26岁的男人-医学毕业生自我鉴定

2021年1月19日发(作者：包琮)
Chapter 1
Medical Terminology
①

I . Introduction
Human Body as a Whole





How many
medical words are there in a
medium-sized medical dictionary? The answer is around
100, 000, which is only a conservative estimate. Moreover, like the jargon

in all forward-moving fields,
the
number
is
expanding
so
constantly
and
quickly
that
it
defies
any
memorization!
There
are
tools,
however,
that
can
aid
in
learning
and
remembering
medical
terms
and
even
help
in
making
informed
guesses as to the meaning of unfamiliar words. Furthermore, their numbers are limited, about 400 to 500
or so (the most active ones) , but the combinations derived from them are enormous. So, to learn how to
use these tools is much more efficient and meaningful than to try to memorize every medical term.





Most
medical
terms
are
based
on
Greek
and
Latin
words,
which
are
consistent
and
uniform
throughout many different areas. The tools you are going to learn to use are these Greek and Latin parts
of words, which are called the root, prefix, suffix, combining vowels and combining forms.


●

The root is the foundation of the word and all medical terms have one or more roots.
●

The prefix is the beginning of the word. Not all medical terms contain prefixes, but the




②
prefix can have an important influence on meaning.

●

The suffix is the ending of the word and all medical terms have a suffix.
③




●

The combining vowel

is the vowel that links the root to the suffix or the root to another root.
①

the special words or terms used in a science, art, business etc.
②

the language of a special group or profession.
③

It takes the form of
centimeter
,
millimeter,
etc.










●

The combining form is the combination of the root and the combining vowel.































Combining form
For example, consider the word:




endo / crin / o / logy
prefix



root





suffix


combing vowel
endo
is the prefix, meaning
within/inner
.
crin
is the root, meaning
secrete
.
o
is the combining vowel
serving as a link
.
crino
is .the. combining form.
logy
is the suffix , meaning the
study of.





S
o,
by analyzing the parts of the word, the .meaning of endocrinology has been unlocked: it means
the
study of
the human inner secretion from glands (the hormones).
II. Combining forms, prefixes and suffixes




Learn the following combining forms, prefixes and suffixes and write the
meaning of the medical
term in the space provided.
Exercises
A. Complete the following sentences.
1. Word beginnings are called














.
2. Word endings are called














.
foundation of a word is known as the














.
4.A vowel linking a suffix and a root, or linking two roots in a term is called














.
combination of a root and a combining vowel is known as the














.
B. Give the meanings for the following combining forms, prefixes and suffixes and provide one
example for each.
1. embry/o




























































2. -ism































































3. cardi/o





























































4. chrom/o




























































5. crin/o






























































6. cyt/o































































7. -gen































































8. lymph/o




























































9. -logy






























































10. -ar































































C. Match Column I with Column II .
Column I
(Combining form, prefix and suffix)

epi-
hemat/o
vascul/o
-somes
-cyte
-plasm
endo-
immun/o
erythr/o
Column II
(English term)

[ 1 ] protection/safe
[ 2 ] above
[ 3 ]..life
[ 4 ] formation, growth, substance of formation
[ 5 ] cell
[ 6 ] inner/within
[ 7 ] bodies
[ 8 ] blood
[ 9 ] tissue


















续表

Column I
(Combining form, prefix and suffix)

hist/o
thyr/o
physi/o
adren/o
-tomy
bi/o
Column II
(English term)

[10] blood vessel


[11] to cut open


[12] red

[13] thyroid gland

[14] adrenal gland

[15] physical

D. Give the stress to the following medical terms, for example:
|
histo'therapy
1. adrenalitis
4. cardiopathy
7. histopathology
10. metabolism
ma
rdial
matitis
22. lymphology
25. ribosome
28. thyroiditis
2. cellular
5. erythrocytometer
8. symptomatic
11. chromatoplasm
14. embryopathology
17. endocellular
20. erythrocyte
23. psychobiology
26. hyperthyroidism
29. anatomy
3. molecular
6. erythrogenesis
9. immunology
12. erythrocyte
15. endocrinology
18. epithelial
21 .lymphoma
24. chromosomes
27. hypothyroidism
30. vasculolymphatic
Chapter 2

In this passage you will learn;
Human Body

●

Classification of organ systems
●

Structure and function of each organ system
●

Associated medical terms




To understand the human body it is necessary to understand how its parts are put together
how they function. The study of the body's structure is called anatomy; the study of the body's
function
is
known
as
physiology.
Other
studies
of
human
body
include
biology,
cytology,
embryology, histology, endocrinology, hematology immunology, psychology etc.
Anatomists
find
it
useful
to
divide
the
human
body
into
ten
systems,
that
is,
the
skeletal
system, the muscular system, the circulatory system, the respiratory system, the digestive system,
the urinary system, the endocrine system, the nervous system, the reproductive system and the
skin. The principal parts of each of these systems are described and illustrated in this article.
The skeletal system
is made of bones, joints between bones, and cartilage. Its function is to
provide
support
and
protection
for
the
soft
tissues
and
the
organs
of
the
body
and
to
provide
points
of
attachment
for
the
muscles
that
move
the
body.
There
are
206
bones
in
the
human
skeleton. They have various shapes
———
long, short, cube-shaped, flat, and irregular. Many of
the long bones have an interior space that is filled with bone marrow, where blood cells are made.
A
joint
is
where
bones
are
joined
together.
The
connection
can
be
so
close
that
no
movement is possible, as is the case in the skull. Other kinds of joints permit movement: either
back
and
forth
in
one
plane
———
as
with
the
hinge
joint
of
the
elbow
———
or
movement
around a single axis
———
as with the pivot joint that permits the head to rotate. A wide range of
movement
is
possible
when
the
ball-shaped
end
of
one
bone
fits
into
a
socket
at
the
end
of
another bone, as they do in the shoulder and hip joints.
Cartilage is a more flexible material than bone. It serves as a protective, cushioning layer
where bones come together. It also connects the ribs to the breastbone and provides a structural
base for the nose and the external ear. An infant's skeleton is made of cartilage that is gradually
replaced by bone as the infant grows into an adult.
The muscular system
allows the body to move, and its contractions produce heat, which
helps maintain a constant body temperature. Striated muscles can be consciously controlled. The
ends of these muscles are attached to different bones by connective tissue bands so that when the
muscle
contracts,
one
bone moves
in
relation
to
the
other.
This
makes
it
possible
to
move
the
whole body, as when walking, or to move just one part of the body, as when bending a finger.
Contractions
of
the
heart
and
smooth
muscles
are
not
under
conscious
control.
Smooth
muscles are found in the walls of organs such as the stomach and the intestines and serve to move
the con-tents of these organs through the body.
The circulatory system.
All parts of the body must have nourishment and oxygen in order
to
function
and
grow,
and
their
waste
products
must
be
removed
before
they
accumulate
and
poison the body. The circulatory system distributes needed materials and removes unneeded ones.
It is made up of the heart, blood vessels, and blood, which together make up the cardiovascular
system. The blood is also part of the body's defense system.
It has antibodies and white blood
cells that protect the body against foreign invaders.
The heart is a muscle that is divided into two nearly identical halves: one half receives blood
from the lungs and sends it to the rest of the body, the other half sends blood that has traveled
through the body back to the lungs. When the heart muscle contracts, the blood is forced out into
ar-teries and enters small capillaries. Blood returns to the heart through veins.
Also
functioning
in
circulation
is
the
lymphatic
system.
Some
of
the
fluid
that
surrounds
cells does not reenter the blood vessels directly. This fluid, called lymph, returns to the heart by
way of another system of channels
———
the lymph vessels. Lymph nodes along these vessels
filter the fluid before it reenters the blood. The spleen is a large lymphatic organ that filters the
blood.
The respiratory system
takes in oxygen from the air and expels carbon dioxide and water
vapor.
Air
enters
the
nose
and
mouth
and
travels
through
the
larynx,
and
trachea. The
trachea
divides to enter each of the two lungs and then divides more than 20 times to form a very large
number of small air spaces. Oxygen from the air enters the blood through capillaries in the walls
of these air spaces, and the blood releases carbon dioxide into the air spaces to be exhaled.
The digestive system
consists of a tube extending from the mouth to the anus .In it, food
and fluids are taken in, moved through the body, and broken down into small molecules that are
absorbed into the circulatory system. This breakdown, known as digestion, is both a mechanical
and a chemical process.
Food enters through the mouth, where chewing and saliva start to break it up and make it
easier
to
swallow.
Next,
the
food
travels
down
through
the
esophagus
to
the
stomach.
Contractions of the stomach's muscular wall continue to break down the food mechanically, and
chemical digestion continues when acid and enzymes are secreted into the stomach cavity.
The
liquified
food
gradually
passes
into
the
small
intestine.
In
the
first
part
of
the
small
intestine, called the duodenum, enzymes from the pancreas are added. These enzymes complete
the chemical breakdown of the food. The digestion of fat is aided by bile, which is made in the
liver and stored in the gall bladder. The small intestine of an adult is about 21 feet (6.4 meters)
long.
Most
of
its
length
is
devoted
to
absorbing
the
nutrients
released
during
these
digestive
activities.
The liquid remainder of the food enters the large intestine, or colon, which is about 12 feel
(3.7 meters) long. It is more than twice as wide as the small intestine. In the large intestine most
of the fluid is absorbed, and the relatively dry residues are expelled.
The urinary system
maintains normal levels of water and of certain small molecules such
as
sodium
and
potassium
in
the
body.
It
does
this
by
passing
blood
through
the
kidneys,
two
efficient
filtering
organs
that
get
rid
of
any
excess
of
various
molecules
and
conserve
those
molecules that arc in short supply.
The fluid that leaves the kidneys, known as urine, travels through a tube called the ureter to
the bladder. The bladder holds the urine until it is voided from the body through another tube, the
urethra.
The
endocrine
system.

The
two
systems
that
control
body
activities
are
the
endocrine
system and the nervous system. The former exerts its control by means of chemical messengers
called
hormones.
Hormones
are
produced
by
a
variety
of
endocrine
glands,
which
release
the
hormones directly into the blood stream.
A major gland is the pituitary, which is located under the brain in the middle of the head. It
produces at least eight hormones, which affect growth, kidney function, and development of the
sex organs. Because some of the pituitary's hormones stimulate other glands to produce their own
hormones, the pituitary is called the master gland.
Another gland, the thyroid, is located between the collar bones. Its hormone controls the rate
of the body's metabolism. The sex organs (ovaries and testes)make the sex cells and also make
hormones that control certain characteristics of males and females. Located on top of each kidney
is the adrenal gland, which produces cortisone and adrenaline. The pancreas produces not only
digestive
enzymes
but
also
insulin
and
glucagon,
which
control
the
body's
use
of
sugar
and
starches.
The nervous system

———
the brain, the spinal cord, and the nerves
———
also controls
body activities. The lower parts of the brain control basic functions such as breathing and heart
rate as well as body temperature, hunger, and thirst. Above these regions are the centers for sight,
sound,
touch,
smell,
and
taste,
and
the
regions
that
direct
voluntary
muscular
activities
of
the
arms and legs. Performed here are the higher functions of integrating and processing information.
The brain receives and sends information by means of nerves, many of which lie partly in
the
spinal
cord. The
spinal cord
is
protected
by
the
spinal
column. Nerves
enter
and
leave
the
spinal
cord
at
each
level
of
the
body,
traveling
to
and
from
the
arms,
legs,
and
trunk.
These
nerves
bring
information
from
the
various
sense
organs.
The
information
is
processed
by
the
brain, and then messages are carried back to muscles and glands throughout the body.
The
reproductive
system

is
constructed
differently
for
males
and
females.
The
male
reproductive system is responsible for producing, transporting and maintaining viable sperm (the
male
sex
cell).
It
also
produces
the
male
sex
hormone,
testosterone,
which
regulates
the
development
of
a
beard,
pubic
hair,
a
deep
voice
and
other
bodily
characteristics
of
the
adult
male.

The female productive system is responsible for producing and transporting ova (the female
sex cells), eliminating ova from the body when they are not fertilized by sperm, nourishing and
providing a place for growth of an embryo when an ovum is fertilized by sperm, and nourishing a
newborn child. The female reproductive system also produces the female sex hormones, estrogen
and progesterone , which regulate the development of breasts and other bodily characteristics of
the mature female.
The
skin

is
a
complete
layer
that
protects
the
inner
structures
of
the
body,
and
it
is
the
largest
of
the
body's
organs.
It
keeps
out
foreign
substances
and
prevents
excessive
water
evaporation.
The
nerves
in
the
skin
provide
tactile
information.
The
skin
also
helps
keep
the
body's
temperature
close
to
98.6
°
F
(about
37
°
C)
:
heat
is
conserved
by
reducing
blood
flow
through the skin or is expended by increasing blood flow and by evaporation of sweat from the
skin. Hair and nails are accessory structures of the skin.
New Words and Phrases
Exercises
A. Discuss the Following Topics:
1. Why do we study anatomy and physiology?
2. Suppose you were a professor of anatomy trying to introduce the human body to your students



at the first class, where would you like to begin and how would you like to proceed? (How



many systems are there in the human body? What are they?)
3. Give brief accounts of the structures and functions of each organ system.
B. Rewrite the following sentences in your own way and use phrases and expressions you




are familiar with.
For example:
The digestive system consists of a tube
extending from the mouth to the anus.
The digestive system begins at the mouth
and ends at the anus and the whole system
is described as a tube.

