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吉林大學第一醫(yī)院泌尿系統(tǒng)疾病診治中心副主任醫(yī)師副教授碩士研究生導師王偉剛.cn專業(yè)外語

泌尿系統(tǒng)部分1.Anadultwomanrelatesthat5daysagoshebegantonoticefrequent,painfulurination,withsmallvolumesofcloudyandmalodorousurine.Forthefirst3daysshehadnofever,butforthepast2daysshehashadpainintherightflank.Shehashadnotreatmentwhatsoeveruptothistime.Whatisit?Pyelonephritis

Pyelo-nephritis2.A63-year-oldmalecomplainsof6-monthhistoryofdifficultyvoidingandfeelingasthoughhecannotemptyhisbladdercompletely.Aftervoiding,heoftenfeelsasthoughheneedstourinateagain.Hedeniesurethraldischargeorburningwithurination.Hehashadmild

hypertensionandtakesathiazidediuretic.Hisonlyothermedicationhasbeenampicillinfortwourinarytractinfectionsduringthepreviousyear.Onexamination,hisbloodpressureis130/84mmHg,pulserate80beats/min,andheiswithoutfever(afebrile).Theheartandlungexaminationarenormal,andtheabdominalexaminationshowsnomasses.Whatisthemostlikelydiagnosis?Benignprostatichyperplasia(BPH)3、A5-year-oldgirlandhermotherarereferredforevaluationofbed-wetting.Themotherstatesthatherdautherhasneverfullygainedcontrolofherbladder.Ittookheranextendedperiodoftimetogrowoutofdiapersandthegirlhasfinallystoppedhaving“accidents”duringtheday.However,shecontinuestowetherbedatnight.Thepatienthasdevelopednormallyinallotheraspectsandwillbefrustratedandhavebeenlosingsleep,asthegirlwakesupatnight4to5timesperweek.Physicalexaminationisunremarkable.Whichofthefollowingwillmostlikelybetheresultoffurtherinvestigation?LargecapacitybladderLearningdisabilityNormal“work-up”UrinarytractinfectionUrologicalcancerThecorrectanswerisC4、A62-year-oldmanpresentswithchills,fever,dysuria,urinaryfrequency,diffuselowbackpain,andanexquisitelytenderprostateonrectalexam.Whatisit?Acutebacterialprostatitis.5、A62-year-oldmanknowntohavenormalrenalfunctionreportsanepisodeofgross,painlesshematuria.Furtherquestioningdeterminesthatthepatienthastotalhematuriaratherthaninitialorterminalhematuria.Whatisit?Thebloodiscominganywherefromthekidneystothebladder,ratherthantheprostateortheurethra.Eitherinfectionortumorcanproducehematuria.Inolderpatientswithoutsignsofinfection,canceristhemainconcern,anditcouldbeeitherrenalcellcarcinomaortransitionalcellcancerofthebladderorureter.Management.DoaCTscanandcystoscopy.DisordersoftheUrinarySystemandSomeMeansforFindingThemOut泌尿系統(tǒng)疾病及檢查手段DisordersoftheUrinarySystemInfectionsGlomerulonephritisAcuterenalfailureUrinarystonesCancer泌尿系統(tǒng)疾病感染腎小球性腎炎急性腎衰竭尿石病癌癥InfectionsCystitisisaninfectionoftheurinarybladder.Organismsgenerallyenterthroughtheurethraandascendtowardthebladder.感染膀胱炎是膀胱（urinarybladder）的感染，病菌一般從尿道而入，并上行到膀胱，引起感染。感染Cystitis,膀胱炎Gallbladder,膽囊InfectionsTheinfectingorganismsareusuallycolonbacteriacarriedinfeces.Cystitisisthusmorecommoninfemalesthaninmalesbecausethefemaleurethraisshorterthanthemaleurethraandit’sopeningisclosertotheanus.感染病菌通常是大便中攜帶的結(jié)腸菌。因女性尿道比男性的短，而且尿道口更靠近肛門，故女性膀胱炎比男性更常見。感染Feces[‘fi:si:z]n.

排泄物，糞便，渣滓

Anus['ein?s]n.

