双语教学查房课程介绍.ppt

2013-7-10到我院检查，B超提示：胆囊结石，收住我科。 入院时：T:36.4℃ P:60次／分 R：19次/分 BP：110／70mmHg 体重：70Kg。 双语教学查房BWR---- 胆囊结石Cholecystolithiasis  : 一、病 史 Course of Disease 主诉:反复发作的右上腹疼痛半年余，再发三天 患者:张运友，男，49岁,诉进食油腻食物后出现右上腹痛，呈持续性胀痛，向腰背部放射，无发热 、恶心、呕吐、腹胀、腹泻、黄疸，无尿频、尿急、尿痛等症状，患者自发病以来，精神、饮食、睡眠尚可。 腹部检查：腹软不胀，无压痛、反跳痛，墨菲氏征（+），腹式呼吸存在。肝肾区无叩痛，肠鸣音4次／分，无血管杂音。 既往史：既往健康，家中无特殊病史，无外伤史、过敏史，预防接种不详。无饮酒嗜好，抽烟30年。 The Case: The patient has a right upper abdominal pain again and again more than six months, has terrible pain three days. Zhang Yunyou, male,49 years old, the patient complain of right upper quadrant abdominal pain witch radiate to back.and remaining persistent pain after eating high fat food. He has no fever, nausea, vomiting, abdominal distension, diarrhea, jaundice, no frequent micturition, urgency,dysuria symptoms, since attack this disease . His sprite ,diet ,sleep is well. The B ultrasound exam in the hospital in 10.july.2013 is cholecystolithiasis Temprature is 36.4 ℃ .Pulse is 60 times per minute. Respration is 19 times per minute. The Blood pressure is 110 to 70 minimigh. The body weight is 70 kilogram. Abdominal examination: the abdomen is soft,has no expansion, no tenderness, rebound tenderness. The Murphys sign is positive.He has the abdominal breathing. Percussion pain without hepatorenal area, bowel sound is 4 times per minute, no vascular murmur.Previous health status is good, no special history of relationship, trauma and allergic. The vaccination is unknown. He had no behaviour of drink and smok about 30 years. Physical Examination 二、体格检查 胆囊结石的定义是什么? The definition of the cholecystolithiasis 三、相关知识Relevant Knowledge 胆囊结石cholecystolithiasis： 指发生在胆囊内的结石，主要为胆固醇结石或以胆固醇为主的混合型结石，常用急性胆囊炎并存。女性多见。 （一）病因Etiology 形成结石的常见原因有： 长期三高饮食 胆固醇↑ 胆固醇过饱和 胆盐的丧失 胆汁潴留时间过长 胆囊收缩功能减退 胆道感染 其他（溶血，胆汁淤滞,胆囊排空延迟...） Long-term high-protein, high-fat, high-calorie diet the loss of bile salts bile stay in the gallbladder too long biliary infection Long-term fasting,intravenous nutrition Others(gastrectomy,v