術(shù)后為主）、痙攣性（常由鉛中毒引起）2. 腸套疊(Intussusception)即腸管套入相連腸管，多“回腸入結(jié)腸”型，腹痛、腹塊、血便One intestinal canal trapped into another intestinal canal, with the symptoms of abdominal pain, lump and bloody excrement3. 機(jī)械性腸梗阻(Mechani

18、cal ileus)各種原因引起的腸腔變窄，食物難以通過，由外壓、內(nèi)堵（糞石為主）、腸壁變（腫瘤、炎癥）所致4. 血運性腸梗阻(Vascular ileus)腸系膜血管硬化或栓塞引起腸麻痹，可迅速腸壞死5. 絞窄性腸梗阻的臨床表現(xiàn)(Strangulated ileus)痛吐脹閉+休克早快，X線有孤立腸袢1）痛：陣發(fā)加重，可有放射2）吐：嘔吐早頻，可有帶血3）脹：局部隆起，腹膜刺激4）閉6. 腸梗阻治療原則1）解除梗阻；2）糾正因腸梗阻引起的全身生理紊亂7. 腸扭轉(zhuǎn)(Volvulus)沿系膜長軸旋轉(zhuǎn)的閉袢型腸梗阻,為絞窄性，死亡率高達(dá)1040%五、肝臟疾?。☉?yīng)該會出一個簡答或問答）1. Chil

19、d-pugh的定義以及B級的指標(biāo)（英文）（06級簡答）Child-pugh classification:Index123AccumulatedEncephalopathyNoneGrade 12Grade 34Child A6Child B 79Child C10AscitesNoneMildModerate of aboveBIL（mol/L）35355050ALB（g/L）35283528PT prolonged（s）13410102. 隱源性肝膿腫(Cryptogenic liver abscess)原因不明的肝膿腫，常抵抗力下降時發(fā)生，可能與肝內(nèi)隱匿病變有關(guān)Occur with lo

20、w immunity, may be associated with latent liver disease3. 小肝癌和巨大肝癌的區(qū)別(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. 肝癌的診斷和治療 診斷：1）AFP：400g/L，持續(xù)8w排除妊娠、肝病活動期、生殖器胚源性腫瘤2）B超：直徑2cm3）CT/MRI：直徑1cm4）DSA：直徑1cm5）穿刺活檢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治療：1）手術(shù)治療：規(guī)則切除不規(guī)則切除肝移植；適應(yīng)征：總體良好病灶局限硬化尚輕代償尚可（Child-Pugh AB級）；無其他器官嚴(yán)重?fù)p傷2）非手術(shù)治療：栓塞化療（TACE)、穿刺射頻（RFA)、注純酒精（PEI）、免疫治療、中醫(yī)治療Treatment: 1) Surgery: regular & irregular resection, live

22、r transplantation2) Non-surgical treatment: TACE, RFA, PEI, Immunology therapy, Traditional Chinese medicine5. 原發(fā)性肝癌的臨床表現(xiàn)1）早期無特異性2）肝區(qū)疼痛3）腹脹、惡心、嘔吐4）體重下降、發(fā)熱5）上消化道出血6）肝腫大7）黃疸8）腹水9）肝硬化體征：肝掌、蜘蛛痣、海蛇頭等10）肝外轉(zhuǎn)移癥狀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. 肝癌并發(fā)癥上消化道出血、破裂、肝衰、感染、黃疸Upper gastrointestinal bleeding, hepatic rupture, hepatic failure, infection, jaundice六、甲狀腺疾病&乳腺疾?。ㄒ粋€簡答或名解）1. 甲狀腺危象的臨床表現(xiàn)及治療（英文）（06級簡答

