一二三院合堂-2017五年制醫(yī)學英語專外

ChapterChapterthe第17 腹吉林大 聯(lián)誼醫(yī)院風濕免疫associateRheumatologyDept.ofChina-JapanUnionHospitalofJilinReviewofSpecificThemostcommonsymptomsofabdominaldiseaseareasThemost和mostThemost:(many,much的 Whichofyouhasmadethemostmistakes?當中誰錯得最多Mostbirdscan疼搔癢NauseaandChangeinbowelRectalAbdominalPainisprobablythemostimportantsymptomofabdominal疼痛是腹部疾病最重要的Althoughabdominalneoplasiamaybepainless,mostabdominaldiseasemanifestsitselfwithsomeamountofpain.盡管腹部腫瘤可以是無痛性的，但是大部分腹部疾病表現(xiàn)出一定程度的疼痛。 新的，現(xiàn)代-生長、形-沒有、n.臨床表FeverisonemanifestationofPaincanresultfrommucosalirritation,smoothmusclespasm,peritonealirritation,capsularswelling,ordirectnerve疼痛可以是由于粘膜的刺激、平滑肌痙攣、腹膜刺激，包膜腫脹，或者直接的神經(jīng)刺激所引起。疼痛可以是由于粘膜的刺激、平滑肌痙攣、腹膜刺激，包膜腫脹，或者直接的神經(jīng)刺激所引起。smoothmuscleskeletalmuscle周Abdominalpainnecessitatesforspeedydiagnosis腹部疼痛需要迅速 和治療Thetwodoctorsmadedifferentdiagnosisofmydisease. usedtodiagnoseavarietyof 治 近義詞therapy指更系統(tǒng) 、治treatment治Physicaltherapyalternateswith理療和化療交替進行Theearlierthetreatmentisgiven,thebetterthepatient's越早接受治療，康復的可能性就越大“抱怨”“訴苦”。指心中對人或事物不滿或身體感到不適或痛苦而對別人訴說或抱怨“抱怨”“訴苦”。指心中對人或事物不滿或身體感到不適或痛苦而對別人訴說或抱怨有時也可表示說話者引起別人對此事的注意。用作不及物動詞時,其后可接of或about引起的短語,of后常是訴苦的內容,可為名詞或動名詞而about后則是對抱怨事物概括的陳述。當表示“向…抱怨…”時,要用complaintosb〔aboutsth結構表訴說plainabout〔 〕應plainofSheisalwayscomplainingofhertoothachetothedoctor.她老是跟大夫說她牙痛Whenapatientcomplainsofabdominalpain,askthefollowingquestions:當患者主訴腹痛時，應該詢問下列問題‘‘Whereisthepain?’’‘‘Hasthepainchangeditslocationsinceitstarted?’’‘‘Doyoufeelthepaininanyotherpartofyourbody?’’‘‘Howlonghaveyouhadthepain?’’‘‘Haveyouhadrecurrentepisodesofabdominalpain?’’周期性、再發(fā) 又、再reinstallre-‘‘Didthepainstartsuddenly?’’‘‘Canyoudescribethepain?Isitsharp?dull?burning? ‘‘Isthepaincontinuous?Doesitcomeinwaves?’’疼痛是持續(xù)的嗎？它的強度是否有波動‘‘Hastherebeenanychangeintheseverityornatureofthepainsinceitbegan?’’從疼痛開始發(fā)作，它的強度和性質是否有任何變化‘‘Whatmakesitworse?’’‘‘Whatmakesitbetter?’’是什么使情況變得更好‘‘Isthepainassociatedwithnausea?vomiting?sweating?constipation?diarrhea?bloodystools?abdominaldistention?fever?chills?eating?’’ ‘‘Haveyoueverhadgallstones?kidneystones?’’ Ifthepatientisawoman,askthis‘‘Whenwasyourlastperiod?’’ 期Doyougetpainbeforeorduringyourperiods？ Notetheexacttimeatwhichthepainstartedandwhatthepatient ngatthattime.注意疼痛開始的準確時間以及疼痛開始時患者在做什么Sudden,severepainawakeningapatientfromsleepmaybeassociatedwithacuteperforation,inflammation,ortorsionofanabdominalorgan. perforation穿Thispreventsbowelperforation.