肛門

InfectionsPoortoilethabitsandurinarystasisarecontributingfactors.Inthehospital,urinarytractinfectionsmaycomplicatecatheterizationforthewithdrawalofurinefromthebladder.感染大小便習慣不良和尿潴留是促發(fā)因素。醫(yī)院用導管從膀胱提取尿液時可并發(fā)尿道感染。感染Urinarystasis尿潴留Catheterization導管插入術(shù)InfectionsAninfectionthatinvolvesthekidneyandrenalpelvisistermedpyelonephritis.Signsofthisconditionincludedysuria,painfulordifficulturination,andthepresenceofbacteriaandpusintheurine,bacteriuriaandpyuriarespectively,asincystitis.感染波及腎臟和腎盂的感染稱為腎盂腎炎。同膀胱炎一樣，腎盂腎炎的體征包括尿痛——亦稱排尿困難，尿液中有細菌和膿，分別稱為菌尿和膿尿。感染Dysuria排尿困難Pyelonephritis腎盂腎炎Bacteriuria細菌尿Pyuria膿尿InfectionsUrethritisisinflammationoftheurethra,generallyassociatedwithsexuallytransmitteddiseasessuchasgonorrheaandchlamydiainfections.感染尿道炎是尿道的炎癥，通常與性傳播的疾病如淋病、支原體感染有關。

感染Gonorrhea[.g?n?‘ri:?]n.

淋病

（-rrhea,流出，溢出）Chlamydia[kl?'midi?]n.

[微]衣原體，衣原體疾病

GlomerulonephritisAlthouththenamesimplymeansinflammationofthekidneyandglomeruli,glomerulonephritisisaspecificdisorderthatfollowsanimmunologicreaction.Itisusuallyaresponsetoinfectioninanothersystem,commonlyastreptococcalinfectionoftherespiratorytract.腎小球性腎炎盡管腎小球性腎炎這一名稱僅指腎臟和腎小球的炎癥，但腎小球性腎炎卻是免疫反應引起的一種特異性疾病，通常是對另外某個系統(tǒng)的炎癥（常對呼吸道鏈球菌感染）的反應。腎小球性腎炎Streptococcal[.strept?'k?k?l]adj.

鏈狀球菌的，鏈球菌所導致的

Strep[strep]n.

鏈鎖狀球菌

adj.

鏈鎖狀球菌的

-coccal球菌的GlomerulonephritisItmayalsopanyautoimmunediseasessuchaslupuserythematosus.Thesymptomsarehypertension,edema,andoliguria,thepassageofsmallamountsofurine.Thisurineishighlyconcentrated.腎小球性腎炎發(fā)病可伴隨紅斑狼瘡之類的自體免疫疾病。其癥狀為高血壓、水腫和少尿，這種尿的濃度高。腎小球性腎炎lupuserythematosusn.

紅斑狼瘡

Edema[i:‘di:m?]n.

[醫(yī)]浮腫，水腫，

[植]瘤腺體

Oliguria[?li'gju?ri?]n.

[醫(yī)]尿過少，少尿(癥)GlomerulonephritisBecauseofdamagetokidneytissue,bloodandproteinsescapeintothenephrons,causinghematuria,bloodintheurine,andproteinuria,proteinintheurine.Bloodcellsmayalsoformintosmallmoldsofthekidneytubulecalledcasts,whichcanbefoundintheurine.腎小球性腎炎因腎組織受損，血液和蛋白質(zhì)滲入腎單位，引起血尿和蛋白尿，紅細胞也可形成腎小管的小型模型，稱為管型，可在尿液中發(fā)現(xiàn)。腎小球性腎炎Hematuria[.hi:m?‘tju:ri?]n.

血尿癥，血尿

Proteinuria[pr?uti:n'ju?ri?;.pr?uti:'nu?'uri:?]

n.

[醫(yī)]蛋白尿(癥)

GlomerulonephritisGlomerulonephritisisoneofthemostcommoncausesofchronicrenalfailure(CRF),orend-stagerenaldisease(ESRD),inwhichureaandothernitrogencontainingcompoundsaccumulateintheblood,whoseconditionistermeduremia.腎小球性腎炎腎小球性腎炎是最常見的慢性腎衰竭或晚期腎病的原因之一，此時脲和其他含氮化合物積累于血液中，這種癥狀稱為尿毒癥。腎小球性腎炎Uremia[ju'ri:mi?]n.

尿毒癥

GlomerulonephritisThesecompoundsaffectthecentralnervoussystem,causingirritability,lossofappetite,stuporandothersymptoms.Thereisalsoelectrolyteimbalanceandacidosis.腎小球性腎炎這些化合物影響中樞神經(jīng)系統(tǒng)，故引起易受刺激、厭食、木僵和其他癥狀，還有電解質(zhì)失衡和酸中毒。腎小球性腎炎Stupor['stju:p?]n.