1. The skeletal system is composed of bones, joints between bones, and cartilage.
2. The contraction of the muscular system produces heat, which helps maintain a constant body




temperature.
3. The circulatory system distributes needed materials and removes unneeded ones.
4. The respiratory system takes in oxygen from the air and expels carbon dioxide and water




vapor.
5. This breakdown (of food) , known as digestion, is both a mechanical and a chemical process.
6. The urinary system maintains normal levels of water and of certain small molecules such as



sodium and potassium in the body.
7. A major gland is the pituitary, which is located under the brain in the middle of the head.
8. The information is processed by the brain, and then messages are carried back to muscles and


glands throughout the body.
9. The male reproductive system is responsible for producing, transporting and maintaining




viable sperm.
10. The skin is a complete layer that protects the inner structures of the body, and it is the largest



of the body's organs.
C. Put the following words or phrases into the following sentences and change the form if





necessary.
skeleton system
striated muscles
cartilage
ovum
residues
tactile
exhale
accessory
evaporation
antibody
1. The blood is also part of the body's defense system. It has ______ and leukocytes that protect
the body against foreign invaders.
2. The skin is a complete layer that protects the inner structures of the body and it is the largest of
the body's organs. Hair and nail are ______structures of the skin.
3.
The
human
skin
is
covered
with
plenty
of
nerves
and
any
touch
on
it
provides
______
information to the central nerve system.
4. The function of______is to provide support and protection for the soft tissues and the organs
of the body and to provide points of attachment for the muscles that move the body.
5 . When we breathe, we inhale fresh air with oxygen and ______carbon dioxide.
6. The body's temperature can be lowered by ______of sweat from the skin.
7. An infant's skeleton is made of ______ that is gradually replaced by bone as the infant grows




gradually replaced by bone as the infant grows into an adult.
8. _____ can be consciously controlled and therefore is called voluntary muscle.
9. When ______are not fertilized by sperm, they are to be eliminated from the body.
10. When liquid remainder of food enters the colon, most of the fluid is absorbed and the





relatively dry ______ are expelled.
D. Match Column I with Column n .
Column I
Column II
inner substance of bone that is responsible for producing blood cells
the physical and chemical processes by which living substance is maintained and
by which energy is produced
nourish substance
a blood vessel with a very slender, hairlike opening
chemical messengers or substance produced by various endocrine glands
a gland located between the collar bones and its secretion control the body's
metabolism
a soft, silverwhite, metallic chemical element that occurs in nature only in com-
pounds
a membranous and cartilaginous tube, commonly called windpipe
a protein substance produced in living cells, that influences a chemical reaction
within a plant or animal without being changed by itself
the study of blood

thyroid




[ 1 ]
metabolism



[ 2 ]
enzyme




[ 3 ]
potassium




[ 4 ]
trachea




[ 5 ]
capillary




[ 6 ]
bone marrow


[ 7 ]
hematology
[ 8 ]
nutrient





[ 9 ]

hormone






[10]

Chapter 3

Human Diseases
In this passage you will learn:
●

disease and pathology
●

the classification of diseases
●

germs' invasion of the human body
●

the body's defense against invasion
●

the body's immunity to diseases




The
brief
survey
of
the
human
body
in
Chapter
One
has
given
us
a
glimpse
into
two
different studies that are considered the fundamentals of medical sciences, namely anatomy and
physiology. However, the picture is not complete without considering pathology, the science that
deals
with
the
structural
and
functional
changes
produced
by
the
disease.
In
fact,
the
modem
approach
to
the
study
of
disorder
emphasizes
the
close
relationship
of
the
pathological
and
physiological aspects and the need to understand the fundamentals of each in treating any body
diseases.




Then what is a disease? It may be defined as a condition that impairs the proper function of
the
body
or
of
one
of
its
parts.
Every
living
thing,
both
plants
and
animals,
can
succumb
to
disease.
People,
for
example,
are
often
infected
by
tiny
bacteria,
but
bacteria,
in
turn,
can
be
infected by even more minute viruses.




Hundreds of different diseases exist. Each has its own particular set of symptoms and signs,
clues that enable a physician to diagnose the problem. A symptom is something a patient can de-
tect, such as fever, bleeding, or pain. A sign is something a doctor can detect, such as a swollen
blood vessel or an enlarged internal body organ.




Diseases can be classified differently. For instance, an epidemic disease is one that strikes
many persons in a community. When it strikes the same region year after year it is an endemic dis-
ease. An acute disease has a quick onset and runs a short course. An acute heart attack, for exam-
ple, often hits without warning and can be quickly fatal. A chronic disease has a slow onset and
runs a sometimes years-long course. The gradual onset and long course of rheumatic fever makes
it a chronic ailment. Between the acute and chronic, another type is called subacute.
Diseases
can
also
be
classified
by
their
causative
agents.
For
instance,
an
infectious,
or
communicable,
disease
is
the
one
that
can
be
passed
between
persons
such
as
by
means
of
airborne droplets from a cough or sneeze. Tiny organisms such as bacteria and fungi can produce
infectious diseases. So can viruses. So can tiny won-us. Whatever the causative agent might be, it
survives
in
the
person
it
infects
and
is
passed
on
to
another.
Sometimes,
a
disease-producing
organism gets into a person who shows no symptoms of the disease. The asymptomatic carrier
can then pass the disease on to someone else without even knowing he has it.
Noninfectious diseases are caused by malfunctions of the body. These include organ or tissue
degeneration, erratic cell growth, and faulty blood fonnation and flow. Also included are distur-
bances of the stomach and intestine, the endocrine system, and the urinary and reproductive sys-
tems. Some diseases can be caused by diet deficiencies, lapses in the body's defense system, or a
poorly operating nervous system.




Disability and illnesses can also be provoked by psychological and social factors. These ail-
ments include drug addiction, obesity, malnutrition, and pollution-caused health problems.




Furthermore, a thousand or more inheritable birth defects result from alternations in gene pat-
terns.
Since
tiny
genes
are
responsible
for
producing
the
many
chemicals
needed
by
the
body,
missing or improperly operating genes can seriously impair health. Genetic disorders that affect
body
chemistry
are
called
inborn
errors
of
metabolism.
Some
forms
of
mental
retardation
are
hereditary.
How Germs Invade the Body




Humans
live
in
a
world
where
many
other
living
things
compete
for
food
and
places
to
breed.
The
pathogenic
organisms,
or
pathogens,
often
broadly
called
germs,
that
cause
many
diseases
are
able
to
invade
the
human
body
and
use
its
cells
and
fluids
for
their
own
needs.
Ordinarily, the body's defense system can ward off these invaders.




Pathogenic organisms can enter the body in various ways. Some
——
such as those that cause
the
common
cold,
pneumonia,
and
tuberculosis
——
are
breathed
in.
Others
——
such
as
those
that
cause venereal diseases
——
enter through sexual contact of human bodies. Still others
——
such
as
those
that
cause
hepatitis,
colitis,
cholera,
and
typhoid
fever
——
get
in
the
body
through
contaminated food, water or utensils.
How the Body Fights Disease




Insects
can
spread
disease
by
acting
as
vectors,
or
carriers.
Flies
can
carry
germs
from
human waste or other tainted materials to food and beverages. Germs may also enter the body
through the bite of a mosquito, louse, or other insect vector.




As a first line of defense, a healthy body has a number of physical barriers against infection.
The skin and mucous membranes covering the body or lining its openings offer considerable resis-
tance to invasion by bacteria and other infectious organisms. If these physical barriers are injured
or
burned,
infection
resistance
drops.
In
minor
cases,
only
boils
or
pimples
may
develop.
In
major cases, however, large areas of the body might become infected.




Breathing passages are especially vulnerable to infection. Fortunately, they are lined with mu-
cus- secreting cells that trap tiny organisms and dust particles. Also, minute hairs called cilia line
the breathing passages, wave like a field of wheat, and gently sweep matter out of the respiratory
tract. In addition, foreign matter in the breathing passages can often be ejected by nose blowing,
coughing, sneezing, and throat clearing.

Unfortunately, repeated infection,

smoking and other
causes can damage the respiratory passageways and make them more susceptible to infection.




Many potential invaders cannot stand body temperature (98.6
°
F or 37
℃
). Even those that
thrive at that temperature may be destroyed when the body assumes higher, fever temperatures.




Wax in the outer ear canals and tears from eye ducts can slow the growth of some bacteria.
And stomach acid can destroy certain swallowed germs.




The body's second line of defense is in the blood and lymph. Certain white blood cells flock
to infected areas and try to localize the infection by forming pus-filled abscesses. Unless the abscess
breaks and allows the pus to drain, the infection is likely to spread. When this happens, the in-
fection is first blocked by local lymph glands. For example, an infection in the hand travels up
the
arm,
producing
red
streaks
and
swollen,
tender
lymph
glands
in
the
armpit.
Unless
the
infection is brought under control, it will result in blood poisoning.




Phagocytes
are
located
at
various
sites
to
minimize
infection.
One
type
in
the
spleen
and
liver
keeps
the
blood
clean.
Others
in
such
high-risk
areas
as
the
walls
of
the bronchi
and
the
intestines remove certain bacteria and shattered cells.
How We Become Immune to Disease




The
body
has
a
special
way
of
handling
infection.
It
has
a
system
that
fends
off
the
first
traces
of
an
infectious
substance
and
then,
through
a

gives
the
body
a
long- lasting
immunity against future attacks by the same kind of invader.




Many substances could harm the body if they ever entered it. These substances, or antigens,
range from bacteria and pollen to a transplanted organ (viewed by the body as an invader). To
fight them the body makes special chemicals known as antibodies.




Antibodies are a class of proteins called immunoglobulins. Each antibody is made of a heavy
chain of chemical subunits, or amino acids, and a light chain of them. The light chain has special
sites where the amino acids can link with their complements on the antigen molecule. When an an-
tibody hooks up with an antigen, it often puts the antigen out of action by inactivating or covering a
key portion of the harmful substance. In some cases, through the process of opsonization, antibod-
ies
antigens. Sometimes an antibody hooks to a bacterial antigen but needs an intermediate, or com-
plement,
to
actually
destroy
the
bacterium.
As
the
antibody-antigen
complex
circulates
in
the
blood, the complex
to eat through the bacterial cell wall and make the organism burst.





There are several kinds of immunoglobulins
——
IgM the largest; IgG
, the most plentiful and
versatile; and IgA, the next most plentiful and specially adapted to work in areas where body secre-
tions could damage other antibodies. Other immunoglobuhns are tied in with allergic reactions.
IgM is made at the first signs of an antigen. It is later supplanted by the more effective IgG
.
When infection first strikes, the immunity system does not seem to be working. During the
first day or so, antibodies against the infection cannot be found in the blood. But this is only be-
cause
the
basic
cells
involved
in
antibody
production
have
been
triggered
by
the
presence
of
antigen
to
multiply
themselves.
The
antibody
level
starts
to
rise
on
about
the
second
day
of
infection and then zooms upward. By the fifth day the antibody level has risen a thousandfold.
The first antibodies, the large IgM type, are not the best qualified to fight a wide range of
antigens, but they are particularly effective against bacteria. The more versatile lgG is circulating
in the blood on about the fourth day of infection. Its production is stimulated by the rising level
of
IgM
in
the
blood.
At
this
time,
IgM
production
drops
off
and
the
immunity
system
concentrates
on
making
IgG
.
The
IgG
type
of
antibody
sticks
well
to
antigens
and
eventually
covers
them
so
that
the
antigens
can
no
longer
stimulate
the
immune
response
and
IgG
production is switched off. This is an example of negative feedback control.
Exercises:
A. Discuss the following topics.
1. What is pathology? What does the modem approach to the study of disorder emphasize?
2. How can a disease be classified?
3. How germs enter the human body?
4. How does the human body fight against diseases?
5. Describe the function of antibodies.
6. Imagine that you were on a lecture tour speaking on the importance of vaccination before a
group of maternal and child health workers in Tibet. Your task is to make them understand the
theory of vaccination.
B. Put the following words or phrases into the following sentences and change the form if
necessary.
endemic disease
minimize
susceptible to
potential
assume
succumb to
acute diseaso
addiction
mental retardation
provoke
ward off
epidemic disease
1. When the same disease strikes a region or district year after year, we call it







.
2. Disability and illnesses can be







not only by infectious and noninfectious diseases, but
also by psychological and social factors. A typical example is drag







.
3.
All
living
things,
animal
or
plant,
can







diseases,
but
a
good
health
care
system



does







the rate of death.
4. Normally a healthy person's defense system can







infection, but the old and weak are
especially vulnerable to diseases.
5. Marriage among relatives may result in
















.
6.