這樣可以防止腸道穿孔inflammation炎Hehasaninflammationofthe 他得 torsion扭Thisovaryisdarkandenlargedfromhemorrhagefollowing扭轉造 而變黑變大biliarybiliary膽的、膽汁Fors,includingchildren,thebiliarytubingischokedwith有許多人包括兒童，膽道都有膽石堵塞著renal腎臟Deathusuallyresultsfromhepaticorrenal Astoneinthebiliaryorrenaltractalsocausesintense膽管或泌尿系統(tǒng)發(fā) 可引起劇烈的疼痛Noteacutenessofthe注意疼痛的劇烈程度Acuteruptureofafallopiantubebyanectopicpregnancy,perforationofagastriculcer,peritonitis,andacutepancreatitiscausesuchseverepainthatfaintingmayresult. gastricgastriculcer -itis炎癥peritonitis腹膜炎pancreatitis胰腺炎rupureHediedofaruptureofblood-vessels.fallopianItiscrucialtodeterminethelocationofthepainatitsonset,itslocalization,itscharacter,anditsradiation.確定疼痛的起始部位、定位、性質和發(fā)射性是非常重要的Commonly,whenanabdominalorganruptures,painisfelt‘‘a(chǎn)lloverthebelly,’’withoutlocalizationtoaspecificarea. Painarisingfromthesmallintestineiscommonlyfeltintheumbilicalorepigastricregions;forexample,painfromacuteappendicitisbeginsattheumbilicus.來源于小腸的疼痛通常位于臍部或上腹部；例如急性闌尾炎的疼痛起始于臍周。 肚臍 在.....之上；epigastric上腹部；appendicitis闌尾Aftertime,pain elocalizedtoother經(jīng)過一段時間，疼痛可能定位到其他位Painfromacuteappendicitistravelsfromtheumbilicustotherightlowerquadrantinabout1to3hoursaftertheinitial急性闌尾炎在發(fā)病的1-3小時后疼痛可以從臍部轉移Paininthechestfollowedbyabdominalpainshouldraisethesuspicionofadissectingaorticaneurysm.繼發(fā)于胸痛的腹痛應該警惕主動脈瘤破裂的可aorticaortic大動脈的aneurysm動脈Notethenatureofthe注意疼痛的性質Paincausedbyaperforatedgastriculcerisoftendescribedas‘‘burning’’;dissectinganeurysmas‘‘tearing’’;intestinalobstructionas‘‘grip ’’;pyelonephritisas‘‘dull,aching’’;andbiliaryorrenalcolicas‘‘crampy,胃潰瘍穿孔引起的疼痛通常被描述為“燒灼感”；動脈瘤破裂通常被描述為“述為“鈍痛”，膽道或腎臟疼痛描述為“痙攣性、壓榨性”。intestinalintestinal的；pyelonephritis[?pa??lo?n?'fra?t?s]腎盂腎炎colic：疝氣、急腹描述疼痛 Referredpainoftenprovidesinsightastothe牽涉痛經(jīng)常能夠提供病因的線索Referredpainisatermusedtodescribepainoriginatingintheinternalorgansbutdescribedbythepatientasbeinglocatedintheabdominalorchestwall,shoulder,jaw,orotherareas dbythesomaticnerves. somaticsomatic身體的、軀體Painappearstooriginateinareas dbythesomaticnervesenteringthespinalcordatthesamesegmentasthesensorynervesfromtheorganresponsibleforthepain. Forexample,right-shoulderpainmayresultfromacutecholecystitis;testicularpainmayresultfromrenalcolicorfromappendicitis.