昏迷，麻木，不省人事AcuteRenalFailureAninjury,shock,exposuretotoxins,infections,andotherrenaldisordersmaycausedamagetothenephronsresultinginacuterenalfailure(ARF).Thereisrapidlossofkidneyfunctionwitholiguriaandaccumulationofnitrogenwastesintheblood.急性腎衰竭損傷、休克、接觸毒素、感染和腎的其他疾病可導致腎單位的損害，引起慢性腎衰竭，此時腎功能迅速喪失，排尿少，血液中氮廢物積累。AcuteRenalFailureFailureofthekidneystoeliminatepotassiumleadstohyperkalemiaalongwithotherelectrolyteimbalancesandacidosis.Whenthereisdestruction,necrosisofkidneytubules,theconditionmaybereferredtoasacutetubularnecrosis.急性腎衰竭腎臟無能力排除鉀，而導致高鉀癥、其他電解質(zhì)失衡和酸中毒。當腎小管遭到破壞即壞死時，這種疾病稱為急性腎小管壞死。急性腎衰竭Potassium[p?‘t?si?m]n.

鉀

hyperkalemia[haip?k?'li:mi?;.haip?kei'li:mi:?]n.

[醫(yī)]血鉀過多，高鉀

AcuteRenalFailureRenalfailuremayleadtoaneedforkidneydialysisortransplantation.Dialysisreferstothemovementofsubstancesacrossasemipermeablemembrane.Inhemodialysis,bloodiscleansedbypassageoveramembranesurroundedbyfluid(dialysate)thatdrawsoutunwantedsubstances.急性腎衰竭腎功能衰竭時需進行透析和腎移植。透析是指體液通過半透膜的運動。透析時，血液透過一層體液即透析液圍繞的膜，有害的物質(zhì)被吸走，血液得以純凈。急性腎衰竭Dialysis[dai‘?lisis]n.

透析，滲析

Unwanted['?n'w?ntid]

adj.

不需要的，多余的，無用的，討厭的，不受歡迎的

AcuteRenalFailureInperitonealdialysis,fluidisintroducedintotheperitonealcavity.Thisfluidisperidicallywithdrawnalongwithwasteproductsandreplaced.Thismaybedoneatintervalsthroughoutthedayincontinuousambulatoryperitonealdialysis(CAPD)oratnightincontinuouscyclicperitonealdialysis(CCPD).急性腎衰竭腹膜透析時，體液導入腹膜腔，這種體液連同廢物定期被抽取、替換。白天定期進行連續(xù)性非住院性腹膜透析，夜間則進行持續(xù)循環(huán)腹膜透析。急性腎衰竭Peritoneal[,perit?‘ni:?l]adj.

[解]腹膜的Ambulatory['?mbjul?t?ri]adj.

可走動的，[醫(yī)]非臥床的，流動的，[法律]可變更的，可撤銷的

UrinaryStonesUrinarylithiasis,whichisknownasaconditionofhavingstones,mayberelatedtoinfection,irritation,diet,orhormonethatleadtoincreasedcalciumintheblood.Mosturinarystones,orcalculi,areformedofcalciumsalts,buttheymaybecomposedofothermaterialsaswell。尿石病尿石，即有結(jié)石的疾病，可能與感染、刺激、飲食、或激素分泌失衡有關，從而導致血液中的鈣質(zhì)增多。多數(shù)尿石由鈣鹽構(gòu)成，但有的可能由其他的物質(zhì)構(gòu)成。UrinaryStonesThestonesgenerallyforminthekidneyandmaymovetothebladder.Thisresultsingreatpain,termedrenalcolic,andobstructionthatcanpromoteinfectionandcausehydronephrosis,collectionofurineintherenalpelvis.Becausetheyareradiopaque,stonescanusuallybeseenonsimplex-raysoftheabdomen.

尿石病結(jié)石通常在腎臟中形成，可運動至膀胱，引起劇痛，稱為腎絞痛，可造成阻塞，進而加劇感染并引起腎盂積水，即尿液滯留于腎盂。因尿石不透光，通常可見于腹部單純透視片。

尿石病renalcolic腎絞痛

UrinaryStonesStonesmaydissolveandpassoutofthebodyontheirown.Ifnot,theymayberemovedsurgically,inalithotomy,orbyusinganendoscope.Inanewermethod,externalshockwavesareusedtocrushstonesintheurinarytractinaprocedurecalledextracorporeal(outsidethebody)shockwavelithotripsy(crushingofstones).尿石病尿石可溶解，自行排出體外;若不能，可用手術(shù)即石切除術(shù)或用內(nèi)鏡清除。一種更新的方法是用體外震波將尿路結(jié)石破碎，稱為體外震波碎石術(shù)。尿石病Lithotomy[li‘θ?t?mi]n.

