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诊断学常见症状的临床表现课件

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诊断 常见 症状 临床表现 课件
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Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见症状的临床表现 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 发热 当机体在致热原作用下或各种原因引起 体温调节中枢功能障碍 使体温超过正常范围 称为发热 分感染性与非感染性发热 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床表现 1 发热分度 低热 37 3 38 中度发热 38 1 39 高热 39 1 41 超高热 41 以上 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 临床经过及特点 分三阶段 1 体温上升期 乏力不适 肌肉酸痛 畏寒 寒战 皮肤苍白 肌肉不自主周期性收缩 骤升型 体温上升数小时达39 以上 伴寒战 如大叶性肺炎 缓升型 渐升 数日内达高峰 不伴寒 战如结核病 伤寒等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 高热期 持续时间依病因而异 特点 寒战消失 皮肤潮红 灼热 开 始出汗 呼吸变快 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 体温下降期 机体防御功能和适当治疗 病因消除 体温下降至正常 出汗 皮肤潮湿 骤降 数小时内速降至正常 伴大 汗 如疟疾 渐降 数天内缓降至正常 如伤寒 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 水肿 过多体液积聚在组织间隙使组织肿胀 可为全身性或局部性 不包括内脏器官局部 的水肿如脑水肿 肺水肿 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床表现 一 全身性水肿 1 心源性水肿 a 先发于下垂部 随体位改变 对称性 凹陷性 严重者遍及全身 胸腹水 b 伴颈V怒张 肝大等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 肾源性水肿 a 早期晨起时出现于眼睑与颜面部 以后发 展至全身水肿 严重者有胸 腹水 b 常伴高血压 尿改变和肾功能损害 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 心源性 肾性水肿鉴别 肾性 心性 开始部位 眼睑 颜面 下垂部 足 腰骶 发展快慢 迅速 较缓慢 水肿性质 软而移动性大 较坚实 移动性小 伴随病征 肾脏病征 高 心脏大 心脏杂音 血压 血尿 颈V怒张 肝大 蛋白尿 管型 肝颈V回流征 尿 眼底改变 静脉压 等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 肝源性水肿 a 发展缓慢 腹水为主 也可先出现踝部水肿 b 伴肝功能减退表现 4 营养不良性水肿 a 病前消瘦 体重 b 足部 下肢 全身 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 5 其他原因 1 粘液性水肿 常于眼睑 颜面 下肢 非凹陷性 2 经前期紧张综合征 3 药物性 用肾上腺皮质激素 雌激素 4 特发性 5 妊娠水肿 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 局部水肿 1 局部炎症 使血管通透性增加 2 局部静脉回流受阻 肿瘤 淋巴结压迫 上腔静脉受压 头面 颈 上肢及胸水肿 下腔静脉受压 下肢 会阴部水肿 3 淋巴回流受阻 丝虫病象皮肿 4 血管神经性 苍白腊样光泽 弹性 无 痛 变态反应 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 咳嗽 咳痰 咳嗽 cough 是一种反射性防御动作 把呼吸道异 物 分泌物排出体外 频繁咳嗽则为病理现 象 咳痰 expectoration 通过咳嗽把呼吸道内病理性分泌物 病 原体 尘埃等混合物 痰 排出的现象 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床表现 1 咳嗽的性质 干性咳嗽 无痰或少痰 刺激性 习惯性 神经性 或咽喉炎 喉癌 胸膜炎等 湿性咳嗽 伴有痰液 慢性支气管炎 肺炎 肺脓 肿 支扩 肺结核 肺水肿等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 咳嗽时间与节律 突发性咳 吸入剌激气体 急性炎症或异 物 长期反复咳 慢支 支扩 尘肺 肺结核 等 发作性咳嗽 百日咳 哮喘等 晨咳 支扩 慢性肺脓肿 夜咳 慢支 肺结核 左心衰 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 咳嗽的音色 指咳嗽声音的改变 金属音 气管受压 支气管肺癌 纵隔肿瘤 气管异物等 鸡鸣样 喉部病变或气管受压 百 日咳 白喉等 嘶哑性 声带受累 喉炎 癌 结核 或喉返神经受压 麻痹 无声性 声带麻痹或全身衰竭 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 4 痰液性状 粘液性 白色 半透明 糊状 急 慢 支 