内科学英文课件：Hemorrhagic Disorders
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内科学教学课件：Gastrointestinal Hemorrhage
Hematochezia [hemətə‘ki:zɪə]便血
Etiology
The most common 4 causes Peptic Ulcer> Varices bleeding > Acut hemorrhagic gastritis> Gastric cancer>
Etiology
1.Upper gastroitation
1. Hematemaesis , Melena, Hematochezia 2. Hemodynamical failure • larg and rapid loss of circulatory volume.
palpitation心悸 lightheadedness头昏, syncope晕厥, Inertia 乏力postural hypotention 体位性低血压 • shock： Dysphoria烦躁不安，confused state of mind, Pale， dyspnea呼吸困难, extremities Coldness， lips cyanosis口唇发绀，BP<90/60mmHg, tachycardia心动过 速，urea volume decrease.
• Esophageal disease :Mallory-Weiss
• Gastroduodenal disease: PU,AGML,Cancer,
Vascular malformation, Dieulafoy’s disease （caliber-persistent-
artery malformations恒径动脉畸形）
1. Hematemaesis: bloody vomits, bright/older red and coffee-ground
Etiology
The most common 4 causes Peptic Ulcer> Varices bleeding > Acut hemorrhagic gastritis> Gastric cancer>
Etiology
1.Upper gastroitation
1. Hematemaesis , Melena, Hematochezia 2. Hemodynamical failure • larg and rapid loss of circulatory volume.
palpitation心悸 lightheadedness头昏, syncope晕厥, Inertia 乏力postural hypotention 体位性低血压 • shock： Dysphoria烦躁不安，confused state of mind, Pale， dyspnea呼吸困难, extremities Coldness， lips cyanosis口唇发绀，BP<90/60mmHg, tachycardia心动过 速，urea volume decrease.
• Esophageal disease :Mallory-Weiss
• Gastroduodenal disease: PU,AGML,Cancer,
Vascular malformation, Dieulafoy’s disease （caliber-persistent-
artery malformations恒径动脉畸形）
1. Hematemaesis: bloody vomits, bright/older red and coffee-ground
英文课件骨髓增生异常综合征s
iron stain
Myelodysplastic syndromes
FAB classification system
• Refractory anemia (RA): cytopenia of one PB lineage; normo- or hypercellular marrow with dysplasias; < 1% PB blasts and <5% BM blasts
• Refractory anemia with ringed sideroblasts (RARS): cytopenia, dysplasia and the same % blasts involvement in BM and PB as RA. Ringed sideroblasts account for > 15% of nucleated cells in marrow.
• Refractory anemia with excess blasts in transformation: (REAEBt): hematologic features identical to RAEB. >5% blasts in PB or 2130% blasts in BM, or the presence of Auer rods in the blasts
• Poor prognosis
1.0
(abnor. 7, complex- >3 abnor.)
Cytopenias
• None or one type
0
• 2 or 3 type
0.5
International Prognosis integrated system (IPSS) IPSS risk-based classification system
Myelodysplastic syndromes
FAB classification system
• Refractory anemia (RA): cytopenia of one PB lineage; normo- or hypercellular marrow with dysplasias; < 1% PB blasts and <5% BM blasts
• Refractory anemia with ringed sideroblasts (RARS): cytopenia, dysplasia and the same % blasts involvement in BM and PB as RA. Ringed sideroblasts account for > 15% of nucleated cells in marrow.
• Refractory anemia with excess blasts in transformation: (REAEBt): hematologic features identical to RAEB. >5% blasts in PB or 2130% blasts in BM, or the presence of Auer rods in the blasts
• Poor prognosis
1.0
(abnor. 7, complex- >3 abnor.)