，
such as heart attack, usually has a sudden and violent onset, but it can be
cured in a few days if treated timely.
7.
Persons










AIDS
are
often
those
who
are
drug
addicts
or
those
who
have
sexual
contact with those who are HIV carriers.
8. Many










invaders of the bocly cannot bear body temperature and those who survive
and thrive will be destroyed when the body










higher, fever temperature.
9. When a large number of cases of the same communicable disease occurs during a single period
of time, it is termed as





















.
C. Fill in each blank with one proper word; try not to look back at the passage until you
have finished this.

Diseases can also be classified by their causative agent. For instance,
an infectious, or


(1)


disease is the one that can be passed
between persons such as by


(2)


of airborne droplets from a
cough or sneeze.
Tiny


(3)


such as bacteria and fungi can produce infectious
diseases, So can


(4)


So can tiny worms. Whatever the
causative agent might be, it survives in the person it infects and is



(5)


on to another.
Sometimes, a disease-producing organism gets into a person who
shows no


(6)


of the disease. The asymptomatic carrier can
then pass the disease on to someone else


(7)


even knowing he
has it.



(8)


diseases are caused by malfunctions of the body, These
include organ or tissue degeneration, erratic cell growth, and faulty
blood


(9)


and flow.
Also


(10)


are disturbances of the stomach and intestine, the
endocrine system, and the urinary and reproductive systems. Some diseases
can be caused by diet deficiencies, lapses in the body's defense system, or a
(10)








(8)








(9)








(6)








(7)








(3)








(4)








(5)








(1)








(2)








poorly operating nervous system.
D. Match Column
Ⅰ

with Column
Ⅱ
.
Column
Ⅰ
















Column
Ⅱ

sign



first line of defense
second line of defense
abscess






pathogen








antigen
chronic disease







symptom









vector
infectious diseases
noninfectious diseases
birth defect
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
cholera, hepatitis, typhoid fever
germs, virus or fungi
carrier
high fever
the skin and mucous membrane
Alzheimer's disease
high body temperature
a result of change in gene patterns
erratic cell growth
substance which causes the formation in the blood of another sub-
stance, antibody
the blood and lymph
a swelling filled with pus in or on the body
E. Translate the following into Chinese
1. Each antibody is made of a heavy chain of chemical subunits, or amino acids, and a light
chain of them. The light chain has special sites where the amino acids can link with their com-
plements on the antigen molecule.
2.
In
some
cases,
through
the
process
of opsonization, antibodies

the
surface
of
some
antigens and make them
3. Sometimes an antibody hooks to a bacterial antigen but needs an intermediate, or complement,
to actually destroy the bacterium. As the antibody-antigen complex circulates in the blood, the
complex
4. During the first day or so, antibodies against the infection cannot be found in the blood. But
this is only because the basic cells involved in antibody production have been triggered by the
presence of antigen to multiply themselves.
F. Translate the following into English.
损害正常功能

污染环境

功能失调

致病因子

易受侵害的人群

局部化的感染

花柳病

抗原与抗体


Chapter 4
The Digestive System
In this passage you will learn:
●

The digestive system as a whole
●

Anatomy and physiology of the major organs in the digestive system
●

Associated medical terms
Introduction.

The
digestive
system,
also
called
the
gastrointestinal
or
alimentary
canal,
contains the organs involved in the ingestion and processing of food. The primary functions of
the digestive system are: ingestion
—
the entry of food into the body digestion
—
the physical and
chemical breakdown of food into nutrients that can be used by the body's cells; absorption
—
the
passage
of
these
nutrients
from
the
gastrointestinal
tract
into
the
bloodstream;
and
elimination
—
the excretion of solid waste materials that cannot be absorbed into the blood.

Anatomy
and
Physiology.
Anatomically,
the
digestive
system
consists
of
a
30-foot
long,
mucous membrane-lined tube beginning with the mouth, where food enters the body, and ending with
the anus, where solid waste is excreted. The digestive system is composed of 9 main organs: mouth,
pharynx, esophagus, stomach, small intestine, large intestine, liver, gallbladder and pancreas. The liver,
gallbladder, and pancreas are also called accessory organs of the digestive system. Although food does
not pass through these organs,
they
aid in the processing
of food and nutrients. The organs of
the
digestive system are illustrated in Figure 5-1 and described in the paragraphs below
.
Figure 5-1

The oral cavity.
The process of digestion begins in the mouth, also called the buccal cavity,
which
is
the
opening
through
which
food
enters
the
body.
The
mouth
has
the
ability
to
mechanically
reduce
the
size
of
the
food
that
is
placed
in
it.
The
lips
form
the
opening
to
the
mouth, while the cheeks or bucca form the borders of the oral cavity. The structures within the
oral cavity including the teeth, tongue, and palate, are involved in the chewing (mastication) and
swallowing (deglutition)of food. They also play a role in speech.
The
teeth
are
used
to
cut,
tear,
and
crush
food
into
smaller
pieces.
They
are
classified
mainly by their shapes and locations. Incisors and cuspids are in front of the mouth; molars are in
the back. Each tooth consists of a mass of nerves and blood vessels, called pulp, surrounded by a
hard
substance
called
cementum
and
a
white
smooth
substance
called
enamel.
The
teeth
are
embedded in fleshy tissue called gums or gingivae. Together, the gums and other structures that
support the teeth are known as the periodontium. Humans have two sets of teeth, the deciduous
dentition of child-hood , which fall out and are replaced by the permanent dentition of adulthood.
The
tongue

extends
across
the
floor
of
the
oral
cavity
and
is
attached
by
muscles
to
the
lower jaw bone. It manipulates food in the mouth during mastication and deglutition. The tongue
is covered with a series of cone-shaped small projections called papillae in which there are taste
buds that can sense flavors, such as sweet, bitter, salty, and sour.
The palate
forms the roof of the mouth. It is divided into two parts; the hard palate and the
soft
palate.
The
hard
palate
forms
the
anterior
portion
of
the
mouth,
while
the
soft
palate
lies
posterior to it. Hanging from the soft palate is a small tissue called the uvula. The word uvula
means
little
grape.
Around
the
oral
cavity
are
three
pairs
of
salivary
glands.
These
exocrine
glands
produce
a
fluid
called
saliva,
which
is
released,
from
the
parotid
gland,
submandibular
gland and sublingual gland on each side of the mouth.
During swallowing, the soft palate and
uvula move upward to prevent food from entering the nasal cavity, the uvula also helps to guide
the food into the pharynx.
The pharynx,
or throat, is a long muscular tube that serves as a passageway for food from
the
mouth
to
the
esophagus
and
as
a
passageway
for
air
from
nose
to
the
windpipe
(trachea).
When
swallowing
occurs,
a
flap
of
tissue,
the
epiglottis,
covers
the
trachea
so
that
food
can
't
enter and becomes lodged there.
The esophagus
is a long muscular tube extending from the pharynx to the stomach. Food is
propelled by rhythmic contractions of muscles in the wall of the esophagus. This process, called
peristalsis,
is
also
how
food
is
moved
through
the
stomach
and
intestines.
It
is
something
like
squeezing a marble (bolus of food) through a rubber tube.
The stomach,
a pouch-like organ located in the upper part of the abdominal cavity, connects
the esophagus with the small intestine. It is composed of an upper portion called fundus, a middle
section
known
as
the
body,
and
a
lower
portion,
called
the
antrum.
Entry
of
food
from
the
esophagus into the stomach is controlled by a
ring of
muscles known as the cardiac sphincter.
The cardiac sphincter relaxes and contracts to move food from the esophagus into the stomach,
whereas the pyloric sphincter allows food to leave the stomach when it has sufficiently digested.
When
the
stomach
is
empty,
the
mucous
membranes
lining
its
walls
are
highly
folded;
buried
within
these
folds,
or
rugae,
are
numerous
digestive
glands.
As
the
stomach
fills,
the
nigae
unfolded, exposing the digestive glands and stimulating them to secrete digestive enzymes and
hydrochloric acid. These substances help transform food present in the stomach into a semifluid
substance called chyme. The pyloric sphincter allows food to pass into the small intestine only
after it has been transformed into chyme.
The small intestine
(small bowel) is the region of the gut where nearly all of the chemical
digestion of the nutritional components of food takes place. It is a coiled long tube that winds
from the pyloric sphincter of the stomach to the beginning of the large intestine, filling much of
the
abdominal
cavity.
By
convention,
the
small
intestine
is
divided
into
three
sections.
(l)The
duodenum,
which
is
only
a
25cm
section,
receives
chyme
from
the
stomach,
helps
regulate
gastric emptying. (2) The jejunum, the central section, is the primary absorptive region. (3) The
last section, the ileum is attached to the large intestine. In the wall of the entire small intestine are
millions of tiny, microscopic projections called villi. It is through the capillaries in the villi that
completely digested nutrients pass into the bloodstream and lymph vessels. Materials that cannot
be absorbed pass from the small intestine to the large intestine.
The
large
intestine.

Compared
with
the
small
intestine,
the
large
intestine
is
relatively
inactive
and
has
much
less
functions.
Extending
from
the
end
of
the
ileum
to
the
anus,
It
is
divided into four parts: cecum, colon, sigmoid colon and rectum.
The cecum,
a pouch on the right side, is connected to the small intestine by the ileocecal
valve, which controls the passage of fluid waste from the small intestine into the large intestine.
Hanging off from the cecum is the appendix, a small organ with no clear function.
The colon
, which comprised the main length of the large intestine, has three divisions. The
ascending colon, extending from the cecum to the upper abdominal area. The transverse colon
passes
horizontally
to
the
left
toward
the
spleen
and
turns
downward
(splenic
flexure)
to
the
descending
colon.
The
sigmoid
colon,
shaped
like
an
S,
is
at
the
distal
end
of
the
descending
colon
and
leads
into
the
rectum.
As
fluid
waste
from
the
small
intestine
passes
through
the
various sections of the colon, water is reabsorbed into body. As a result, the fluid waste turns into
a solid material known as stool or feces.
The
rectum

serves
as
a
reservoir
for
feces.
It
terminates
in
the
lower
opening
of
the
gastrointestinal
tract,
the
anus,
which
is
the
external
opening
through
which
feces are
released
from the body.
Accessory digestive organs.
Three important accessory organs of the digestive system are
the liver, gallbladder, and pancreas. Although food does not pass through these organs, each plays
an indispensable role in the proper digestion and absorption of nutrients.
The liver,
a large glandular organ located in the upper right quadrant of abdomen, produces
agreenish fluid called bile. Bile contains cholesterol, bile acids and bile pigments. It has a deter-
gent-like effect on fats. It breaks apart large fat globules so that enzymes from the pancreas
can digest the fats. This action is called emulsification. Bile produced in the liver passes through
the hepatic duct to the cystic duct and into the gallbladder. Besides producing bile, the liver has
several
other
vital
functions.
It
manufactures
blood
proteins,
destroys
old
erythrocytes
and
releases bilirubin, removes poisons ( detoxification) from the blood, stores and releases glycogen
needed by the body.
The gallbladder,
a pear-shaped sac behind the lower portion of the liver, stores bile, which
is continuously secreted by the hepatic cells between meals. When the stomach and duodenum
are full, the gallbladder contracts, forcing bile to pass through the cystic duct to the common bile
duct and into the duodenum where it helps in digestion.
The
pancreas,
an
elongated
organ
just
behind
the
stomach,
manufactures
digestive
juice
containing enzymes (amylase and lipase)that aid in the digestion of proteins, starches and fats.
These digestive juices pass into the duodenum via the pancreatic duct. The pancreas also secretes
insulin and glucagon. Those hormones are needed to help release sugar from the blood to be used
for energy by the cells of the body.
Conclusion.
Our
digestive
system
kicks
in
the
minute
food
enters
our
mouths.
Moving
through the digestive tract
———
down the esophagus, into the stomach, ending up in the small
intestine
——
food is chemically broken down into smaller molecules, and nutrients are absorbed
into the body. From here, solid wastes move into the colon, where they remain for a day or two
until they are passed out of the body.
New Words and Phrases
Exercises
A. Discuss the following topics:
1. What are the primary functions of the digestive system?
2. Imagine you were lecturing in front of rural health workers on the topic of digestive




system, draw a picture to illustrate the whole system.
3. Give brief accounts of the structures and functions of each organ?
B. Rewrite the following sentences in your own way and use phrases and expressions you
are familiar with.
For example:
The mouth has the ability to
By mechanical movement, the






