哮喘 肺Tb等 浆液性 稀薄泡沫状 肺淤血 肺水肿 脓性 化脓性感染 支扩 肺脓肿 痰多静置分三层 上层 泡沫 中层 浆液或浆液脓性 下层 坏死组织 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 5 气味 痰恶臭味 肺脓肿 支扩或晚期肺癌 合并厌氧菌感染 6 痰色 黄色痰 呼吸道感染 绿色痰 铜绿假单胞菌感染 白粘丝痰 白色念珠菌感染 红色痰 血痰 支扩 肺TB 肺Ca 铁锈色痰 肺炎球菌肺炎 粉红色泡沫痰 肺水肿 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 7 痰量 一般每口痰约1 2 ml 10 ml 天 为无痰 10 50 ml 天 少量咳痰 50 100 ml 天 中等量咳痰 100ml 天 大量痰 痰量增多见于肺脓肿 支扩 慢性肺 结核 肺泡癌等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 咯 血 喉部以下的呼吸道出血 经口咯出 下列情况不属咯血 1 喉以上部位 口腔 咽 鼻 出血 2 肺内出血 但未咳出者 3 上消化道出血误吸入呼吸道再咳出者 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床表现 1 年龄 青壮年 肺结核 支扩 二尖瓣狭窄 40岁以上长期吸烟 肺癌 2 咯血量的估计 少量 每日咯血量 100 ml 中量 每日咯血量100 500 ml 大量 每日咯血量 500 ml 100 500 ml 次 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 颜色与性状 鲜红色 肺结核 支扩 肺脓肿 出血性 疾病 铁锈色 肺炎球菌性肺炎 肺泡出血 砖红色胶冻样 克雷伯杆菌肺炎 粉红色泡沫痰 急性左心衰 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 咯血与呕血的鉴别 咯 血 呕 血 基本疾病 支扩 Tb 肺炎 肺癌 心脏病等 PU 急性胃粘膜病变 肝硬化 胃癌等 出血先兆 喉痒 胸闷 咳嗽恶心 上腹不适 呕吐 出血方式 咯出 呕出 可为喷射状 出血物 性状 鲜红 混有泡沫与 痰液 呈碱性 棕黑或暗红 鲜血 混食物残渣 呈酸性 出血后 情况 有血丝痰 无黑便 除非将血咽下 无痰 柏油便持续数天 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸痛 牵涉痛 放射痛 内脏病变 除患病脏器疼痛外 还引起 远离该器官的体表发生感觉过敏或痛觉 特点 定位明确 疼痛剧烈 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 临床表现 1 部位 胸膜炎 自发性气胸 患侧 带状疱 疹 肋间神经痛 支配区 心绞痛 心梗 心前区 胸骨后 放射左肩 臂 颈 面颊 主动脉夹层 胸背部 放射至腰 腹 膈下脓肿 膈胸膜炎 患侧下胸 放射 肩 颈部 食管纵隔疾病 胸骨后 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 性质 带状疱疹 持续刀割样 烧灼痛 肋间神经痛 阵发 刺痛 灼痛 心绞痛 心梗 压榨样 窒息感 自发性气胸 干性胸膜炎 撕裂痛 食管炎 灼热痛 肿瘤 闷痛 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 影响因素及持续时间 自发性气胸 屏气 剧咳 用力诱发 持续性 胸膜炎 深呼吸 咳嗽加剧 持续性 食管炎 进食时加重 持续性食管炎 服抗酸药可缓解 心绞痛 劳力加重 阵发性 心肌梗死 持续性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 发绀 血液中还原血红蛋白增多 皮肤 粘膜呈 青紫色表现 毛细血管还原Hb 50g L 观察部位 皮肤较薄 色素较少和毛细血 管丰富部位 唇 鼻尖 甲床 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一 血液中还原血红蛋白增多 真性发绀 1 中心性发绀 2 周围性发绀 3 混合性发绀 二 血液中存在异常血红蛋白衍生物 1 高铁血红蛋白血症 高铁血红蛋白含量达30g L 2 硫化血红蛋白血症 硫化血红蛋白含量达5g L Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 呼吸困难 患者主观上感到空气不足 呼吸费力 客观上表现为呼吸运动用力 可有呼吸频 率 深度与节律的改变 严重时出现鼻翼 扇动 发绀 端坐呼吸 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 肺源性呼吸困难 三种类型 1 吸气性呼吸困难 2 呼气性呼吸困难 3 混合性呼吸困难 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 1 吸气性呼吸困难吸气性呼吸困难 由于喉 气管 大支气管炎症或狭由于喉 气管 大支气管炎症或狭 窄所致 喉癌 气管异物 白喉等窄所致 喉癌 气管异物 白喉等 临床特点 吸气费力 深而慢 可有高调吸气性喘鸣音 吸气时三凹征 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 呼气呼吸困难 由于肺泡弹性减弱及小支气管痉 挛 狭窄所致 支气管哮喘 COPD 痉 挛性细支气管炎等 临床特点 呼气费力 延长而缓慢 呼气性干罗音或哮鸣音 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 混合性呼吸困难 因肺及胸腔病变 肺实变 