例如，急性膽囊炎引起右肩痛，腎絞痛或闌尾炎引 痛spinalspinalcord脊髓；sensorynerves感覺神經(jīng)cholecystitis膽囊炎 的ThecommonsitesforreferredpainareshowninFigure17-常見的牽涉痛部位見圖17-3Thelocationsofpain常見的牽涉痛部位見圖17-3腹腹部疾病的疼痛定位歸納于表17-2Thetimeofoccurrenceandfactorsthataggravateoralleviatesymptoms(e.g.,mealsordefecation)areparticularlyaggravateaggravate：加重；alleviate：減Periodicepigastricpainoccurring1/2to1houraftereatingisaclassicsymptomofgastricpepticulcers.患有十二指腸潰瘍疼痛多在進食后2-3小時或下次進餐前出現(xiàn)患有十二指腸潰瘍疼痛多在進食后2-3小時或下次進餐前出現(xiàn)進食后半小時到1小時出現(xiàn)周期性上腹痛是胃潰瘍的典型癥狀gastricpepticulcersgastricpepticulcers：消化性胃潰瘍duodenalpepticulcer：消化性十二指腸潰瘍patientswith:患有......Foodtendstolessenthepain,especiallyinduodenal十二指腸潰瘍穿孔至胰腺可以導致后背痛，看似矯形十二指腸潰瘍穿孔至胰腺可以導致后背痛，看似矯形外科問題特別是十二指腸潰瘍，食物能夠減輕疼痛orthopedicorthopedic[??θ?'pi?d?k]整形外nocturnal：nocturnal：夜間內臟Nocturnalpainisaclassicsymptomofduodenalpepticulcer十二指腸潰瘍的典型癥狀是夜間痛Painaftereatingmayalsobeassociatedwithvasculardiseaseoftheabdominalviscera.腹 的血管類疾病也可伴隨進食后疼痛Patientswiththisconditionareolderandhavepostprandialpain,anorexia,andweightloss.這類患 較大，伴有餐后痛、厭食和消瘦Thistriadisseeninabdominalanginaresultingfromobstructivevasculardiseaseintheceliacaxisorthesuperiormesentericartery.這一三聯(lián)癥見于腹腔干或腸系膜上動脈的血管阻塞類疾病引起的腹絞痛。post-post-:后面的；postprandial：餐后anorexia：厭食triad：三個一angina：[?n'd?a?n?]絞celiacaxis：腹腔superiormesentericartery：腸系膜上動Table17-3summarizestheimportantmaneuversforamelioratingabdominalpain.表17-3表17-3NauseaandVomitingmaybecausedbysevereirritationof resultingfromtheperforationofanabdominalorgan;fromobstructionofthebileduct,ureter,orintestine;orfromtoxins. Vomitingresultingfromaperforationisrarely穿孔引起 很少是大量的bileductbileduct：膽管NauseaandObstructionofthebileductorothertubeproducesstretchingofthemuscularwall,resultinginepisodicvomitingthatoccursattheheightofthepain. Intestinalobstructionpreventstheintestinalcontentsfrompassingdistally;consequently,vomitingmayresultintheexpulsionofintestinalcontents.腸道梗阻阻礙腸內容物經(jīng)腸道排出，隨 導致腸內容的排出distallydistally['d?st?la?]遠expulsion：排emergency：緊急事emergency：緊急事科Toxinsgenerallycausepersistent毒素通常引起持續(xù) Notallabdominalemergenciescause不是所有的腹部急癥都導 NauseaandIntraperitonealbleedingmayoccurintheabsenceof腹腔內 往往沒 癥狀Vomitingisfrequentlyalsocausedbyinflammationofintra-abdominalstructures,aswellasbyextra-abdominalconditions,includingdrugtoxicity,centralnervoussystemdisorders,myocardialinfarction,andpregnancy. 的； 外部NauseaandAskthefollowingquestionsifapatientcomplainsofnausea,vomiting,orboth: ‘‘Howlonghaveyouhadnauseaorvomiting?’’ ‘‘Whatisthecolorofthe 物是什么顏色‘‘Isthereanyunusuallyfoulodortothevomitus?’’ Nauseaand‘‘Howoftendoyouvomit?’’ ‘‘Isvomitingrelatedtoeating?’’Ifyes,‘‘Howsoonaftereatingdoyouvomit?Doyouvomitonlyaftereatingcertainfoods?’’ Howoften：多久一Howoftendoyougotochurch你隔多久去Howoften：多久一Howoftendoyougotochurch你隔多久去做一次禮拜Howsoon：多快，多久以HowsooncanIbereleasedfromthehospital?什么時候才能出院Nauseaand‘‘Isthenauseaorvomitingassociatedwithabdominalpain?constipation?diarrhea?alossofappetite?achangeinthecolorofyourstools?achangeinthecolorofyoururine?fever?chestpain?’’ ‘‘Haveyounoticedachangeinyourhearingability?’’ ‘‘Haveyounoticedringinginyour“你是否存在耳鳴NauseaandIfthepatientisawoman,askthis如果患者為女性，應詢問‘‘Whenwasyourlastperiod?’’ Therelationshipofthepaintovomitingisimportantandmayhelpinprovidingthediagnosis.疼痛 的關系非常重要，有可能有助 NauseaandInacuteappendicitis,painprecedesthevomitingusuallybyafewhours.急性闌尾炎時，疼痛通常 前幾小時發(fā)生Thecharacterofthevomitusmayaidindeterminingits物的特點可以幫助明確病因Acutegastritiscausesthepatienttovomitstomach急性胃炎可導致患 胃內容物-itis炎癥；gastr的、骯臟的、臭Biliarycolicproducesbilious,orgreenish-yellow膽絞 物為膽汁，或黃綠色物質Intestinalobstructionoftencausesthepatienttoexpelbiliousvomitus,followedbyfeculent-smellingfluid. Feculentvomitusisusuallycausedbyintestinalobstruction. NauseaandNauseawithoutvomitingisacommonsymptominpatientswithhepatocellulardisease,pregnancy,andmetastatic 通常是肝細胞疾病、懷孕和代謝疾病患者的常見癥狀NauseamaybeassociatedwithahearinglossandtinnitusinpatientswithMe′nie`re’sdisease. 喪失和耳鳴常提示美尼爾病hepato-肝tinnitus：['t?n?t?s]耳ChangeinBowelTakeacarefulhistoryofbowel注 排 的詳細病史Achangeinbowelmovementsnecessitatesfurther排便變化需要更詳盡的描述Askthesequestionsofthepatientwithacuteonset急性腹瀉患者需要詢問如下問題bowelhabitsbowelhabits：腸道排便ChangeinBowel“你腹瀉多久了‘‘Howlonghaveyou“你腹瀉多久了“你一天排便多少次‘‘Howmanybowelmovementsdo“你一天排便多少次‘‘DidthediarrheastartChangeinBowel‘‘Didthediarrheabeginafterameal?’’Ifyes,‘‘Whatdidyoueat?’’‘‘Arethestoolswatery?bloodymalodorous?’’‘‘Isthediarrheaassociatedwithabdominalpain?lossappetite?nausea?“腹瀉是否伴有腹痛？食欲下降 malodorousmalodorous：惡臭mal-壞的ChangeinBowelTheacuteonsetofdiarrheaafteramealsuggestsanacuteinfectionortoxin.進餐后急性發(fā)作的腹瀉提示 染 Waterystoolsareoftenassociatedwithinflammatoryprocessesofthesmallbowelandcolon.水樣便常提示小腸或結腸的炎癥過程Shigellosisisadiseaseofthecolonthatproducesbloody痢疾是一種伴發(fā)血樣便腹瀉的結腸疾病coloncolon：結Shigellosis：[???g?'lo?s?s]志賀氏細菌性痢ChangeinBowel阿米巴病也伴發(fā)血樣便腹瀉Amebiasis阿米巴病也伴發(fā)血樣便腹瀉慢性腹瀉的患者應詢問如下問題Thepatient慢性腹瀉的患者應詢問如下問題 阿米巴ChangeinBowel“腹瀉多久了‘‘Howlonghave“腹瀉多久了“腹瀉是否與便秘交替出現(xiàn)‘‘Doyouhave“腹瀉是否與便秘交替出現(xiàn)“大便呈水樣？