>
mechanically reduce the size of
mouth is able to break down the






































>
the food that is placed in it.
food inside into smaller pieces.
1.
Although
food
does
not
pass
through
these
organs,
they
aid
in
the
processing
of
food
and
nutrients.
2. The pharynx, or throat, is a long muscular tube that serves as a passageway for food from the
mouth to the esophagus and as a passageway for air from nose to the windpipe.
3. The tongue extends across the floor of the oral cavity and is attached by muscles to the lower
jaw bone.
4. The teeth are embedded in fleshy tissue called gums or gingivae.
5. When the stomach is empty, the mucous membranes lining its walls are highly folded; buried
within these folds, or rugae, are numerous digestive glands.
6. The esophagus is a long muscular tube extending from the pharynx to the stomach.
7. Food is propelled by rhythmic contractions of muscles in the wall of the esophagus.
8. The small intestine is a long coiled tube that winds from the pyloric sphincter of the stomach to
the beginning of the large intestine.
9. The sigmoid colon, shaped like an S, is at the distal end of the descending colon and leads into
the rectum.
10. Bile has a detergent-like effect on fats. It breaks apart large fat globules so that enzymes from
the pancreas can digest the fats.
C. Put the following words or phrases into the following sentences and change the form if
necessary.
incisors and cuspids
pyloric sphincter
peristalsis
antnim
glucagon
rectum
deciduous
accessory
emulsification
small intestine

1. The teeth are classified mainly by their shapes and locations: ______ are in front of the mouth;
molars are in the back.
2.
Human
beings
have
two
sets
of
teeth,
the
______dentition
of
childhood
and
the
permanent
dentition of adulthood.
3.
Food
is
propelled
by
rhythmic
contractions
of
muscles
in
the
wall
of
the
peptic
tract.
This
process is called ______ .
4. The stomach is composed of three portions: fundus, the body, and the ______.
5. The cardiac sphincter relaxes and contracts to move food from the esophagus into the stomach,
whereas the ______allows food to leave the stomach and pass into the small intestine
6. Nearly all of the chemical digestion of the nutritional components of food takes place in the __
7. The liver, gallbladder, and pancreas are important ______organs of the digestive system.
8. Bile breaks apart large fat globules to help digest the fats. This action is called ______.
9. The pancreas secretes insulin and ______. Those hormones are used for energy by the cells of
the body.
10.
The
_______
serves
as
a
reservoir
for
feces.
It
terminates
in
the
lower
opening
of
the
gastrointestinal tract, the anus.
D. Match Column I with Column II .
Column I
Column II
bile
[1] The waste material eliminated from the intestine; stool
duodenum
[2] A mass, such as the rounded mass of food that is swallowed
feces
[3] The fluid secreted by the liver that aids in the digestion and absorption of fats
ileum
[4] The large folds in the lining of the stomach seen when the stomach is empty
bolus
[5] The first portion of the small intestine
deglutition
[6] Chewing
gallbladder
[7] A hanging fleshy mass. Usually means the mass that hangs from the soft palate
mastication
[8] Swallowing
rugae
[9] The terminal portion of the small intestine
uvula
[10] A sac behind the lower portion of the liver that stores bile
E. Fill in the blanks with the missing terms for the organs of the digestive system.
Your digestive system consists of organs that break down food into components which
(1)












your
body
uses
for
energy
and
for
building
and
repairing
cells
and
tissues.
With
the
(2)












contraction
of
the
muscles
that
line
the,
alimentary
canal,
food
is
propelled
down
(3)












through the digestive system. The process begins in the mouth.
(4)












Food
passes
down
the

(1)

through
a
muscular
tube
called
the

(2)
,
and
into
a
big
(5)












container
called
the
stomach,
where
food
continues
to
be
broken
down.
After
its
trip
(6)












down the stomach, the partially digested food passes into a short tube called the (3)


The jejunum and the

(4)

are also parts of the small intestine.
substances that help with digestion.
The
large
intestine
is
where
the
remaining
chyme
goes
after
the
nutrients
have
been
removed. It includes the (7) , colon, and the (8)

The
(9)
is a branch off the large intestine, which has no known function. Now water
is
removed
from
this
undigested
material.
The
remaining
product
is
called
feces
and
(7)












(8)












(10)











Meanwhile,
the
accessory
organs
the
liver,

(5)

and
the

(6)
produce
enzymes
and
(9)












eliminated through the rectum and __(10) _



F. Translate the following into English.
1.
牙周组织






























2.
唾液腺
























3
．口腔























5
．贲门括约肌

















7
．消化道





















9
．锥形的突起

















11
．会厌






















13
．乙状结肠


















15
．舌下腺




















17
．下颌下腺


















19
．回盲瓣




















4
．升结肠
























6
．乳化作用






















8
．脾弯曲
























10
．似袋状的器官

















12
．十二指肠





















14
．幽门括约肌



















16
．蠕动

























18
．解毒作用





















20
．胰岛素






















Pasorders Two Disorders of the Digestive System
In this passage, you will learn:






●

Some of the major disorders of the Digestive System: their symptoms and signs,













causes, examinations and treatments






●

Medical terms pertaining to the diseases of the digestive system
Each
year
62
million
Americans
are
diagnosed
with
digestive
disorders,
ranging
from
the
occasional upset stomach to the more life- threatening colon cancer. They encompass disorders of
the gastrointestinal tract, as well as the liver, gallbladder, and pancreas. Most digestive diseases
are very complex, with subtle symptoms, and the causes of many remain unknown. They may be
inherited
or
develop
from
multiple
factors
such
as
stress,
fatigue,
diet,
or
smoking.
Abusing
alcohol imposes the greatest risk for digestive diseases.
The first organ of digestion is the
mouth. Disorders of
the mouth are
very serious
because
they can inhibit
ingestion of food. The main threat to the mouth and the teeth is gum disease,
such as gingivitis. The disease is caused by bacterial plaque built up in the mouth. With these
gums
becoming
inflamed,
teeth
are
loosen
and
shifted,
causing
eating
painful.
As
a
result,
a
person is unable to consume the proper food and nutrients that the body needs.
Peptic ulcer
is among the most common conditions affecting the upper digestive tract. It is
caused by
the damaging action of digestive juice on the lining of the GI tract (gastrointestinal
tract).It can cause bleeding, pain, vomiting, perforation, obstruction if not properly treated. Most
people thought that ulcer is caused by stress. This is now known to be wrong. Two major causes
are: (1) infectionwith a bacterium (HP) (2) the use of NSAIDs (nonsteroidal anti-inflammatory
drugs) such as aspirin, Advil, naproxen, etc. H. pylori is a bacterial infection of the stomach that
does
not
cause
any
problem
until
a
person
develops
ulcers.
Current
treatment
includes
the
administration
of
drugs
that
block
the
action
of
histamine
which
stimulates
gastric
secretion.
Peptic Ulcers may lead to hemorrhage or to perforation of the wall of the digestive tract. It can be
diagnosed by endoscopy and by x-ray studies of the upper gastrointestinal tract using a contrast
medium,
usually
barium.
Other
conditions
include
hiatal
hernia,
gastritis
and
cancer
of
the
stomach.
A
hiatal
hernia
is the
protrusion
of
part
of
the
stomach
moves
upward
into
the
chest
cavity through an abnormal opening in the diaphragm. This may be diagnosed through ultrasound
or x-ray. The disorder may be life threatening and should be treated immediately.
Liver
is
one
of
the
most
important
organs
in
the
body.
It
is
specially
designed
to
perform
many
essential
functions.
-However,
its
distinctive
characteristics
and
activities
render
it
susceptible
to
damage
from
a
variety
of
sources.
Hepatitis

is
a
general
term
denoting
the
inflammation
and
damage
of
the
liver.
Liver
injury
results
in
the
elevation
of
liver
enzymes,
which is detected by simple blood test. There are several known types of hepatitis virus, but the
main ones are hepatitis A virus (HA
V)and hepatitis B virus (HBV). Type A is spread by fecal-oral
contamination, often by food handlers and in crowded, unsanitary conditions. Type B is caused
by
blood
and
blood
products,
and
may
also
be
transmitted
sexually.
Individuals
nay
become
carriers of the disease. Most cases of hepatitis following transfusion are now caused by type C.
The
ultimate
danger
of
chronic
liver
disease
is
the
development
of
cirrhosis
with
its
complications and liver cancer. Cirrhosis is a chronic liver disease characterized by hepatomgaly,
edema, and jaundice. It is the endpoint of many chronic liver diseases, since inflammation and
death eventually yield to fibrosis, or scar formation. Cirrhosis involves irreversible damage to the
lobular
architecture,
with
diffuse
bands
of
scar
tissue
surrounding
nodules
of
regenerating
hepatocytes.
With
a
pathologic
diagnosis
based
on
liver
biopsy,
cirrhosis
is
described
as
micronodular if the nodule diameter is less than 3 mm and macronodular if it is more than 3 mm.
Patients with cirrhosis have significantly shortened life spans and are at risk for decompensation
and hepatic failure, as well as the development of hepatocellular carcinoma.
Cholelithiasis
refers to the condition of having stones in the gallbladder or bile ducts, which
is usually associated with cholecystitis, inflammation of the gallbladder. Most of these stones are
composed of cholesterol, an ingredient of bile. Women are more likely than men to develop the
disease,
especially
in
those
taking
oral
contraceptives
and
those
who
have
had
several
pregnancies. The condition is characterized by biliary colic in the right upper quadrant, nausea,
and
vomiting.
Drugs
may
be
used
to
dissolve
gallstones,
but
often
the
cure
is
removal
of
the
gallbladder.
Such
a
cholecystectomy
is
traditionally
performed
through
a
major
abdominal
incision, but a newer method for removing the gallbladder with a laparoscope through a small
incision in the abdomen is now in use. Pancreatitis is either an acute or chronic inflammation of
the
pancreas.
If
you
think
about
all
the
enzymes
the
pancreas
normally
produces,
you
will
appreciate
the
damage
that
the
pancreas
can
cause.
It
can
cause
paralytic
ileus,
pancreatic
autodigestion
necrosis
and
edema.
Patients
usually
have
severe,
constant,
epigastric
pain
that
radiates to the back. In the United States, gallstones and alcohol are major causes of pancreatitis.
The disease often subsides with only treatment of the symptoms.
Appendicitis

occurs
in
all
age
group,
but
is
most
common
between
the
ages
of
5
and
30.
Symptoms typically begin with discomfort in the navel area that shifts into a steady, sharp pain in
the lower right abdomen. A lower-grade fever may be present along with nauseated vomiting and
loss of appetite. An inflamed appendix is usually surgically removed
——
delay in treatment may
cause the appendix to rupture, resulting peritonitis (infection of the abdominal cavity) . This is a
potentially life-threatening complication that requires intensive antibiotic therapy.
The term
disease (IBD):
Crohn's disease
and
ulcerative colitis
, both of which occur mainly in adolescents
and young adults. The first is a chronic inflammation of segments of the intestinal wall causing
pain, abscess, and often fistula formation. Sometimes Crohn 's disease can cause blockages in the
intestine and, if medical treatment is not working, surgery may be considered. Other people may
have areas of narrowing in the small intestine, which can be surgically widened or stretched to
relieve
the
obstruction.
Ulcerative
colitis
encompasses
a
spectrum
of
diffuse,
continuous,
superficial
inflammation
of
the
colon
that
begins
within
the
rectum
and
extends
to
a
variable
level. Treatment depends on the extent and severity of the condition. A mild attack may be treated
with
steroids
directly
into
the
back
passage,
by
an
enema
or
suppositories.
For
severe
attack,
steroids
may
be
given
directly
into
a
vein.
If
the
drug
does
not
work,
surgery
may
eventually
be'suggested.
Diverticula
are
small
pouches
in
the
wall
of
the
intestine,
most
commonly
in
the
colon.
if
present in large number, the condition is determined
diverticulosis
, which has been attributed to
a diet low in fiber. Collection of waste and bacteria in these sacs leads to diverticulitis, which is
accompanied
by
pain
and
sometimes
bleeding.
The
disease
is
common
in
developed
or
industrialized
countries-,
particularly
in
the
United
States,
England,
and
Australia
where
low-fiber diets are common. It is rare in countries of Asia and Africa, where people eat high-fiber,
vegetable diets.
Diverticulitis
can be seen by x-ray studies using a contrast medium, a so-called
barium enema. Although there is no cure, diverticulitis is treated with diet, stool softeners, and
drugs to reduce motility.
The most common sites for cancer of the GI tract are the colon and rectum. Together these
colorectal cancers rank among the most frequent causes of deaths in the United States. A diet low
in fiber and calcium and high in fat is a major risk factor in colorectal cancer. Heredity is also a
factor, as is chronic inflammation of the colon. Polyps (growths) in the intestine often become
cancerous and should be removed. Often this can be accomplished by endoscopy. Bleeding into
the
intestine
is
a
sign
of
cancer
and can
be
tested
for
in
the
stool.
Because
this
blood
may
be
present
in
very
small
amounts
it
is
described
as
occult
blood.
Colorectal
cancers
are
staged
according to Dukes' classification, ranging from A to D according to severity. The interior of the
intestine can be observed with various endoscopes named for the specific area in which they are
used, such as proctoscope (rectum) , sigmoidoscope (sigmoid colon) , or colonoscope (colon). In
some areas of cancer, it may be necessary to surgically remove a portion of the gastrointestinal
tract and create a stoma (opening) on the abdominal wall for elimination of waste. Such ostomy
surgery is named for the organ involved, such as ileostomy (ileum)or colostomy (colon) . When a
connection is formed between two organs of the tract, both are included in naming, for instance,
gastroduodenostomy (stomach and duodenum) or coloproctostomy (colon and rectum).
New Words and Phrases
Chapter 5
Respiratory System
In this passage you will learn:






●

The organs of the respiratory system






●

The structure and eunction of these organs






●

The mechanism of breathing






●

The gas transport and cleaning system




All living animals must take in oxygen and get rid of carbon dioxide. In the vertebrates
——

animals
with
backbones
——

that
get
their
oxygen
from
the
air,
both
tasks
are
performed
by
special gas-exchange organs called lungs. The lungs provide a place where oxygen can reach the
blood and carbon dioxide can be removed from it. They are equipped with tubes and a bellows
system for drawing in air from the outside, while the pulmonary veins and arteries circulate blood
through from inside. The lungs also have a cleaning system that traps, ejects, or destroys irritants
and other harmful substances that travel in with the air.