不张 栓塞 气胸 大量积液等 或呼吸肌麻 痹 重症肌无力 影响换气 或胸廓剧 痛 呼吸受限 临床特点 吸 呼气均费力 呼吸浅 快 弱 病理性呼吸音 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 2 心源性呼吸困难心源性呼吸困难 左心衰呼吸困难 有引起左心衰的基础心脏病 混合性呼吸困难 活动后或卧位加重 夜间阵发呼吸困难 心源性哮喘 端坐呼吸 喘鸣伴咳 嗽 咳粉红色泡沫痰 双肺底或全肺湿性罗音 强心 利尿 血管扩张剂可缓解症状 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial n n 3 3 中毒性呼吸困难中毒性呼吸困难 1 代谢性酸中毒 特点 有引起代谢性酸中毒的基础病 尿毒症 糖尿病酮症 呼吸深长规则伴鼾音 酸中毒大呼吸 Kussmaul呼吸 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 药物中毒 吗啡 巴比妥类 有机磷杀虫药中毒 抑制呼吸中枢 特点 有药物中毒史 呼吸慢而浅伴呼吸节律改变 潮式呼吸或间停呼吸 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 4 化学物中毒 CO 亚硝酸盐 苯胺中毒 氰化物中毒 使血红蛋白失去携O2能力 组织缺O2 产生高铁血红蛋白血症 抑制细胞色素氧化酶活性 影响细胞 呼吸 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 4 4 神经精神性呼吸困难神经精神性呼吸困难 1 神经性 由于颅脑疾患 脑出血 脑肿瘤 颅脑外 伤等 颅内压 压迫呼吸中枢 或呼吸中 枢血液供应 功能减低 脑动脉硬化 特点 呼吸深而慢 常伴呼吸节律异常 如 呼吸遏制或双吸气 2 精神性 癔病 呼吸浅快 叹息样呼吸 手足搐搦 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 5 5 血源性呼吸困难血源性呼吸困难 由于血红蛋白质 量改变 携O2能力 1 重度贫血 高铁或硫化血红蛋白血症 2 大出血 休克 特点 呼吸浅快 心率增快 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 心悸 一种自觉心脏跳动的不适感或心慌感 当心率加快时感到心脏跳动不适 心率 缓慢时则感到搏动有力 心悸时心率可快 可慢 也可有心律失常 也可以心率和 心律都正常 可阵发性或持续性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 恶心 呕吐 恶心为上腹部不适 紧迫欲吐的感觉 常为呕吐前奏 呕吐是通过胃的强烈收缩迫使胃或部分 小肠内容物经食管 口腔而排出体外的现 象 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 呕吐的时间 晨起呕吐 早期妊娠 尿毒症 鼻窦炎 晚上呕吐 幽门梗阻 2 与进食关系 餐后即呕吐 幽门管溃疡 餐后1小时 胃张力下降 餐后较久 幽门梗阻 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 呕吐特点 喷射性呕吐 颅内高压 4 呕吐物性质 发酵腐败味 胃潴留 带粪臭 低位小肠梗阻 咖啡样呕吐物 上消化道出血 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 指上消化道疾病 屈氏韧带以上的消化 器官 包括食管 胃 十二指肠 肝 胆 胰疾病 或全身性疾病所致的急性出血 血液经口腔呕出 呕血 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 呕血与黑便 颜色与出血量 出血部位 血液在胃肠内 停留时间的长短有关 柏油便 tarry stool 出血 血红蛋白 肠内硫化物 硫化 亚铁 粪便变黑色 附有黏液而发亮 类似柏油 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 失血性周围循环障碍 出血量为血容量的10 15 头晕 畏寒 无血压 脉搏变化 出血量为血容量的20 以上 冷汗 四肢 厥冷 心慌 脉搏增快等 出血量为血容量的30 以上 脉搏频数微弱 血压下降 呼吸急促 及休克等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 血液学改变 血红蛋白 红细胞比容 白细胞计数 4 其他 肠性氮质血症 发热 以低热为主 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 便血 指消化道出血 血液由肛门排出 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 下消化道出血 鲜红色 肛门或肛管疾病 鲜红色血 不与粪便混合 上消化道出血或小肠出血停留时间长 柏油便 粘液脓血便 急性细菌性痢疾 暗红色果酱样脓血便 阿米巴痢疾 洗肉水样便 急性出血坏死性肠炎 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 腹痛 1 疼痛部位 与脏器位置一致 胃 十二指肠病 中上腹 肝胆疾病 右上腹 小肠 脐周 阑尾炎 麦氏点 结肠 盆腔疾病 下腹 牵涉痛 胰 胆 放射腰背 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 2 疼痛性质及程度 因病 因人而异 急剧 隐袭 消化性溃疡 烧灼痛 隐 钝痛 胃肠穿孔 刀割样 剧痛 急性胰腺炎 刀割样 绞痛 持续剧烈 胆石 泌尿结石 绞痛 剧烈 胆道蛔虫 钻顶样 剧痛 肿瘤 闷痛 