Cytopenias
• None or one type
0
• 2 or 3 type
0.5
International Prognosis integrated system (IPSS) IPSS risk-based classification system
内科护理学_课程课件_35.出血性疾病
内脏出血 表现：为咯血、呕血、便血、尿血、阴道出血
及颅内出血等，一般出血量较大。 原因：局部血管损伤及有关脏器病变，
重症血小板减少及凝血障碍性疾病。 颅内出血：是致命性的，主要见于血小板低于 20×109／L 的重症血小板减少症，也可见于 复合因素所致的出血性疾病。
贫血 anaemia
一般不会有贫血症状 长期反复出血者可有轻中度慢性贫血表现。
出血性疾病概述 Hemorrhagic
Disorders
教学目标：
1、了解出血性疾病的概念； 正常止血、凝血和抗凝血机制； 出血性疾病的分类。 2、熟悉出血性疾病发病机制 三要素、出血性疾病的临床表 现、有关检查的特点、防治原 则。
概念
出血性疾病系指因先天性或获得性因素，导致 患者止血、凝血及纤维蛋白溶解等机制的缺馅或 异常，从而引起以自发性出血或轻度损伤后过度 出血甚至出血不止为特征的一组疾病。
出 血 haemorrhage
是出血性疾病的主要症状和体征。 皮肤粘膜出血： 深部组织出血：
内脏出血
皮肤粘膜出血：是血管及血小板疾病最常见
最易发现的症状和体征。 出血可散布于全身各部位，但以四肢较多见，
其表现因出血程度、范围及出血部位不同而 类型：出血点、紫癜、淤斑、血疱、鼻出血、
牙龈出血等。 皮肤粘膜下出血要注意与蜘蛛痣、角化性血管
预防
遗传性出血性疾病的病因预防措施： 防止外伤、尽可能避免各种外科手术， 成年患者的职业应选择比较“安全”的工作。 向患者介绍出血性疾病的常识和出血时一般 的处理措施等。
血管因素
病因治疗最重要，其次为 减低血管壁脆性和通透性的药物： 路丁、安络血、维生素C 缩血管药：垂体后叶素 肾上腺皮质激素 局部处理：局部压迫式加压包扎止血、 局部置冰袋冷敷、 明胶海绵、止血药物。
(内科学课件)02.慢性肾小球肾炎-english
6. Alport syndrome
positive family history ,more onset in adolescent (< 10 years old);Kidney damage (hematuria, mild-to-moderate proteinuria and progressive renal impairment) , deafness ,eyes impaired
2. DN（diabetic nephropathy)
A long history of diabetes, then urinary abnormality. Evidence of other diabetic microvascular complications :such as diabetic retinal lesions or diabetic neuropathy. Glomerular hematuria is not obvious.
5. Chronic pyelonephritis
Recurrent urinary tract infection history; Urine bacteriological examination often positive; Imageology examination : double kidney asymmetric shrink.
Clinical manefestation
edema:
hypertention
hypertention
female at the age of 31 impaired vision ophthalmologist →fundus hemorrage →hypertention(160/102mmHg) cardiologist →urine analysis kidney fuction
(内科学课件)02.慢性肾小球肾炎-english
hematuria:
gross hematuria and microscopic hematuria(the count of RBC in fresh urinary sediment is more than 3 per high power field under
inflammation mediated by primary immunological reaction MAIN
hypertension severe proteinuria hyperlipidemia(high blood fat) hyperuricemia(high uric acid) (etc)
and prognosticate
diagnosis
abnormal urine analysis(proteinuria and, or hematuria),edema,hypertention with or without renal disfunction,excluding secondary and hereditary glomerulonephritis.
Clinical manefestation
edema:
hypertention
hypertention
female at the age of 31 impaired vision ophthalmologist →fundus hemorrage →hypertention(160/102mmHg) cardiologist →urine analysis kidney fuction
(内科学课件）02.慢性肾小球肾炎-english
What is chronic glomerulonephritis (CGN)?
内科学教学课件：英文班尿路感染
4: B-ultrasound to exclude obstruction and urolithiasis
Diagnosis
True bacterial urine:
1) mid-stream clean-catch bacteria count≥105/ml, excluding false positive
bacteria placed are rapidly cleared, the antibacterial properties of urine and the bladder mucosa , high urea concentration and high osmolarity .
Precipitating factors
Urinary Tract Infection
Definition
UTI is the urinary infective disease which is causing by many different microorganisms growing and breeding in urinary tract often occur in old man ,worst immune, urinary deformity and woman in child-bearing period
2) puncture urinary bladder can find bacteria count
Differential diagnosis
1: chronic glomerulonephritis 2: Renal tuberculosis 3: Urethral syndrome: not find true
2: a: Urine bacteria culture: midstream clean-catch bacteria count ≥ 10 5/ml. puncture urinary bladder find bacteria count.
Diagnosis
True bacterial urine:
1) mid-stream clean-catch bacteria count≥105/ml, excluding false positive
bacteria placed are rapidly cleared, the antibacterial properties of urine and the bladder mucosa , high urea concentration and high osmolarity .
Precipitating factors
Urinary Tract Infection
Definition
UTI is the urinary infective disease which is causing by many different microorganisms growing and breeding in urinary tract often occur in old man ,worst immune, urinary deformity and woman in child-bearing period
2) puncture urinary bladder can find bacteria count
Differential diagnosis
1: chronic glomerulonephritis 2: Renal tuberculosis 3: Urethral syndrome: not find true
2: a: Urine bacteria culture: midstream clean-catch bacteria count ≥ 10 5/ml. puncture urinary bladder find bacteria count.