In the simpler cold-blooded amphibians and reptiles, the lungs are two balloon-like sacs. In
active
animals
that
require
large
amounts
of
oxygen,
especially
the
warm-blooded
birds
and
mammals , the lungs are a spongy labyrinth of sacs that supply an enormous surface area for the
transfer of gases. In the adult human the total lung surface, if flattened out, would be larger than a
badminton court, about 100 square yards (83 square meters).




Air enters the body through the nose and passes through the nasal cavity, which is lined with
a mucous membrane and fine hairs (cilia) to help filter out foreign bodies, as well as to warm and
moisten
the
air.
Paranasal
sinuses
are
hollow,
air-containing
spaces
within
the
skull
that
communicate with the nasal cavity. They, too, have a mucous membrane lining and function to
provide the lubricating fluid mucus. as well as to lighten the bones of the skull and help produce
sound.




After passing through the nasal cavity, the air next reaches the pharynx (throat). There are
three divisions of the pharynx. The nasopharynx is the first division, and it is nearest to the nasal
cavities.
It
contains
the
adenoids,
which
are
masses
of
lymphatic
tissue.
The
adenoids
(also
known
as
the
pharyngeal
tonsils)
are
more
prominent
in
children,
and
if
enlarged,
they
can
obstruct air passageways . Below the nasopharynx and closer to the mouth is the second division
of the pharynx, the oropharynx. The palatine tonsils, two rounded massed of lymphatic tissue, are
located in the oropharynx. The third division of the pharynx is the hypopharynx (also called the
laryngopharynx).





It is in the hypopharyngeal region that the pharynx, serving as a common passageway for
food from the mouth and air from the nose, divides into two branches, the larynx (voice box) and
the esophagus.




The esophagus leads into the stomach and carries food to be digested. The larynx contains
the vocal cords and is surrounded by pieces of cartilage for support. Sounds are produced as air is
expelled past the vocal cords, and the cords vibrate. The tension of the vocal cords determines the
high or low pitch of the voice.




Since food entering from the mouth and air entering from the nose mix in the pharynx, what
prevents
the
passing
of
food
or
drink
into
the
larynx
and
respiratory
system
after
it
has
been
swallowed?
Even
with
a
small
quantity
of
solid
or
liquid
matter
finding
its
way
into
the
air
passages, breathing could be seriously blocked. A special deterrent to this event is provided for
by a flap of cartilage attached to the root of the tongue that acts like a lid over the larynx. This
flap of cartilage is called the epiglottis. The epiglottis lies over the entrance to the larynx. In the
act
of
swallowing,
when
food
and
liquid
move
through
the
throat,
the
epiglottis
closes
off
the
larynx, so that these things cannot enter.




On its way to the lungs, air passes from the larynx to the trachea (windpipe), a vertical tube
about 4
1
2

inches long and 1 inch in diameter. The trachea is kept open by 16-20 C-shaped rings
of cartilage separated by fibrous connective tissue that stiffens the front and sides of the tube. In
the
region
of
the
mediastinum,
the
trachea
divides
into
two
branches
called
bronchi.
Each
bronchus
leads
to
a
separate
lung
and
divides
and
subdivides
into
smaller
and
finer
tubes,
somewhat like the branches of a tree (see Figure 6-1) .




























Diaphragm
Figure 6-1




The smallest of the bronchial branches are called bronchioles. At the end of the bronchioles
are clusters of air sacs called alveoli. Each alveolus is made of a one-cell layer of epithelium. The
very
thin
wall
allows
for
the
exchange
of
gases
between
the
alveolus
and
the
capillaries
that
surround and come in close contact with it. The blood that flows through the capillaries accepts
the
oxygen
from
the
alveolus
and
deposits
carbon
dioxide
into
the
alveolus
to
be
exhaled.
Oxygen is combined with a hemoglobin in erythrocytes and carried to all parts of the body.




Each lung is enveloped in a double-folded membrane called the pleura. The outer layer of
the pleura, nearest the ribs, is the parietal pleura, and the inner layer, closest to the lung, is the
visceral pleura. The pleura is moistened with a serous secretion that facilitates the movements of
the lungs within the thorax.




The two lungs are not quite mirror images of each other. The right lung, which is the slightly
larger of the two, is divided into three lobes, or divisions, and the left lung is divided into two
lobes. It is possible for one lobe of the lung to be removed without damage to the rest, which can
continue to function normally; The uppermost part of the lung is called the apex, and the lower
area is the base. The hilum of the lung is the midline region where blood vessels, nerves, and
bronchial tubes enter and exit the organ.




The
lungs
extend
from
the
collarbone
to
the
diaphragm
in
the
thoracic
cavity.
The
diaphragm is a muscular partition that separates the thoracic from the abdominal cavity and aids
in
the
process
of
breathing.
The
diaphragm
contracts
and
descends
with
each
inhalation
(inspiration) .The downward movement of the diaphragm enlarges the area in the thoracic cavity
and
reduces
the
internal
air
pressure,
so
that
air
flows
into
the
lungs
to
equalize
the
pressure.
When
the
lungs
are
full,
the
diaphragm
relaxes
and
elevates,
making
the
area
in
the
thoracic
cavity smaller, and thus increasing the air pressure in the thorax. Air then is expelled out of the
lungs to equalize the pressure; this is called exhalation (expiration) . Other parts are also involved
in
the
process.
The
cycle
of
respiration
really
begins
when
the
phrenic
nerve
stimulates
the
diaphragm to contract and flatten. Also, the intercostal muscles between the ribs aid in inspiration
by
pulling
the
ribs
up
and out.
The
measure
of
how
easily
the
lungs
expand
under
pressure
is
compliance.




Breathing
is
regulated
unconsciously
by
center
in
the
brainstem.
These
centers
adjust
the
rate and rhythm of breathing according to changes in the composition of the blood, especially the
concentration of carbon dioxide.




Gas Transport.
Oxygen is carried in the blood bound to hemoglobin in red blood cells. The
oxygen is released to the cells as needed. Carbon dioxide is carried in several ways, but is mostly
converted
to
an
acid
called
carbonic
acid.
The
amount
of
carbon
dioxide
that
is
exhaled
is
important
in
regulating
the
acidity
or
alkalinity
of
the
blood.
If
too
much
carbon
dioxide
is
exhaled
by
hyperventilation,
body
fluids
tend
to
become
more
alkaline,
a
condition
termed
alkalosis. If too little carbon dioxide is exhaled as a result of hypoventilation, body fluids tend to
become more acid, a condition termed acidosis.
The
cleaning
system

of
the
lungs
has
four
main
components.
Lining
the
trachea
and
bronchial
tree
are
cells
that
secrete
mucus,
which
traps
pollutants
and
bacteria.
Also
in
the
bronchi are cells containing tiny cilia, that project into the blanket of mucus and with constant
wavelike
motions
push
the
mucus
up
out
of
the
airways.
Irritating
chemicals,
stagnant
and
excessive mucus, and large bits of foreign matter are forcibly ejected as sputum from the bronchi
by
a
cough.
This
third
important
cleaning
device
——

like
breathing,
under
partial
voluntary
control
——
is a rapid muscle contraction and bronchial-tube constriction that generates a wind
force far stronger than a tornado. Small harmful substances that make their way into the alveoli
are
destroyed
by
the
fourth
line
of
defense,
the
macrophages.
These
are
patrolling
cells
that

New Words and Phrases
Exercises
A. Discuss the following topics:
1. Imagine you were lecturing in front of rural health workers on the topic of respiratory system,
draw a picture to illustrate the whole system.
2. Describe their structures and functions.
3. How can epiglottis prevent the passing food and drink into the respiratory system?
4. What role does the diaphragm play in the process of breathing?
5. What are the four components of the cleaning system? How do they function?
B. Fill in the blanks with the words given below and change their forms if necessary.
alveolus
capillary
diaphragm
hemoglobin
thoracic cavity

gas exchange
parietal pleura

visceral pleura
mediastinum
pleural space




The lungs are two cone-shaped, spongy organs consisting of alveoli, blood vessels, elastic
tissue and nerves. Each of the two lungs consists of smaller divisions called lobes; the left lung
hastwo lobes, while the right lung is divided into three lobes. In the lungs, ( 1 ) are surrounded by
a network of tiny blood vessels called capillaries; oxygen from the lungs passes into these ( 2 )
for distribution to tissue cells, while carbon dioxide from the blood passes into the lungs to be
expelled by exhalation. Once absorbed into blood cells, oxygen becomes attached to ( 3 ) and is
released to tissue cells as needed. Thus, the primary function of the lungs is to bring air into close
contact with blood, which allows ( 4 ) to occur.




The lungs are surrounded by a membrane called the ( 5 )

. The space that the lungs occupy
within the chest is called the ( 6 )

, which is lined by a membrane called the ( 7 ). The parietal
and
visceral
pleurae
lie
very
close
to
each
other;
the
small
space
between
theses
membranes,
called the ( 8 ) , is filled with a fluid that prevents friction when the two membranes slide against
each other during respiration. In the central portion of the thoracic cavity (in the area between the
lungs) is a space called the ( 9 ) , which contains the heart. A group of smooth muscles called the

( 10 ) separates the lower portion of the thoracic cavity from the abdomen.
C. Match Column I with Column n.
Column I
bronchiole
compliance
hypoventilation
intercostal
paranasal sinuses
acidosis
apex
pharynx
alkalosis
palatine tonsils

[ 1 ]
[ 2 ]
[ 3 ]

[ 4 ]
[ 5 ]
[ 6 ]
[ 7 ]
[ 8 ]
[ 9 ]
[ 10 ]
Column II
any of the small subdivision of the bronchi
the peak portion of the lungs
a condition in which there is too much carbon dioxide in the
blood
between the ribs
air-conditioning cavities in the bones near the nose
a condition in which there is too much carbon dioxide in the
blood
weak , inadequate exchange of gas
rounded masses of lymph tissue in the oropharynx ( palatine
means roof of the mouth) .
in agreement with
throat;
composed
of
the
nasopharynx,
oropharynx,
and
laryngopharynx.
D. Define the following terms of the respiratory system in line with the text you have just,
learned (making use of the vocabulary provided in the brackets if necessary), for exam-
ple:
Oxygen
(gas, cell, release energy from
>
>


the gas needed by cells to release energy
from food in metabolism
food, metabolism)
1.
mirror image
(as seen, right side,
as if, left side, vice versa)
2.
adenoids
(lymphatic tissue, nasophar-
ynx)
3.
alveolus
(air sac, gas exchange, in
respiration)
4.
bronchus
(main branch, trachea,
mediastinum)
5.
epiglottis
( leaf- shaped, cartilage,
larynx, prevent, trachea)
6.
hyperventilation
(extreme, rapid,
deep, result in, alkalosis)
7.
diaphragm
(dome-shaped, muscle,
move, increase, decrease, space,



thoracic cavity)
8. pharynx ( common, passageway,
esophagus, food, air, larynx)
9. pleura (double-layered, membrane,
visceral pleura, pariatal pleura, tho-
racic cavity)
10. sputum


( substance,


releases,
coughing, clearing the throat, res-
piratory tract)
E. Translate the following into English.

1.
副鼻窦















3.
脊椎动物















5.
二氧化碳















7.
横膈膜神经















9.
威慑物















11.
滞痰















13.
纵隔















15.
碱中毒















>

>

>

>

2.
口咽















4.
肺泡















6.
肺换气不足















8.
双重折叠的















10.
润滑液















12.
食管















14.
哺乳动物















16.
迷宫
















17.
污染物质















18.
脑干

20.
刺激物





























19.
上皮；上皮细胞















Passage Two Respiratory Disorders and Diseases

In this passage you will learn:



●

Various disorders and diseases of the respiratory system



●

Their definitions, causes and treatment



●

Detailed description of the signs and symptoms of chronic obstructive pulmonary disease



●

Medical terms pertaining to the diseases of the respiratory system



●

The
respiratory
system
is
subject
to
a
wide
variety
of
disorders
and
diseases.
The
most
frequent attacks come from common cold and flu viruses. Other diseases that affect the lungs include
bacterial
infections
such
as
pneumonia
and
tuberculosis.
The
lungs
are
especially
vulnerable
to
allergic dis- eases
such
as
asthma.
There
are
more
serious
diseases
such
as
respiratory
distress
syndrome, em-
physema, chronic obstructive pulmonary diseases (COPD), lung cancer, etc.