切開取石術(shù)

Extracorporeal[.ekstr?k?:'p?:ri?l]

adj.

身體外的

CancerCarcinomaofthebladderhasbeenlinkedtooccupationalexposuretochemicals,parasiticinfections,andcigarettesmoking.Akeysymptomissudden,painlesshematuria.Oftenthecancercanbeseenbyviewingtheliningofthebladderwithacystoscope.Thisinstrumentcanalsobeusedtobiopsytissueforstudy.癌癥膀胱癌與職業(yè)性接觸化學物質(zhì)、與寄生蟲感染及吸煙有聯(lián)系。最重要的癥狀是突然無痛性血尿。?？捎冒螂诅R觀察膀胱粘膜發(fā)現(xiàn)膀胱癌。該方法也可用于取病理活檢。CancerIftreatmentisnoteffectiveinpermanentlyremovingthetumor,acystectomy,removalofthebladder,maybenecessary.Inthiscase,theuretersmustbeventedelsewhere,suchasdirectlytothesurfaceofthebody,throughtheileuminanilealconduitortosomeotherportionoftheintestine.癌癥若治療不能根治腫瘤，則需進行膀胱切除術(shù)，此時輸尿管應在其他地方開口排尿，例如回腸造瘺，通過回腸直接通到體外排尿或接通到腸道的其他某部分排尿。CancerCancermayalsoinvolvethekidneyandrenalpelvis.Additionalmeansfordiagnosingcancerandotherdisordersoftheurinarytractincludeultrasound.CTscans,andx-raystudies:intravenouspyelogramandretrogradepyelography.

癌癥癌也可累及腎和腎盂。診斷泌尿道的癌癥和其他疾病的其他手段包括超聲波、CT掃描和下列放射線檢查：靜脈腎盂造影和逆行性腎盂造影術(shù)。癌癥Pyelogram[‘pai?l?gr?m]腎盂造影

Retrogradepyelography逆行性腎盂造影術(shù)SomeMeansforFindingoutDisordersoftheUrinarySystemCTscans

Intravenouspyelogram（IVP）Retrogradepyelogramultrasonography部分泌尿系統(tǒng)檢查方法

CT掃描靜脈腎盂造影照片（IVP）逆行性腎盂造影照片超聲波檢查CT

scansTransversex-rayviewsofthekidneyaretakenwithorwithoutcontrastmaterialandareusefulinthediagnosisoftumors,cysts,abscessesandhydronephrosis.Studiesmaybeobtainedinrenalfailure,whencontrastmaterialshouldnotbegiven.CT掃描不論是否使用造影劑，腎的橫向透視影像均可拍攝，有利于診斷腫瘤、囊腫、膿腫和腎盂積水。在腎衰竭患者也可應用，但不用造影劑。Intravenouspyelogram（IVP）Contrastmaterialisinjectedwithinaveinandtravelstothekidneywhereitisfilteredintotheurine.X-raysarethentakenshowingthedyefillingthekidneys,ureters,bladder,andurethra.Thesex-raysprovideanindexofrenalfunctionaswellasshowcysts,tumors,infections,hydronephrosis,andcalculi.Alsocalledanexcretoryurogram.IVPtomogramsshowaseriesofpicturesofthekidney.

靜脈腎盂造影照片（IVP）對比劑注入靜脈，流至腎臟，在此滲透至尿液，而后透視，顯現(xiàn)染料充填腎臟、輸尿管、膀胱和尿道情況。這些透視不僅顯現(xiàn)囊腫、腫瘤、感染、腎盂積水和結(jié)石，而且提供腎功能指數(shù)，靜脈腎盂造影（IVP）X線斷層照片也稱為排泄性尿路造影照片，顯現(xiàn)腎的系列影像。

