《司考周报》第7期刑法笔记号是对73.ppt

Tuberculosis(TB) of the Genitourinary Tract泌尿生殖系结核 瑞金医院泌尿外科 邵 远 Urinary TB A disease of young adults. 60% between 20~40y. Infecting organism — Mycobacterium tuberculosis (结核分支杆菌，结核杆菌), Tubercle bacilli Infecting Route(感染途径) Hematogenous route(血行途径) from the lungs. Primary sites(初发部位): Kidney, Prostate (前列腺) Other organs involved: direct extension Pathogenesis(发病机理) Tubercle bacilli hit the renal cortex(肾皮质): Normal resistance(抵抗力): organism destroyed Sufficient virulence(致病力): clinical infection established. Pathogenesis TB of kidney: progresses slowly, 15~20y to destroy a kidney with good resistance. No clinical disturbance until the calyces / pelvis(肾盏/肾盂) involved. Pathology(病理) Kidney Ureter (输尿管) Grossly: a soft, yellowish localized bulge (隆起). On section: involved area filled with cheesy material (caseation, 干酪样物质). Kidney Ureter Walls of pelvis, calyces and ureter thickened. Ulceration(溃疡形成) in calyces. Complete ureteral stenosis(输尿管狭窄) Autonephrectomy(肾自截). Bladder urine normal and symptom absent. Kidney Ureter Basic lesion——Tubercle foci(结核结节) Epithelioid reticulum(上皮样网) Peripheral giant cells Heal by fibrosis(纤维化). Kidney Ureter TB is a combination of caseation(干酪样变), cavitation(空洞形成) and healing by fibrosis scarring(纤维化和疤痕愈合). Depending on virulence vs resistance. Calcification(钙化): strongly suggestive of TB. Secondary renal stones in 10%. Left kidney: autonephrectomy Right Kidney: hydronephrosis ureteral reflux (肾积水输尿管返流) Contraction of the bladder (膀胱孪缩) 左肾萎缩 萎缩肾外观 Caseation Fibrosis L Renal Dysfunction on Isotope Scan (同位素扫描) Calcification (钙化) Bladder Tubercle form: white/yellow raised nodules(结节) surrounded by a halo of hyperremia(充血). Tubercles break downdeep ragged ulcers bladder irritable. 膀胱结核，多个粟粒样黄色小结节 膀胱结核，结核性溃疡 Diagnosis(诊断) Just saying you had turned a corner doesn’t make it so. Just saying there is massive destruction doesn’t make it so. __John Kerry Ju