Influenza
and
pneumonia.

Influenza
is
a
viral
disease
of
the
respiratory
tract.
Different
strains of the influenza virus have caused serious epidemics through history. Pneumonia is caused by
several different microorganisms. The name represents any inflammation of the lungs caused by in-
fection, so an alternate term for pneumonia is pneumonitis. Streptococcal pneumonia usually in-
volves
one
or
more
lobes
of
the
lung
and
described
as
lobar
pneumonia.
Other
agents
of
pneumonia localize in the bronchial tubes, causing bronchopneumonia.




Pleurisy
is severe chest pain accompanying each deep breath in a person with an inflamed
pleura, the twin membranes around each lung and lining the chest cavity. Pleurisy can attend pneu-
monia or result from direct infection of the pleura.




Tuberculosis (TB
)has increased in recent years along with the rise of AIDS and the appear-
ance of resistance to antibiotics in the organism that causes the disease. The name of the disease
comes from the small lesions, or tubercles, that appear with the infection. The symptoms of TB in-
clude fever, weight loss, weakness, cough, and as a result of damage to blood vessels in the lungs,
hemoptysis, i. e. the coughing up of phlegm (sputum) containing blood. Accumulation of exudate
in the alveoli may result in solidification or consolidation of lung tissue. The tuberculin test is
used to reveal tuberculosis infection, PPD (purified protein derivative) is the form of tuberculin
commonly used.




Asthma
. Attacks of asthma result from narrowing of the bronchial tubes. The constriction, a-
long with edema, swelling of the bronchial linings, and accumulation of mucus results in wheezing,
extreme dyspnea and cyanosis. Although the cause of asthma is uncertain, foreign particles such as
pollen or certain environmental pollutants are believed to be the culprits, which stimulate the smooth
muscle of the bronchial tree to releases histamine causing the muscle to contract. The bronchial air-
ways
are
consequently
restricted.
Treatment
of
asthma
includes
removal
of
allergens,
administration of bronchodilators to widen the airways, and administration of steroids.




Respiratory
distress syndrome is a disorder of some prematurely bom infants. The alveoli of
afflicted babies are lined with a protein material, limiting the amount of oxygen their blood can re-
ceive. The disease is often fatal. Mechanical ventilators can be used to help infants breathe until
their lungs become more mature. As a result of some accidents and diseases, such as polio, the res-
piratory center or nerves carrying its impulses may be paralyzed. Treatment may involve cutting
a hole through the windpipe and passing a tube attached to a mechanical respirator through the
hole.
In
other
cases,
the
patient
may
be
placed
on
a
heart
and
lung
machine
that
maintains
respiration and heartbeat.




Acute pulmonary
edema results when fluid quickly accumulates in the lungs and fills the
alveoli. The fluid buildup is caused by heart trouble that, in turn, produces back pressure in the
pulmonary veins and the left atrium of the heart to which they carry oxygen-rich blood from the
lungs. A person suffering acute pulmonary edema is suddenly breathless and turns blue because
of oxygen- poor blood. The condition is treated with oxygen, digitalis to strengthen heart action,
and diuretics to speed fluid removal by the kidneys.
Pneumothorax
occurs when air gets into the chest between the pleural lining. The lung then
cannot
fully
expand
and
breathing
becomes
difficult.
As
a
result,
the
lung
may
even
collapse.
Pneumothorax may result from a wound in the chest, such as a knife wound, or after a sudden
tear
in
the
lung.
Infection
of
the
pleural
space
by
gas-producing
microbes
can
also
cause
pneumothorax.
Physicians
treat
pneumothorax
by
removing
the
gas
by
suction,
surgically
repairing the chest or lung, or prescribing antibiotics when an infection is present.
Pneumoconiosis

(black
lung)
means

disease.
It
can
strike
miners
and
industrial
work-ers
who
inhale
damaging
amounts
of
dust
over
a
long
period
of
time.
One
of
the
most
serious
is
sili-cosis,
which
results
from
inhaling
quartz
dust.
Another,
anthracosilicosis,
arises
from inhalation of coal and quartz dust. Pneumoconiosis often occurs in combination with other
diseases, such as bron-chitis , emphysema, or tuberculosis. There is no treatment for it, but the
disease can be prevented by minimizing dust inhalation.
Emphysema.
This is a chronic disease associated with overexpansion and destruction of the
alveoli. Common causes are exposure to cigarette smoke and other forms of pollution, as well as
chronic
infection.
Emphysema
is
the
main
disorder
included
under
the
heading
of
chronic
obstructive pulmonary disease (COPD), which will be discussed in detail soon.
Chronic obstructive pulmonary disease
(COPD) is a rather broad term used to describe
sim-ple chronic bronchitis, chronic obstructive bronchitis, asthmatic bronchitis and emphysema,
for
it
is
convenient
to
describe
various
combinations
of
these
disorders
that
may
coexist,
for
instance, pa-tients often have chronic obstructive bronchitis as well as emphysema.
Unfortunately, chronic bronchitis has been used variably to refer to a simple smoker's cough
or,
as
in
the
British
literature,
to
severe
COPD.
In
this
discussion,
chronic
bronchitis
will
be
con-sidered
dif-ferentiate between the extremely common simple chronic bronchitis and the less common but
often devastating form of chronic obstructive bronchitis.
Simple
chronic
bronchitis,
a
syndrome
characterized
primarily
by
a
chronic
productive
cough,
is
the
result
of
low-grade
exposure
to
bronchial
irritants
in
an
individual
without
hyperreac-tive
airways.
This
syndrome
is
associated
with
enhanced
mucous
secretion,
reduced
ciliary
activity,
and
impaired
resistance
to
bronchial
infection.
Simple
chronic
bronchitis
is
defined in clinical terms: (1) excessive production of mucus; (2) presence of symptoms, largely
cough, on most days for at least three months annually during two or more successive years; (3)
exclusion of bronchiecta-sis, tuberculosis, or other causes of these symptoms. The term does not
describe the underlying pro- cess , which may vary widely. The patient population ranges from
those who are asymptomatic except for a morning
amounts (simple chronic bronchitis) to patients with a severe disabling condition manifested by
increased resistance to airflow, hypoxia, and often hypercatnia (chronic obstructive bronchitis) .
Chronic
obstructive
bronchitis,

which
develops
in
a
relatively
small
proportion
of
individuals with simple chronic bronchitis, results in irreversible narrowing of airways. Because
the obstruction is in bronchioles and bronchi 2 mm or less in diameter, the term small airways
disease has been used.
Brochospasm
. Exposure to bronchial irritants in individuals with hyperreactive or
airways
can
lead
to
bronchospasm
(i.e.
,
bronchial
smooth
muscle
constriction),
frequently
accom-panied by excessive mucous production and edema of bronchial walls. Recurrent episodes
of
symp-tomatic
bronchospasm
are
called
asthma.
The
present
discussion
must
consider
bronchospasm,
since
a
degree
of
reversible
airways
obstruction
often
accompanies
other
reactions
to
inhaled
noxious
a-gents.
In
fact,
episodic
airways
obstruction
is
common
in
individuals with chronic bronchitis. This combination, called asthmatic bronchitis, may closely
resemble
classic
asthma.
The
term
chronic
asthmatic
bron'chitis
is
applied
in
patients
with
persistent
airways
obstruction,
a
chronic
productive
cough,
and
a
major
problem
of
episodic
bronchospasm.
Emphysema,
another
lung
response
to
noxious
stimuli,
is
characterized
by
abnormal,
perma-nent
enlargement
of
airspaces
distal
to
the
terminal
bronchioles,
accompanied
by
destruction
of
their
walls,
and
without
obvious
fibrosis.
The
alterations
of
emphysema
cause
reduction
in
lung
elastic
re-coil,
which
permits
excessive
airway
collapse
upon
expiration
and
leads to irreversible airflow ob-struction .
These
definitions
are
not
mutually
exclusive;
there
is
considerable
crossover
between
the
em-physematous
(type
A)
and
bronchial
(type
B)
signs
and
symptoms.
For
example,
most
individuals
with
emphysema
also
have
a
chronic
productive
cough.
It
may
be
difficult
to
determine
the
relative
importance
of
emphysema
and
chronic
obstructive
bronchitis,
with
obliteration of small airways. Ac-cordingly, a general term such as chronic obstructive pulmonary
disease (COPD)has been used to describe this clinical syndrome.
New Words and Phrases
Chapter 6
In this passage you will learn:


Common Disorders of the Cardiovascular
System

●

Common disorders of the cardiovascular system
●

Associated medical terms




Atherosclerosis

Atherosclerosis
is
caused
by
accumulation
of
fatty
deposits
within
the
lining of an artery. The resultant plaques gradually thicken and harden with fibrous material, cells,
and other deposits, restricting the' lumen of the vessel and reducing blood flow to the tissues, a
condi-tion known as ischemia.




Atherosclerosis of the coronary vessels is a primary cause of coronary heart disease. One of
its symptoms is angina pectoris, which is manifested as a feeling of constriction around the heart
or pain radiating to the left arm or shoulder, usually brought on by exertion. Often there is anxiety,
diaphoresis, and dyspnea.




Atherosclerosis predisposes to thrombosis, the formation of a blood clot or thrombus in a
ves-sel. Sudden occlusion (blockage) of a coronary artery by a thrombus causes local necrosis of
tissue
and
formation
of
an
infarct.
This
is
myocardial
infarction,
which
is
a
leading
cause
of
sudden death.
Often
there
is
an
abnormality
of
the
heart
rhythm,
or
arrhythmia,
usually
fibrillation,
an
ex- tremely rapid, ineffective beating of the heart.
Embolism.
Embolism refers to occlusion of a vessel by a thrombus or other mass carried in
the bloodstream. Usually the mass is a blood clot that breaks loose from the wall of a vessel, but
it
may
also
be
air,
fat,
bacteria,
or
other
solid
materials.
Often
a
venous
thrombus
can
travel
through
the
heart
and
then
lodge
in
an
artery
of
the
lungs,
resulting
in
a
life-threatening
pulmonary embolism. An embolus from a carotid artery often blocks a cerebral vessel, causing a
stroke.




Heart
Failure.

The
heart
fails
to
empty
effectively,
being
unable
to
pump
its
required
amount of blood; that is to say, more blood enters the heart from the veins than leaves through the
arteries. The resulting increased pressure in the venous system leads to edema, often in the lungs
(pulmonary
edema),
causing
left-sided
heart
failure.
Damming
back
of
blood
resulting
from
right-sided heart failure results in accumulation of fluid in the abdominal organs (liver and spleen)
and subcutaneous tissue of the legs. Other symptoms are cyanosis, dyspnea, and syncope.




Hypertension.
High blood pressure in arteries is called hypertension, which can be divided
into two groups: essential and secondary hypertension. In essential hypertension, the cause of the
increased
pressure
is
idiopathic.
In
secondary
hypertension,
there
is
always
some
associated
le-sion , such as glomerulonephritis, pyelonephritis, or disease of the adrenal glands.




Hypertension is defined as a systolic pressure greater than 140 mmHg or a diastolic pressure
greater
than
90
mmHg.
It
causes
the
left
ventricle
to
enlarge
(hypertrophy)
as
a
result
of
increased
work. The
heart has
to
pump
vigorously
to
overcome
the
increased
resistance
in
the
arteries. The vessels lose their elasticity, and place increased burden on the heart to pump blood
through the body.




Rheumatic
Heart
Disease.
This
is
a
kind
of
heart
disease
caused
by
rheumatic
fever.
Rheumatic fever usually occurs in childhood, which can follow a few weeks after a streptococcal
in-fection
that
sets
up
an
immune
reaction
ultimately
damaging
the
heart
valves.
The
valves,
especial-ly the mitral valve, become inflamed and scarred (with vegetations) , so that they do not
open and close normally. Mitral stenosis, atrial fibrillation, and congestive heart failure can occur.
A
key
sign
in
cases
of
valvular
defects
is
the
presence
of
murmurs.
Systolic
murmurs
occur
during
systole,
usually
due
to
mitral
or
tricuspid
regurgitation
or
to
aortic
or
pulmonary
obstruction.
They
can
be
classified
as
early,
mid-,
late,
or
pansystolic
murmurs.
Diastolic
murmurs occur during diastole usually due to semilunar valve regurgitation or to altered blood
flow
through
atrioventricular
valves;
they
are
frequently
divided
into
early
and
mid- diastolic
murmurs.




Endocarditis

Endocarditis
is
exudative
and
proliferative
inflammatory
alterations
of
the
inner lining of the heart caused by bacteria (also called bacterial endocarditis). Endocarditis may
be a complication of another infectious disease, an operation, or an injury. Damage to the heart
valves can produce lesions called vegetations that may break off into the bloodstream as emboli,
which can lodge in the small vessels, causing obstruction of the vessels.