松散的？呈漂浮狀？“大便呈水樣？松散的？呈漂浮狀？帶有惡臭氣味ChangeinBowel‘‘Haveyounoticedbloodinthestools?mucus?undigestedfood?’’“你是否注意到便中帶血？帶粘液？“你是否注意到便中帶血？帶粘液？含有未消化的食物“大便是什么顏色的‘‘Howmanybowelmovementsdo“大便是什么顏色的“腹瀉出現(xiàn)在進食后mucus：粘液“腹瀉出現(xiàn)在進食后mucus：粘液“你每天排便幾次ChangeinBowel‘‘Whathappenswhenyoufast?Doyoustillhave“當你禁食后發(fā)生了什么情況？你是否還存在腹瀉‘‘Isthediarrheaassociatedwithabdominalpain?abdominaldistention?nausea?vomiting?’’“腹瀉是否伴隨腹痛？腹脹 ‘‘Haveyounoticedthatthediarrheaisworseatcertaintimesoftheday?’’“你是否注意到腹瀉在每天的固定時間變得更加嚴重fastfast：齋戒、禁ChangeinBowel“你的食欲如何‘‘How“你的食欲如何“你的體重有無改變‘‘Hastherebeenany“你的體重有無改變ChangeinBowel腹瀉和便秘交替出現(xiàn)常見于結腸癌或腹瀉和便秘交替出現(xiàn)常見于結腸癌或憩室炎患者Loosebowelmovementsarecommonindiseasesofthecolon,whereaswaterymovementsareseeninsevereinflammatoryboweldiseaseandprotein-losingenteropathies.Loosebowelmovements：腹瀉ChangeinBowelFloatingstoolsmayresultfrommalabsorption浮浮便是由于吸收不良綜合征導致的Patientswithulcerativecolitiscommonlyhavestoolwithbloodand潰瘍潰瘍性結腸炎患者通常大便中混有血和粘液colitis：結腸ChangeinBowel任何炎癥性小腸疾病或結腸疾病表現(xiàn)為大便混任何炎癥性小腸疾病或結腸疾病表現(xiàn)為大便混有血或未消化的食物Irritablebowelsyndromeclassicallyproducesmoreinthe腸激腸激惹綜合征典型的表現(xiàn)是清晨頻繁腹Irritable：易怒的、急躁ChangeinBowel患者主訴便秘應該詢問下列問題Patients患者主訴便秘應該詢問下列問題“你發(fā)生便秘多久‘‘Howlong“你發(fā)生便秘多久“多長時間排便一‘‘Howoftendoyou“多長時間排便一“大便條的長度是多少‘‘Whatis“大便條的長度是多少ChangeinBowel‘‘Whatisthecolorofyour““大便是什么顏色‘‘Isthestoolevermixedwithblood?““大便是否曾混有血？粘‘‘Haveyounoticedperiodsofconstipationalternatingperiodsof““腹瀉和便秘是否交替出‘‘Haveyounoticedachangeinthecaliberofthe““大便條的粗細是否發(fā)生了改變ChangeinBowel‘‘Doyouhavemuch““你是否有漲氣‘‘How’syour““食欲如何‘‘Hastherebeenanychangeinyour““體重是否發(fā)生了變化Changeinthecaliberofthestoolis大大便條粗細的變化是有意ChangeinBowel‘‘Pencil’’-diameterstoolsmayresultfroman oradistalrectalcarcinoma. Achangeinthecolorofstoolsisimportant.Asisdiscussedlater,palebrowntograystoolsindicateabsenceof正如下文將要討論的，淺棕色至灰色的大便提示膽汁ChangeinBowel這可能是由于膽汁從膽囊流出通道梗阻或膽汁產(chǎn)生減少這可能是由于膽汁從膽囊流出通道梗阻或膽汁產(chǎn)生減少所致Weightchangesareimportantwiththesymptom體重體重改變是便秘重要的伴隨癥狀gallbladder：膽囊ChangeinBowelAnincreaseinweightmayindicatedecreasedmetabolismseeninhypothyroidism;體重增加提示新陳代謝減慢見于甲狀腺功能減adecreaseinweightmaybeassociatedwithcancerofthecolonorotherhypermetabolicconditions.體重降低可能見于結 或其他高代謝情況MetabolismMetabolismHypothyroidism：[?ha?po?