RetrogradepyelogramContrastmaterialisintroduceddirectlyintothebladderanduretersthroughacystoscopeandx-raysaretakentodeterminethepresenceofstonesorobstructions.Thistechniquemaybeindicatedwhenpoorrenalfunctionmakesitimpossibletovisualizethekidneys,ureters,andbladderbyuseofintravenousdyeasinanIVP.ItmayalsobeusedasasubstituteforanIVPwhenapatientisallergictointravenousdye.逆行性腎盂造影照片：用膀胱鏡直接將對比劑導入膀胱和輸尿管，攝影確定有無結(jié)石或梗阻。因腎功能不良而不能象靜脈腎盂造影照片（IVP）中使用造影劑顯現(xiàn)腎臟、輸尿管、膀胱時，便可使用逆行性腎盂造影照片技術(shù)?；颊邔o脈造影劑過敏時，這一方法可用來替代靜脈腎盂造影照片（IVP）.UltrasonographyKidneysize,tumors,hydronephrosis,polycystickidney,andureteralandbladderobstructionaresomeofthemanyconditionsthatcanbediagnosedusingsoundwaves,butnoinformationaboutrenalfunctionisobtained.超聲波檢查有些疾病，例如腎臟大小異常、腫瘤、腎盂積水、多囊腎和輸尿管及膀胱阻塞可用超聲波診斷，但不可用來診斷腎功能情況。1.Anadultwomanrelatesthat5daysagoshebegantonoticefrequent,painfulurination,withsmallvolumesofcloudyandmalodorousurine.Forthefirst3daysshehadnofever,butforthepast2daysshehashadpainintherightflank.Shehashadnotreatmentwhatsoeveruptothistime.Whatisit?Pyelonephritis

Pyelo-nephritisUrinarytractinfectionsshouldnothappeninmenorinchildren,andthustheyshouldtriggeraworkuplookingforacause.Womenofreproductiveage,ontheotherhand,getcystitisallthetime,andtheyaretreatedwithappropriateantibioticswithoutgreatfuss.However,whentheygetflankpainandsepticsignsit’sanotherstory.Thiswomanneedshospitalization,IV(intravenousinjection)antibiotics,andatleastasonogramtomakesurethatthereisnoitantobstruction.2.A63-year-oldmalecomplainsof6-monthhistoryofdifficultyvoidingandfeelingasthoughhecannotemptyhisbladdercompletely.Aftervoiding,heoftenfeelsasthoughheneedstourinateagain.Hedeniesurethraldischargeorburningwithurination.Hehashadmild

hypertensionandtakesathiazidediuretic.Hisonlyothermedicationhasbeenampicillinfortwourinarytractinfectionsduringthepreviousyear.Onexamination,hisbloodpressureis130/84mmHg,pulserate80beats/min,andheiswithoutfever(afebrile).Theheartandlungexaminationarenormal,andtheabdominalexaminationshowsnomasses.Whatisthemostlikelydiagnosis?Benignprostatichyperplasia(BPH)Summary:A63-year-oldmalewhohashypertensioncomplainsofa6-monthdifficultyinvoidingandthesensationthathecannotemptyhisbladdercompletely.Hehashadtwoepisodesofurinarytractinfectionsbutdeniesdysuria(burningwithurination)orurethraldischarge.Mostlikelydiagnosis:Benignprostatichyperplasia3、A45-year-oldfemaleunderwentsurgicalremovaloftheuterus(totalhysterectomy)forsymptomaticendometriosis2dayspreviously.Shecomplainsofrightbackandflanktenderness.Onexamination,hertemperatureis102F,heartrateis100beats/min,andbloodpressureis130/90mmHg.Theheartandlungexaminationsarenormal.Herabdomenisslightlytenderdiffusely,butbowelsoundsarenormal.Thesurgicalincisionappearswithinnormallimits.Thereisexquisiterightcostovertebralangletendernessonpalpation.Ultrasoundofthekidneysshowsmarkeddilationoftherightrenalcollectingsystemanddilationoftherightureter.Whatisthemostlikelydiagnosis？Whatistheanatomicalexplanationforthiscondition?UreteralinjuryatsurgerySummary:A45-year-oldfemalewhounderwenttotalabdominalhysterectomyforsymptomaticendometriosis2dayspreviouslyhasfeverof102Fandexquisiterightflanktendernessatthecostovertebralangle.Thesurgicalincisionappearsnormal.Mostlikelydiagnosis:InjurytotherightureterAnatomicalexplanationforthiscondition:Probableligationoftherightureterasitpassesinferiorlytotheuterinearterywithinthetransversecervical(cardinal)ligamentoftheuterus.4、A5-year-oldgirlandhermotherarereferredforevaluationofbed-wetting.Themotherstatesthatherdautherhasneverfullygainedcontrolofherbladder.Ittookheranextendedp