Pericarditis
Pericarditis is an inflammation of the membrane (pericardium) surrounding the
heart.
In
most
instances,
pericarditis
is
secondary
to
disease
elsewhere
in
the
body
(such
as
pul- monary
infection) .
Bacteria
and
viruses
can
cause
the
condition,
or
the
etiology
may
be
idiopathic.
There
may
be
accumulation
of
fluid
within
the
pericardial
cavity.
If
a
considerable
amount of fluid is present, pressure on the pulmonary veins may slow the return of blood from
the lungs. Compres-sion of the heart by pericardial fluid can cause cardiac tamponade.




Hemorrhage.
A profuse escape of blood from the vessels is known as hemorrhage, a word
which means
of
any
size,
and
may
involve
any
part
of
the
body.
Capillary
oozing
is
usually
stopped
by
the
nor-mal
process
of
clot
formation.
Flow
from
larger
vessels
can
be
stopped
by
appropriate
first-aid measures by anyone who happens to be at the scene. In most cases pressure with a clean
bandage directly on the wound will stop the bleeding effectively. The loss of blood from a cut
artery
may
be
rapid
and
unpleasantly
spectacular.
Often
it
is
rapidly
fatal,
and
yet
immediate
appropriate action can be lifesaving. Since hemorrhage is the number one problem in case of an
accident,
everyone
should
know
that
certain
arteries
can
be
pressed
against
a
bone
to
stop
hemorrhage.




Shock.
The word
it refers to a highly dangerous condition owing to sudden failure of the circulation. The state of
shock
can
be
precipitated
by
a
number
of
factors:
severe
hemorrhage,
a
sudden
nervous
disturbance,
bums,
prolonged
surgery,
certain
drugs,
anything
causing
a
lack
of
oxygen
in
the
blood and such accessory factors as cold and exhaustion.




What
happens
in
shock
is
essentially
this;
one
or
a
number
of
these
precipitating
factors
(maybe a complicated process) cause the small vessels to expand (dilate), with the result that the
blood drains from the large vessels into the small vessels of the tissues. Here the blood lies and
stagnates instead of circulating. The victim of shock will die very quickly unless something is
done
to
restore
circulation
immediately.
The
usual
treatment
is
to
administer
blood
plasma
or
whole blood intravenously; this increases the blood volume and helps to restore the circulation to
normal.
If
neither
whole
blood
nor
plasma
is
immediately
available,
dextran
may
be
used.
Dextran expands the volume of plasma, although it is not a substitute for blood.




The
symptoms
of
shock
are
a
cold,
clammy
skin,
a
pale
and
drawn
face,
lowered
temperature, very low blood pressure, and shallow breathing. Immediate first-aid measures for a
person in shock include placing him in a horizontal position, keeping him warm with blankets
and hot-water bottles, and making sure that his head is kept to one side so that he will not inhale
his own vomi-tus, which is an important cause of death in shock.




Varicose veins.
The condition of varicose
veins is
characterized by swollen, tortuous and
in-effective
superficial
veins.
It
is
frequently
a
problem
in
the
esophagus,
the
rectum,
the
spermatic cord in the male and in the broad ligament of the uterus in the female. This kind of
veins
which
are
most
commonly
found
to
be
abnormally
enlarged
are
those
that
involve
the
saphenous veins of the lower extremities, and this condition is found frequently in people who
spend
a
great
deal
of
time
standing
——
salespeople,
for
instance.
Also
pregnancy,
with
the
accompanying pressure on the veins in the pelvis, may be a predisposing cause. Varicose veins in
the rectum are commonly referred to as piles, or more properly, hemorrhoids. The general term
for these enlarged veins is varices, the singu-lar form being varix.




Phlebitis.

Inflammation
of
a
vein
is
called
phlebitis.
There
is
marked
pain,
often
consider-able swelling, and involvement of the entire vein wall. A blood clot may form, causing
the
danger-ous
condition
called
thrombophlebitis,
with
the
possibility
of
a
piece
of
the
clot
becoming loosened and floating in the blood as an embolus. If this embolus reaches the lungs, as
it
does
too
often,
sudden
death
from
pulmonary
embolism
may
be
the
result.
Prevention
of
infection, early activity to insure circulation following an injury or an operation, and the use of
anticoagulant drugs have great- ly reduced the number of sufferers from this complication.
Notes, New Words and Phrases
Exercises
A. Discuss the following topics.
1. What does atherosclerosis result from? What is coronary heart disease? What is coronary heart
disease characterized by?
2. How is rheumatic heart disease formed? What is the clinical picture of heart failure?
3. Imagine you were the chief resident (
住院总
) in the hospital, discuss the differences between
embolism and thrombosis with other residents.
4. What is the definition of shock?
B. Spell out the medical term for each of the following definitions.



For example:
slow heart condition > > bradycardia
1. hardening of the arteries


































2. discomfort around the heart, usually radiating to the left shoulder and



arm, caused by insufficient blood supply to the heart
3. low blood pressure
4. inflammation of a vein complicated by the formation of a blood clot
5. narrowing of the aorta
6. inflammation of the blood vessels





























7. an abnormally rapid heart rate
8. high blood pressure
9. circulatory failure resulting in inadequate supply of blood to the heart


with symptoms of cold, clammy skin, etc.
10. any abnormality in the rate or rhythm of the heartbeat















11. local deficiency of blood supply due to obstruction of the circulation
12. any disease of the heart muscle




























> > _________
> > _________
> > _________
> > _________
> > _________
> > _________
> > _________
> > _________
> > _________
> > _________
> > _________
> > _________
C. Put the following words or phrases into the following sentences and change the form if


necessary.

heart failure
flat
effect
left
factor
eye
at night
shortness
feature
liver
fluid
right
enlargement
hypertension
atherosclerosis




Hypertension accelerates the process of (1) ____ __, or hardening of the arteries, which is a
(2)
____
__contributing
to
strokes
and
heart
attacks.
Damage
to
the
arterioles
leads
to
brain
hemorrhage or kidney failure. The arterioles can be visualized in the retina, thus permitting the
physician to evaluate the severity of the disease and to estimate the prognosis by examining the
(3) ____ __. (4) ____ __overworks the heart muscle, and this may result in (5) ____ __ of the
heart (hypertensive heart disease) and ultimately in (6) ____ __. The brain, the heart, the kidneys,
and the eyes are especially vulnerable to the (7) ____ __ of hypertension. Clinical (8) ____ __of
heart failure may vary considerably. The main symptom of (9) ____ __ heart failure is shortness
of
breath,
which
often
occurs
during
mild
exercise
and
which
may
result
in
periodic
sudden
attacks that frequently occur (10) ____ __ which the victim is lying (11) ____ __. As heart failure
progresses, (12) ____ __ of breath becomes more difficult to relieve. The principal symptoms of
(13) ____ __ heart failure include edema of the ankles, and tenderness in the upper part of the
abdomen due to swelling of the (14) ____ __. In advanced stages swelling becomes more severe,
and (15) ____ __ may collect in the abdomen.
D. Tick the term that is spelled correctly and write its meaning in Chinese.
For example:








rheumatic





rhumatic







风湿的

1.




2.




3.




4.



5.



6.



7.



8.



coronary












arrhythmia










disastole











angina pectorus






vasodilation










cardiomegaly









artheriosclerosis







dispenea












coronery




arythemia




diastole






angina pectoris


vasodilitation



cardiomegely



atherosclerosis


dyspnea







symptom






atrium
_____

____
_____

____
_____

____
_____

____
_____

____
_____

____
_____

____
_____

____
_____

____
_____

____
9.





symptem












10.




artrium













E. Fill in one word to make the following sentences true.
essential
rheumatic fever
blood pressure
myocardium
left ventricular hypertrophy
secondary

interatrial
septum
interventricular
septum
cardiac

myocardial infarction

1. Elevated blood pressure of unknown cause is called ____


_ hypertension.
2. Blood pressure which is elevated as a result of another condition is called ____


_ hyper-
tension .
3. Rheumatic heart disease is a type of heart disease caused by ____


_.
4. The muscular layer of the heart is called ____


_.
5. The right and left atria are separated by a muscular wall called the ____


_.
6. The right and left ventricles are separated by a structure known as the ____


_.
7. The sequence of events occurring during each beat of the heart is called the ____


_ cycle.
8. ____


_ refers to the force exerted by blood on the walls of the arteries.
9.
____


_
is
a
condition
in
which
delivery
of
oxygen
to
a
portion
of
the
heart
muscle
is


im-paired, resulting in death of the tissue in that area.
10. Enlargement of the left ventricular wall, usually occurring as a result of chronic hypertension,
is called ____


_.
F. Read the following statements and then decide whether they are true or false.
1. [


] Atherosclerosis is an extremely common form of arteriosclerosis in which deposits of
yel-lowish
plaques
containing
cholesterol,
lipoid
material,
and
lipophages
are
formed
within the intima and inner media of large and medium-sized arteries.
2.
[


]
Heart
failure
is
inability
of
the
heart
to
pump
blood
at
an
adequate
rate
to
fill
tissue
metabolic requirements or the ability to do so only at an elevated filling pressure. It can
be defined clinically as a syndrome of ventricular dysfunction accompanied by reduced
ex-ercise capacity and other characteristic hemodynamic', ? renal, neural, and hormonal
re-sponses.
3. [


] Secondary hypertension is hypertension due to or associated with a variety of primary
dis-eases,
such
as
essential
hypertension,
renal
disorders,
disorders
of
the
central
nervous system, endocrine diseases, and vascular diseases.
4.
[


]
Rheumatic
heart
disease
is
directly
caused
by
streptococci,
or
is
the
most
important
mani-festation
of
and
sequel
to
rheumatic
fever,
consisting
chiefly
of
valvular
deformities.
5.
[


]
Shock
may
be
a
condition
of
profound
hemodynamic
disturbance
characterized
by
failure
of
the
circulatory
system
to
maintain
adequate
perfusion
of
vital
organs.
The
clinical
mani-festations
of
hypovolemic
or
cardiogenic
shock
include
hypotension,
hyperventilation,
cold,
clammy,
cyanotic
skin,
a
weak
and
rapid
pulse,
oliguria,
and
mental confu-sion, combativeness, or anxiety.
Passage Three Clinical Manifestations

of Heart Failure





The
signs
and
symptoms
of
heart
failure
depend
on
which
ventricle
has
failed
and
the
severity

and duration of failure. The clinical picture in left ventricular failure is dominated by
symptoms
of
pulmonary
congestion

and
edema.
By
contrast,
right
ventricular
failure
is
dominated by signs of systemic venous congestion and peripheral edema. Weakness, fatigue, and
effort intolerance

are common to right or left ventricular failure as well as biventricular failure
.
Left Ventricular Failure




The
symptom
of
essness
predominates
in
patients
with
left
ventricular
failure
and
varies with position and activity. Noteworthy
○

physical signs are most evident in the heart, lungs,
or respiratory control mechanisms.




Dyspnea (breathlessness) during limited exertion is typically the earliest symptom of left
failure
and
is
usually
associated
with
an
increased
rate
of
breathing
(tachypnea
○
).
Although
many details of the physiologic basis for the sensation of dyspnea
○

remain unclear, some aspects
of the origin of respiratory symptoms from pulmonary congestion deserve consideration. Because

①

临床表现

②

本文节选自
“
Heart failure
”

of
Cecil Texbook of Mebicine
，
20
th
edition.
作者为

Thomas Woodward Smith
③

严重性

④

充血

⑤

对体力活动的耐受性下降

⑥

全心衰

○

重要的

○

呼吸加快

○

呼吸困难

⑤
⑥
④
③
①
②
the bronchial capil-laries drain for the most part via the pulmonary veins, congestion tends to
develop
in
alveolar
and
bronchial
vascular
networks
simultaneously.
Interstitial
edema
surrounding
pulmonary
capillaries
ap-pears
to
stimulate
juxtacapillary
receptors
known
as
J-receptors
○
, which in turn elicits
○

a reflexly mediated pattern of rapid and shallow breathing
○
.
At
the
same
time,
bronchial
congestion
stimu-lates
mucus
production,
and
the
distended
bronchial
capillaries
○

may
rupture,
with
resulting
cough
and
hemoptysis.
Bronchial
mucosal
edema causes increased resistance in small airways, producing wheezing and respiratory distress
known
as
cardiac
asthma.
The
increased
work
of
moving
fluid-laden
,
noncompliant
lungs
○

must
be
accomplished
in
the
face
of
decreased
blood
flow
to
respiratory
muscles
and
also
increased
diffusion
barriers
to
oxygen
exchange
across
the
alveolar-capillary
inter-face,
contributing to respiratory muscle fatigue and the sensation of dyspnea.




Thus, the symptom of
dyspnea in left heart failure clearly relates to the increase in blood
vol-ume and interstitial fluid content of the lungs at the expense
○

of air. Ventilation increases,
and
the
awareness
of
dyspnea
becomes
more
severe
as
minute
ventilation
approaches
the
maximal ventilatory capacity
○
.