胀痛 隐袭 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 疼痛发作的特点 呈周期性 间歇性 发作性 持续性 消化性溃疡 周期性 节律性 胆道蛔虫病 阵发性剧痛 辗转不安 呻吟 易缓解 再发作 急性腹膜炎 突发 持续刀割样痛 定位明确 压痛反跳痛 肌紧张 肠鸣音消失 泌尿系结石 阵发性 间歇发作 腹腔肿瘤 持续性 进行性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 4 疼痛影响因素 急性胃炎 胃扩张 胰腺炎 发作前暴饮暴食史 胆囊炎 胆石症 进食油腻食物发作 胃溃疡 进食后痛 空腹时痛 十二指肠溃疡 进食后痛 空腹痛时 胃粘膜脱垂 左侧卧疼痛 肝脾破裂 暴力冲击诱发 急性腹膜炎 仰卧屈腿痛 腹压 痛 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 腹泻 指排便次数增多 便质稀薄 或带有粘 液 脓血或未消化的食物 解液状便 每日三次以上 或每天粪便总 量大于200克 其中粪便含水量大于80 则认为是腹泻 分急性与慢性两种 超2个月者属慢性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 起病及病程 急性病程短 急性感染或食物中毒 缓慢病程长 慢性感染 吸收不良 肠道 肿瘤或神经功能紊乱 2 腹泻次数与粪便性质 急性次数明显增多伴粘液脓血便 细菌感染 慢性次数增多 稀便 可有粘液脓血 慢性痢疾 炎症性肠病 肠癌 粪便带粘液而无病理成分 肠易激综合征 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 3 腹泻与腹痛的关系 急性腹泻常伴腹痛 尤其以感染性腹泻明显 小肠疾病 脐周痛 便后腹痛缓解不明显 结肠疾病 多在下腹 便后腹痛常缓解 分泌性腹泻 往往无腹痛 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 便秘 指大便次数减少 一般每周少于3次 排便 困难 粪便干结 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 急性便秘 主要是原发病表现 如各种原因的肠梗阻 慢性便秘 常无明显症状 时有腹胀 下腹不适 容易出现痔疮或便血 慢性习惯性便秘 多见于中老年人 尤其是经产女 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 黄疸 由于血清中总胆红素浓度升高致使皮肤 黏 膜和巩膜发黄的症状和体征 胆红素 34 2 mol L 正常胆红素1 7 17 1 mol L 其中 结合胆红素0 3 42 mol L 非结合胆红素1 7 13 68 mol L Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 病因分类 溶血性 肝细胞性 胆汁淤积性 阻塞性 先天非溶血性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一 溶血性黄疸 临床特点 1 黄疸轻 呈浅柠檬色 不伴皮肤瘙痒 2 急性溶血 寒战 高热 腰痛 酱油色尿 贫血 严重者急性肾功能衰竭等 3 非结合胆红素 结合胆红素 4 RBC 网织RBC 5 尿胆原 6 粪胆素 粪色深 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 二 肝细胞性黄疸 临床特点 1 浅黄至深黄色 可有皮肤轻度瘙痒 2 全身乏力 食欲 肝区痛等 3 肝功能异常 4 血清结合 非结合胆红素均增加 5 尿胆原 粪胆素正常或 取决于肝细胞损害程度与毛细胆管阻塞 程度 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 三 胆汁淤积性黄疸 临床特点 1 黄疸多为暗黄或绿黄 2 皮肤搔痒 心动过缓 3 肝 胆肿大 胀痛或绞痛 胆石等 4 血清结合胆红素 尿中胆红素 5 尿色深 尿胆原 或消失 粪胆素 或消失 粪色浅 白陶土色 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 四 先天性非溶血性黄疸 肝细胞对胆红素的摄取 结合 排泄有 缺陷所致 1 Gilbert 综合征 UBG摄取障碍和 微粒体内葡萄糖醛酸转移酶不足 2 Dubin Johnson综合征 对CB排泄障碍 3 Rotor 综合征 摄取UBG和排泄CB障碍 4 Crigler Najiar综合征 缺乏葡萄 糖醛酸转移酶 UBG不能结合为CB Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 血尿 镜下血尿和肉眼血尿 前者指尿色正常 尿沉渣镜检每高倍视野 有红细胞3个以上 后者指尿呈洗肉水色或血色 肉眼即可见 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 尿颜色改变 1 白色混浊 尿盐结晶 脓尿 乳糜尿 2 黄色 尿中有结合胆红素 深黄色 浓茶样 提示肝细胞性黄疸或者梗阻性黄疸 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 红色 尿中有RBC 颜色可从淡红 洗肉水样 黑红色 伴混有血块 膀胱或前列腺出血 酱油样色 尿中混有血红蛋白 见于各样血管内溶血性疾病 Five weeks of practice ended in this way and my feelings can only be summed up in e
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