‘θa?r??d?z?mRectalRectalbleedingmaybemanifestedbybrightredblood,bloodmixedwithstool,orblack,tarrystools.直腸 可以表現(xiàn)為鮮紅色的血，便中混有血，或者黑色、柏油便。Brightredbloodperrectum,alsoknownashematochezia,canoccurfromcolonictumors,diverticulardisease,orulcerativecolitis.經(jīng)直腸排出鮮紅色血，也稱為便血，見于結腸腫瘤、憩室疾病、或潰瘍性結腸炎。RectalRectal：直腸的]hema-：血RectalBloodmixedwithstoolcanbetheresultofulcerativecolitis,diverticulardisease,tumors,orhemorrhoids.便中混有血見于潰瘍性結腸炎、腫瘤、或痔Askthepatientwhodescribesrectalbleedingthefollowing對于直 的患者應詢問如下問題Hemorrhoids：[‘hem?r??dzRectal‘‘Howlonghaveyounoticedbrightredbloodinyour““你注意到大便中有鮮紅色血有多久了‘‘Isthebloodmixedwiththe“血液是混在大便中嗎‘‘Aretherestreaksofbloodonthesurfaceofthe““大便表面是否有血液Rectal‘‘Haveyounoticedachangeinyourbowel“你是否注意到你的排 發(fā)生了變化‘‘Haveyounoticedapersisten sationinyourrectumthatyouhavetomoveyourbowels,butyoucannot?’’“你是否持續(xù)感覺到不得不排便但卻排不出來Tenesmusisthepainful,continued,andineffectiveat里急后重是指在排便時疼痛的、持續(xù)而無效的RectalItiscausedbyinflammationoraspace-occupyinglesionsuchasatumoratthedistalrectumoranus.它是由炎癥或空間占位損害如直腸末端 部位的腫瘤所引起Hemorrhoidalbleedingisacommoncauseofhematocheziaandstreakingofstoolwithblood.痔 是便血和大便帶血的常見原因LesionLesion：[‘li??n]損害、損傷hematochezia：[hem?t?‘ki?z??]便RectalMelenaisablack,tarrystoolthatresultsfrombleedingabovethefirstsectionoftheduodenum,withpartialdigestionofthehemoglobin. MelenaMelena：[m?'li?n?]黑便duodenum：[?du??‘di?n?m]十二指腸Hemo-血；-globinRectalInquireaboutthepresenceof應應了解黑便存在的Ausefulwayofquestioningistoshowthepatientthetubingonthestethoscopeandask,‘‘Haveyourbowelmovementseverbeenthiscolor?’’一種有效地詢問方法是向患者展示聽診器的黑管并問，“你的大便一種有效地詢問方法是向患者展示聽診器的黑管并問，“你的大便是否有過這種顏色？”Stethoscope：[‘steθ?sko?p]RectalIfaskeddirectlywhetherthebowelmovementshaveeverbeenblack,thepatientmayanswerintheaffirmative,equatingdark(normal)stoolswithblackstools.如果直接詢問患者是否有過黑色大便，患者的答復往往是肯定的，他們把正常暗色的大便等同于黑便。如果直接詢問患者是否有過黑色大便，患者的答復往往是肯定的，他們把正常暗色的大便等同于黑便。Equating：等同于；～withRectalAskthesequestionsofapatientwhodescribes如如果患者描述有黑便應詢問下列‘‘Haveyoupassedmorethanoneblack,tarrystool?’’If““是否排過多次黑色、柏油樣大便？”如果是，“什么時候‘‘Howlonghaveyoubeenhavingblack,tarry““排黑色、柏油樣便多久Rectal‘‘Haveyounoticedfeeling“是否曾感覺頭昏眼花‘‘Haveyouhadanynauseaassociatedwiththesestools?anyvomiting?diarrhea?abdominalpain?sweating?’’“排便時是否伴 ？腹瀉？腹痛？出汗LightheadedLightheaded：頭昏眼花RectalTheanswerstothesequestionscanprovidesomeinformationregardingtheacutenessandtheamountofthe這些問題有助于提供關 的急性程度 量的相關信息Lightheadedness,nausea,anddiaphoresisareseenwithrapidgastrointestinalbleedingandhypotension.