Orthopnea
○
.
Dyspnea
that
occurs
soon
after
lying
flat
(and
is
relieved
by
sitting
up)
is
known as orthopnea. The pathophysiologic basis for orthopnea is the increase in venous return
from
the
lower
extremities
and
splanchnic
bed
○

to
the
lungs
in
the
recumbent
position
○
,
together with the reabsorption of peripheral edema that accumulates during the day. Orthopnea is
a
relatively
reliable
marker
for
left
ventricular
failure,
whereas
the
dyspnea
associated
with
chronic
lung
disease
or
mus-culoskeletal
disorders
is
typically
less
aggravated
by
lying
flat.
Patients usually leam to avoid dyspnea of this sort by sleeping with the head and thorax on two or
more pillows.
In advanced heart failure, orthopnea may be so severe as to cause the patient to
sleep
upright
in
a
chair.
An
orthopneic
cough
has
the
same
significance
as
orthopnea
and
is
presumably the consequence of venous conges-tion and edema. Patients with left heart failure
○

J-
感受器

○

引起

○

引出反射介导的快而浅呼吸

○

扩张的支气管

○

液体积聚和肺顺应性下降

○

以
…

为代价

○

最大通气量

○

端坐呼吸

○

内脏血管丛

○

斜躺姿势

may also complain of precordial distress
○

in the supine position
○

that is difficult to distinguish
from symptoms caused by myocardial ischemia.





Nocturia
○
. In early heart failure, limitation of renal blood flow with upright activity during
the day gives way
to more
normal renal perfusion
○

and diuresis
○

while supine at night. This
causes nocturia, a common early symptom of incipient
○

heart failure.




Paroxysmal
Nocturnal
Dyspnea
○
.
Severe
respiratory
distress
may
arouse
the
patient
from
sleep. Relief is urgently sought by sitting up and often by finding an open window. In addition to
exacerbation
○

of pulmonary vascular congestion and edema during supine sleep, blunting
○

of
the
respiratory
center
response
to
sensory
input
from
the
lungs
during
sleep,
together
with
increased
ve-nous
return,
allows
pulmonary
venous
congestion
and
edema
to
accumulate
and
trigger the alarming episode of breathlessness.




Acute Pulmonary Edema. In an episode of acute left ventricular failure, pulmonary venous
and capillary pressure can increase abruptly to levels exceeding plasma oncotic pressure
○
, with
consequent
rapid
accumulation
of
edema
fluid
in
the
interstitial
spaces
and
tends
to
produce
alveolar hyperventilation and respiratory alkalosis. However, when free fluid enters the alveoli
and bronchi-oles, respiratory acidosis may occur owing to an intolerable increase in the work of
breathing.
Hy-poxemia
also
occurs
commonly
because
of
imbalances
between
alveolar
ventilation and alveolar blood flow.




Symptoms of pulmonary edema may begin with a nonproductive cough, with wheezing, or
with frank dyspnea. Apart from tachypnea and possibly evidence of underlying heart disease on
physical examination, few physical signs may be present initially. Later, as free fluid accumulates
in
distal
airways,
rales
become
audible
at
the
lung
bases
and
extend
upward
accompanied
by
rhonchi
○

as
the
episode
progresses.
In
severe
acute
pulmonary
edema,
the
patient
is
typically
pale,
sweating,
cyanotic,
gasping
for
breath,
and
sometimes
producing
pink
or
blood-tinged
frothy
○

ysis. Rust- colored
○

sputum containing heart failure cells
○

( alveolar
○

心前区不适

○

仰卧姿势

○

夜尿症

○

肾脏灌注

○

利尿

○

初发的

○

阵发性夜间呼吸困难

○

增剧

○

迟钝

○

血浆渗透压

○

干啰音

○

泡沫的

○

铁锈色

○

心力衰竭细胞

macrophages
○

containing hemosiderin
○
)
sometimes
occurs
in
severe
chronic
left
heart
failure
and
is
seen
with
par-ticular
frequency
in
patients
with
advanced
mitral
stenosis
○
.
Frankly
○

bloody sputum should sug-gest the possibility of pulmonary infarction
○
, but expectoration
○

of
substantial
quantities
of
blood
can
also
occur
as
a
consequence
of
rupture
of
engorged
○

bronchial
capillaries
in
patients
with
chron-ic
left
heart
failure,
including
that
caused
by
uncorrected mitral stenosis.

Right Ventricular and Biventricular Failure

Clinical
Manifestations.
Isolated
right
ventricular
failure
is
uncommon
in
adults
and
is
usually a consequence of cor pulmonale
○

secondary to intrinsic
○

lung disease or, on occasion,
chronic
volume
overload
from
a
congenital
intracardiac
left-to-right
shunt
(
e.
g.,
atrial
septal
defect)
○
. Right ventricular failure is encountered most often as a complication of left ventricular
failure. In the presence of elevated right heart filling pressures
○
, neck veins are distended and fill
from be-low
○
. Hepatic enlargement and tenderness to gentle palpation
○

result from passive
congestion,
and
manual
compression
over
the
liver
causes
further
distention
of
the
neck
veins
(
hepatojugular
reflux
○
) .In
the
presence
of
biventricular
failure
○
,
signs
of
right
ventricular
failure
may
dominate,
but
the
presence
of
dyspnea
and
rales
should
suggest
additional
left
ventricular failure. Accompanying low cardiac output results in signs of increased sympathetic
nervous
activity
○

and
of
organ
hypoperfusion
○
.
It
should
be
remembered
that
a
critically
lowered
cardiac
output
from
any
cause
suf-ficient
to
produce
metabolic
acidosis
occasions
hyperventilation in defense of acid-base balance
○
, and this must be distinguished from the
○

肺泡巨噬细胞

○

血铁质

○

二尖瓣狭窄

○

明显地

○

梗塞

○

吐出物；痰

○

充盈的

○

肺心病

○

内在的

○

先天性心脏左向右分流（如房间隔缺损）

○

右心室充盈压升高

○

颈静脉怒张，充盈自下而上

○

轻度扪诊产生的触痛○

肝颈静脉回流

○

左右心室衰竭

○

交感神经活动

○

灌注不足

○

任何导致代谢性酸中毒因素引起的心输出量明显下降均使患者出现通气过度以维持酸碱平衡

tachypnea of left heart failure. Advanced right-sided or biven-tricular failure may be associated
with anorexia, weight loss, and malnutrition (
○

Cyanosis. Cyanosis is caused by 5 or more grams per 100 ml of unoxygenated hemoglobin
in
the
subpapillary
venous
plexus
○

of
the
skin.
This
occurs
in
right
heart
failure
because
the
53
congested venules contain blood from which considerable oxygen has been extracted because of
the
slow
flow.
This
is
typically
accompanied
by
relatively
normal
arterial
P
02
○

values
unless
54
intrinsic lung disease of intracardiac shunting
○

is present. Cyanosis is usually absent in left heart
55
failure unless caused by a complication (e.g. , pneumonia) or by pulmonary edema. Abnormal
Heart
and
Lungs.
Although
dyspnea
accompanying
left
ventricular
failure
may
be
partially
relieved
by
onset
of
right
ventricular
failure,
some
dyspnea
usually
persists,
together
with
tachypnea
and
basal
rales.
Tricuspid
valvular
insufficiency
○

commonly
accompanies
severe
56
right
ventricular
dilation
and
failure
and
contributes
to
systemic
venous
engorgement
○
.
The
57
murmur of tricuspid insufficiency is distinguished from that of mitral insufficiency by its location
(lower left border of sternum) , by its tendency to increase during inspiration, and by associated
physical
signs,
such
as
hepatic
pulsation
○

and
systolic
waves
in
the
jugular
venous
pulse
○
.
58
59
Doppler echocardiography
○

greatly assists in the assessment of this problem. Pleural effusion,
60
often unilateral
○
, is more common in right-sided or biventricular than in isolated left ventricular
61
failure.





Systemic
Venous
Congestion.
Elevated
systemic
venous
pressure
is
a
sine
qua
non
○

of

62
right failure. Responsible mechanisms include (1) the inability of the failing ventricle to eject the
venous return without abnormally high filling pressures, causing (2) an increase in the volume of
blood
in
the
large
systemic
veins,
and
(3)
increased
venomotor
tone
○

resulting
from
63
increased sympathetic nervous system activity. Increased systemic venous pressure is responsible

○

恶病质

○

乳头下静脉丛

○

动脉血氧分压

○

心脏内血液分流

○

三尖瓣关闭不全

○


体静脉充血

○


肝脏搏动

○


颈静脉搏动

○

多普勒超声心动图检查

○

单侧的

○


必要指征

○

静脉运动张力

for
the
hepatomegaly,
occasional
splenomegaly
○
,
and
peripheral
edema
that
characterize
64
decompensat- ed
○

right ventricular failure. Usually less apparent are the associated congestion
65
and edema of the gastrointestinal tract.
Pressure
in
the
jugular
venous
system,
a
useful
index
of
right
atrial
pressure,
may
be
estimated from the height of the column of blood distending the cervical veins
○
. The cervical
66
veins are normally
flat in the upright posture in the absence of raised intrathoracic
○

pressure,
67
whereas in right heart failure they are prominent and distended.
Liver
Enlargement.
The
liver
is
typically
enlarged
and
tender
in
right
heart
failure. If
the
onset is acute, right upper quadrant pain may result from constraint
○

of the swollen liver by its
68
tight capsule. Splenomegaly is uncommon except in prolonged passive congestion of the liver,
and
pain
or
tenderness
of
the
spleen
should
raise
the
question
of
superimposed
systemic
embolization
○

and splenic infarction.
69
Early
congestion
of
the
liver
may
cause
modest
increases
in
the
concentrations
of
hepatic
enzymes such as alkaline phosphatase
○

in serum, and an increase in serum bilirubin may occur.
70
Hyperbilirubinemia
○

from
this
cause
usually
consists
of
a
combination
of
conjugated
○

and
71
72
unconjugated bilirubin. Frank jaundice is uncommon unless hepatic congestion is associated with
longstanding
○

pulmonary congestion or pulmonary infarction.


73
Peripheral Edema
○
. Dependent edema developing over the course of the day and subsiding
74
by morning is a characteristic feature of right heart failure. It is' a direct consequence of elevated
systemic
venous
pressure
and
is
typically
preceded
by
a
gain
in
weight.
Persistent
edema
is
accompanied
relatively
frequently
by
complications
such
as
low-grade
cellulitis
○
,
and
the
75
combination of edema and sluggish
○

venous flow predisposes to deep venous thrombosis and

76
○


脾脏肿大

○


代谢失调

○


颈静脉

○


胸腔内的

○

约束

○

栓塞现象

○

碱性磷酸酶

○

高胆红素血症

○

结合的

○

长期的

○

外周水肿

○

蜂窝织炎

○

迟缓的

pulmonary embolism.
Pleural
Effusion
○
.
The
infrequency
of
hydrothorax
○

in
isolated
right
ventricular
failure
77
78
dictates
○

that the association of pleural effusion and cor pulmonale should lead one to search for
79
another
cause,
such
as
pulmonary
infarction.
It
is,
however,
common
in
biventricular
failure.
Hydrothorax resulis from impaired removal of isotonic fluid
○

from the pleural space because of
80
elevated
venous
pressures
in
both
the
pulmonary
and
the
systemic
circulations,
compromising
trangcapillary
○

exchange
of
water
at
the
pleural
surface
and
also
impeding
○

lymphatic
81
82
drainage
○
. Hydrothorax contributes to dyspnea reflexly, probably by stimuli from the lungs and
83
chest wall, as well as by displacing ventilated lung tissue from the relatively fixed volume of the
thoracic space
○
.
84
Ascites
○
. The presence of free fluid in the abdominal cavity is a late manifestation of right
85
heart
failure,
usually
associated
with
systemic
venous
hypertension,
peripheral
edema,
and
hydrothorax.
It
is
commonly
encountered
in
the
setting
of
tricuspid
valve
disease
or
chronic
constrictive
pericarditis
○
.
Elevated
pressure
in
portal
and
hepatic
veins
○

and
in
the
systemic
86
87
veins
draining
the
peritoneum
○

contribute
to
the
formation
of
ascites,
but
renal
retention
of
88
sodium
and
water
is
a
prerequisite
○
.
It
may
contribute
to
anorexia
and
can
cause
abdominal
89
discomfort or pain in patients with severe right ventricular failure.

Pericardial Effusion
○
. Patients with chronic heart failure commonly have increased amount
90
of
fluid
in
the
pericardial
sac
that
can
be
demonstrated
echocardiographically
○
.
Only
rarely,
91
however, does it accumulate to an extent that produces further hemodynamic compromise

(tamponade)
○
.
92
○

胸膜腔积液

○

胸膜腔积液，胸水

○

指示

○

等渗液体，等张液体

○

经毛细血管间的

○

阻止

○

淋巴引流

○

其机制可能力较固定的胸腔容量出现通气肺组织移位，加上来自肺和胸壁的刺激

○

腹水

○


缩窄性心包炎

○


门静脉和肝静脉

○


腹膜

○


先决条件

○


心包积液

○


超声心动图检查

○


心包积液很少引起进一步血液动力学改变，很少引起心包填塞

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