内科学_各论_疾病：绝经与阿尔茨海默病综合征_课件模板
内科学疾病部分：绝经与阿尔茨海默病综合征>>>
病因：
治疗AD的作用。2个雌、孕激素（醋甲孕 酮，MPA）联合治疗的小样本研究显示MPA 抵消了雌激素的效果。
（3）ERT能否改善无AD老年妇女的认 知功能研究报道对词语记忆及流利度、视 觉记忆有改善，Yaffe K（2000）报道仅 对APOEε4阴性的妇女有效，APOEε4阳性 的妇女无
内科学疾病部分：绝经与阿尔茨海默病综合征>>>
病因：
1.雌激素影响脑结构功能 雌激素对 脑结构功能的影响涉及神经细胞、血管结 构、神经递质三个方面：
（1）神经细胞：雌激素有神经营养 作用：胎鼠海马、基底前脑、大脑皮质神 经元的体外培养研究显示小剂量结合雌激 素能促进神经细胞轴突、树突的生长，突 触的形成。雌激素还能促进星状神经胶
内科学疾病部分：绝经与阿尔茨海默病综合征>>>
病因：
（rCBF）的研究，有报道绝经后妇女rCBF 低，尤其在潮热发作时。ERT改善rCBF约 增加22%，尤其是颞叶、海马区。雌激素 促进一氧化氮（NO）合成酶的表达，降低 IL-1的活性、阻断IL-6的生成，从而减少 β淀粉样蛋白所引起的炎性反应。
（1）雌激素补充治疗（ER
内科学疾病部分：绝经与阿尔茨海默病综合征>>>
病因：
T）与AD发病关系的流行病学研究：1994 年后的5个回顾性病例对照研究中4个显示 用ERT者患本症的危险性与未用ERT者比较， 优势比为0.33～0.60;但Seshadri s （2001）的病例对照研究报道差异不显着。 1993～2000年后3个前瞻性队列研究显示 ERT者发生AD或因
内科学疾病部分：绝经与阿尔茨海默病综合征>>>
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3
disorders of
blood coagulation
4
disorders of anticoagulation system
and fibrinolytic
system
5
Complex disorders
of hemostatic mechanism
Classification: Vascular disorders
Mechanism of normal hemostasis
– Vascular mechanism – Platelet mechanism – Blood coagulation mechanism
Normal hemostasis
凝血瀑布反应
凝 第血 一活 阶酶 段生
成
第二阶段
第三阶段
Other purpuras: purpura simplex, senile purpura, mechanic purpura, paraproteinemia.
Classification: platelet disorders
Thrombocytopenia
Thrombocytosis
Thrombocytopathy
disorders of metabolism (Vitamin C deficiency), pathological changes of vascular wall (atherosclerosis), connective tissue diseases.
Allergy: allergic purpura.
Classification: disorders of blood coagulation
Hereditary
Acquired: Vitamin K deficiency, severe liver diseases, disseminated intravascular coagulation (DIC) etc.
Hereditary:
– Hereditary hemorrhagic telangiectasia（遗传性出 血性毛细血管扩张症）,
– hereditary disorders of connective tissue such as Ehlers-Danlos syndrome.
Secondary: infections, chemical factors or drugs,
Classification: platelet disorders
Classification: platelet disorders
Thrombocytosis
– Primary: essential thrombocythemia – Secondary: infections, injury, post-splenectomy,
red thrombus
Anticoagulation and fibrinolytic mechanism
Anticoagulation system
– AT-Ⅲ – Protein C system: PC, PS, TM – TFPI – Heparin
Anticoagulation system
TFPI
蛋白C系统
ATIII
肝素
Anticoagulation and fibrinolytic mechanism
Fibrinolysis system
– Plasminogen – Tissue-type plasminogen activator(t-PA) – Urokinase- type plasminogen activator(u-PA) – Inhibitors:α2-plasmin inhibitor(α2-PI),
Inherited Disorders of blood coagulation
(FVII缺乏症) VII/TF
组织损伤 TF
IX
XII
XIIaa (血友病B)
(血友病A) VIII
VIIIa
(FX缺乏症) X （低凝血酶原血症） 凝血酶原
Xa
X
Va
V (FV缺乏症)
凝血酶
(纤维蛋白原缺乏症 纤维蛋白原
低纤维蛋白原血症)
XIII
纤维蛋白
XIIIa (FXIII缺乏症) 交联的纤维蛋白
Classification:
disorders of anticoagulation system and fibrinolytic system
– Hereditary – Acquired: due to drugs, uremia, liver
diseases, dysproteinemias.
Inherited Disorders of Platelet Function
Giant platelet syndrome (Bernard-Soulier syndrome) 巨大血小板病 Glanzmann Thrombasthenia 血小板无力症
Hemorrhagic Disorders
Definition
When the normal hemostatic mechanism fails, major hemorrhage may follow minor trauma or may arise apparently spontaneously
chronic myelocytic leukemia, other myeloproliferative disorders (such as polycythemia vera 真性红细胞增多症）
Classification: platelet disorders
Functional abnormalities of platelets
plasminogen activator inhibitor-1(PAI-1)
Fibrinolysis system
An overview of endothelial function in coagulation
Classification
1
vascular disorders
2
platelet disorders