頭昏 和出汗提示快速胃腸 和低血壓Diaphoresis:[?da??f?‘ri?s?s]出汗Gastrointestinal：gastro-胃的intestinal腸的RectalThepresenceofsilver-coloredstoolsisrarebutpathognomonicofacholicstoolswithmelena,aconditionresultingfromcanceroftheampullaofVaterinthe銀色便很少見但特異性的提示患者便中無尿膽原并伴有黑便，提十二指腸泛特氏 癌。Thecancerproducesbiliaryobstruction,andthefrondsaresloughed,causingPathognomonic：特殊病癥的、特異的Acholic：無膽汁的；anotcholic膽汁的FrondPathognomonic：特殊病癥的、特異的Acholic：無膽汁的；anotcholic膽汁的FrondThepresenceofjaundice(icterus)mustalerttheexaminerthatthereiseitherliverparenchymaldiseaseoranobstructiontobileflow.存在黃疸提醒檢查者患者或者存在肝細胞疾病或者存在膽汁排出梗存在黃疸提醒檢查者患者或者存在肝細胞疾病或者存在膽汁排出梗阻。Jaundice:Jaundice:Icterus：[‘?kt?r?s]parenchymal：[p?‘r??k?m?l]黃疸的出現(xiàn)是由于流入膽汁的結合型黃疸的出現(xiàn)是由于流入膽汁的結合型膽紅素減少引起Thiscanresultfromintrahepaticbiliaryobstruction,asmedicaljaundice,orfromextrahepaticbiliaryobstruction,knownassurgicaljaundice.黃疸的病因包括肝內膽管梗阻導致的內科黃疸，和肝外膽管梗阻導致的外科黃疸。黃疸的病因包括肝內膽管梗阻導致的內科黃疸，和肝外膽管梗阻導致的外科黃疸。conjugatedbilirubin：結合型膽紅素Intra-內的；extra-外的“黃疸“黃疸是否發(fā)展迅對于任何黃疸患者，檢查者應該詢問如下問題以尋找對于任何黃疸患者，檢查者應該詢問如下問題以尋找疾病線索：‘‘Howlonghaveyoubeen““黃疸發(fā)生‘‘Didthejaundicedevelop‘‘Isthejaundiceassociatedwithabdominalpain?lossappetite?nausea?vomiting?distastefor“黃疸是否伴有腹痛？食欲減退 ？討厭香煙‘‘Isthejaundiceassociatedwithchills?fever?itching?weightloss?’’“黃疸是否伴有寒戰(zhàn)？發(fā)熱？搔癢？體DisDistaste：不喜歡、厭惡，dis‘‘Inthepastyearhaveyouhadanytransfusions?tattooing?在過去一年里你是否曾經(jīng)輸液？紋身？接 Inoculation‘‘Doyouuseanyrecreationaldrugs?’’Ifyes,‘‘Doyouuseanydrugsintravenously?’’ ‘‘Doyoueatraw fish?“你是否使用生的貝類食品？牡recreationalrecreationaldrugs：消遣性 “Haveyoutraveledabroadinthepastyear?”Ifyes,“Where?Wereyouawarethatyoumayhaveconsumedunclean“過去的一年中你是否出過國？”如果是，“你去過哪里？你是否知道你可能使用過 凈的水？”‘‘Haveyoubeenjaundiced““既往是否有黃疸病史‘‘Hasyoururinechangedcolorsinceyounoticedthatwere““出現(xiàn)黃疸后，你的尿液顏色是否發(fā)生改變‘‘Whatisthecolorofyour““大便是什么顏色‘‘Doyouhaveanyfriendsorrelationswhoarealso“你是否有朋友或親屬也發(fā)生了黃疸‘‘Whattypeofworkdoyoudo?Whatothertypesofworkhaveyoudone?’’“你從事何種工作？你曾經(jīng)從事過何種工作‘‘Whatareyour“你的業(yè) 是什么Viralhepatitisisassociatedwithnausea,vomiting,alossofappetite,anda siontosmoking.性肝炎伴 、食欲減退、和討厭吸煙HepatitisAhasafecal-oralrouteoftransmissionandanincubationperiodof2to6weeks.甲型肝炎是通過糞—口途 ，潛伏期是2-6周aversionaversionHepatitis：肝炎；hepat：肝的；-itisItmaybelinkedtoingestionofraw 它可能與攝入生的貝類食物有關HepatitisBisblood-borneandhasanincubationperiod