24、）(Thyroid crisis)臨床表現(xiàn)：1）多數(shù)發(fā)生于術(shù)后12-36h2）主要表現(xiàn)為高熱和脈率快而弱3）神經(jīng)癥狀：煩躁不安、譫妄，也為神志淡漠、嗜睡4）常有嘔吐及水瀉，以及全身紅斑及低血壓Symptoms & Signs:1) Occur after surgery in 12 36h2) High fever, rapid but weak pulse3) Neural symptoms: dysphoria, delirium OR apathetic, somnolence治療：1）應(yīng)用碘劑2）腎上腺皮質(zhì)激素的應(yīng)用 3）應(yīng)用抗甲狀腺藥物 4）降低周圍組織對甲狀腺素的反應(yīng) 5）應(yīng)用鎮(zhèn)靜

25、劑 6）靜脈輸入大量葡萄糖溶液 7）有心力衰竭加用洋地黃制劑Treatment:1) Idodine2) ACTH3) Antithyroid drugs, ATD4) Inhibit the effect of thyroxin5) Sedative6) Mass glucose solution7) Digitalis fof heart failure2. 濕疹樣乳頭癌(Pagets carcinoma of the breast)特殊的乳腺癌，即Pagets病，瘙癢糜爛潰瘍，多于中老年，惡性程度低Special type of breast cancer; pruritus erosi

26、on ulcer; commonly in elders; low malignancy3. 酒窩征(Dimple sign)乳腺癌早期，累及Cooper韌帶，韌帶縮短，表面皮膚凹陷In early breast cancer, tumor involved the Cooper ligament. Skin sagged because of the short ligament.4. “橘皮樣”改變(“Orange peel like” changes)乳腺癌癌塊增大，堵塞皮下淋巴管，引起淋巴回流障礙，出現(xiàn)真皮水腫，呈“橘皮樣”改變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，局部皮膚可呈炎癥樣表現(xiàn)，開始時比較局限，不久即擴(kuò)展到乳房大部分皮膚，皮膚發(fā)紅、水中、增厚、粗糙、表面溫度升高，進(jìn)展快，預(yù)后差Special type of breast cancer; inflammation; rapidly progress, bad prognosis6. 甲狀腺腫手術(shù)指征（Indication of surgery）1）較大的結(jié)節(jié)

28、性甲狀腺腫2）胸骨后甲狀腺腫3）有壓迫癥狀者4）結(jié)節(jié)性甲狀腺腫繼發(fā)功能亢進(jìn)5）疑有惡變1) Large nodular goiter2) Retrosternal goiter3) Symptoms of oppression4) Nodular goiter with hyperthyroidism5) Suspicious canceration7. 甲亢手術(shù)指征（Surgical indication of hyperthyroidism）1）繼發(fā)性甲亢及高功能腺瘤2）中度以上的原發(fā)性甲亢3）藥物減量或停藥后復(fù)發(fā)者4）不能堅持長期用藥5）腺體較大有壓迫癥狀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. 甲亢手術(shù)并發(fā)癥1）呼吸困難和窒息2）喉返及喉上神經(jīng)

30、損傷3）甲狀腺危象4）甲狀腺功能減退5）甲狀旁腺功能減退1) Dyspnea and apnea2) Injuries of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN)3) Thyroid crisis4) Hypothyroidism5) Hypoparathyroidism七、門脈高壓癥（一個簡答）1. 經(jīng)頸內(nèi)靜脈內(nèi)門體分流術(shù)(Transjugular Intrahepatic Portosystenic Stent Shunt, TIPSS)經(jīng)頸內(nèi)靜脈，入下腔靜脈，入肝靜脈，向門靜脈穿刺并放入支架T

31、hrough jugular vein postcava hepatic vein, put a stent between hepatic vein and portal vein.2. 門靜脈和腔靜脈之間的交通支(Communicating branches between portal vein and vena cava)1）食管下段胃底支2）直腸下端肛管支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. 門脈高壓治療（針對并發(fā)癥）(Treatment of portal hypertension)1）食管靜脈曲張破裂出血（EVB）：手術(shù)治療：斷流術(shù)、分流術(shù)非手術(shù)治療：a）輸血輸液防休克 b）血管加壓素 c）內(nèi)鏡治療 d）三腔二囊管 e）TIPSS2）巨脾：可單純脾切3）腹水：穿刺+白蛋白；TIPSS、腹水頸內(nèi)靜脈轉(zhuǎn)流術(shù)；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. 門脈高壓臨床表現(xiàn)1）脾腫大/脾亢2）EVB3）海蛇頭4）門脈高壓性胃炎5）腹水6）肝性腦病1) Splen

34、omegaly/Hypersplenism2) EVB3) Portal hypertensive gastritis/gastropathy4) Ascites5) Hepatic encephalopathy5. 布-加氏綜合征(Budd-Chiari syndrome, B-CS)肝靜脈、肝段下腔靜脈狹窄，引起回流受阻所致的肝后型門高癥為主的綜合征A syndrome of posthepatic portal hypertension caused by stenosis of hepatic veins and hepatic inferior vena cava八、胰腺疾?。饣?/p>

35、簡答）1. 胰頭癌的治療（Treatment of pancreatic cancer）1）根治手術(shù)胰十二指腸切除術(shù)膽囊空腸吻合術(shù)膽總管空腸吻合術(shù)胃空腸吻合術(shù)2）化療3）放療4）基因治療5）免疫治療1) Radical resection is the only effective therapy optiona) Pancreatoduodenectomyb) Cholecystojejunostomyc) Choledochojejunostomyd) Gastrojejunostomy2) Chemotherapy3) Radiotherapty4) Gene therapy5) Imm

36、notherapy2. Whipple三聯(lián)征(Whipple triad)清晨空腹低血糖+持續(xù)血糖2.8mmol/L+攝入葡萄糖即緩1) Hypoglycemia symptom after fasting or work2) glucose 2.8mmol/L3) Symptom relieves after administration of glucose by oral or vein3急性胰腺炎的臨床表現(xiàn)1）腹痛2）惡心、嘔吐3）腹脹4）腹部柔韌感、反跳痛、肌緊張5）發(fā)熱、黃疸6）Gray-turner征、Cullen征7）多器官功能障礙綜合癥（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. 急性胰腺炎局部并發(fā)癥1）胰腺壞死a）感染性壞死b）無菌性壞死2）胰腺膿腫3）胰腺假性囊腫1) Pancreatic necrosisa) Infective pancreatic necrosisb) Sterile

38、pancreatic necrosis2) Pancreatic abscess3) Pancreatic pseudocyst5. 胰腺炎的病因（至少6種）膽源性（炎癥、結(jié)石、梗阻）、酗酒、暴飲暴食、高血脂、藥源性、感染（腮腺炎病毒）、自免疫Biliary, Alcohol, Craputence, Hyperlipidaemia, Drugs, Infection, Autoimmunology6. 胰腺假性囊腫(Pancreatic pseudocyst)發(fā)病率10-20%，急性胰腺炎后形成的由纖維組織或肉芽組織包裹的胰液積聚，可由體格檢查及影像學(xué)檢查診斷，呈圓形或橢圓形，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. 急性胰腺炎治療（參考內(nèi)科）(Tre

40、atment of AP)治療原則： 1）減輕和控制胰腺本身炎癥 2）阻斷和防止并發(fā)癥發(fā)生 3）全身支持療法和治療并發(fā)癥Principle of treatment1) Lighten and control the inflammation of pancreas2) Block up and prevent the complication3) Systemic supportive therapy and treat the complication重癥急性胰腺炎治療：（內(nèi)科版，應(yīng)該不會算錯）1) 監(jiān)護(hù)Monitor：禁食+ICU2) 液體復(fù)蘇3) 預(yù)防感染4) 營養(yǎng)支持5) 抑制胰腺外分泌和胰酶活性：生長抑素、加貝脂6) 預(yù)防和治療腸道衰竭7) 內(nèi)鏡治療：ERCP,EST8) 中醫(yī)中藥9)手術(shù)治療1) Monitor: Fasting and ICU2) Fluid recovery3) Prevent infection4) Nutrient support5) Inhibit external secretion and pancreatin activity6) Prevent and treat intestin