# 病概記憶點(期中)
1105
感冒(common cold)最常見的病毒感染
* 鼻病毒(Rhinovirus)
* 腺病毒(Adenovirus)
* 伊科病毒(Echovirus)
* 流感病毒(Influenza virus)

過敏性鼻炎(Allergic Rhinitis):
免疫球蛋白(IgE)媒介的第一型過敏反應

鼻咽癌(Nasopharyngeal carcinoma):
致癌因素，遺傳，環境，EB病毒( Epsten-Barr virus)

乳突瘤(Learyngeal papilloma): --良性
人類乳突瘤病毒(HPV11 and 6)

肺炎(Pneaumonia):
大葉形肺炎(Lobar pneumonia):細菌
支氣管型肺炎(Bronchopneumonia):細菌
間質性肺炎(Interstitial pneumonia):病毒，黴漿菌

20min

慢性阻塞性肺病(Chronic obstructive pulmonary disease,COPD)
成因:**吸菸**、職場粉末化學物質、空汙
分類:
1. 慢性支氣管炎(Chronic bronchitis)
2. 肺氣腫(Emphysema)
* 中央腺泡型(Centriacinnar):吸菸
* 全腺泡型(Panacinar):a1-antiypsin deficiency
* 遠端腺泡型(Distal acinar):自發性氣胸
* 不規則形(Irregular):

肥大細胞分泌組織胺->過敏反應

支氣管擴張(Bronchiechtasis):
致病機機:阻塞和感染
死因首位:惡性腫瘤
癌症首位:肺癌
相關尹素:吸菸、職業暴露(石綿)

肺癌分類:
* Adenocarcinoma(腺癌):
* 最常見於惡性上皮腫瘤
* 染色:Mucine,TTF-1 `
* Squamous cell carcinoma(鱗狀細胞癌):
* 男性吸菸者
* 位置:中央
* 角質化(keratinization)
* 細胞間橋(intercellular bridge)
* Neuroendocrine tumors
* **Small cell carcinoma**(小細胞癌)
* 吸菸者，要做化放療
* Large cell neuroendocrine carcinoma
* Carcinoid tumor
* Large cell carcinoma(大細胞癌)
* 沒有腺癌和林狀細胞癌分化


1029

食道先天性異常(congenital anomalies)
* 食道胃發育
* 食道閉鎖(atresia) & 食道，氣道廔管(fistula)
* 較常見(兩者常合併發生)
* 食道，氣道廔管以typeC (食道近端閉鎖，遠端與氣管產生廔管)最常見
* 食道狹窄

食道裂孔疝氣(hiatal hernia):
* 胃經由橫膈裂孔突出於橫膈之上
* 滑動疝氣(sliding hernia)-95%
* 食道旁疝氣(paraesophageal hernia,rolling hernia)
* 先天或後天因素
* 併發症:反流性食道炎，潰傷，出血，穿孔

食道靜脈屈張(esophegeal varices):
* 常因肝門靜脈高壓引起，多見於肝硬化病人

23min

食道炎(Esophgitis):
* 反流性食道炎(reflux esophagitis)最常見，主要原因為下食道括約肌異常->太鬆(逆流)
* 長期反流刺激，遠端鱗狀上皮繪化生(metaplasia)為住狀上皮，稱為巴雷氏食道(Barret esophgus)，約10%轉變為腺癌

食道腫瘤(esophagealtumor):
* 良性腫瘤:以平滑肌瘤(leomyoma)最常見，另外還有脂肪瘤、纖維瘤、血管瘤
* 惡性腫瘤:占所有腸胃道惡性腫瘤6%
* 最常見:鱗狀上皮癌 (squamous cell carcinoma)
* 次常見:腺癌(危險因素:巴雷氏食道，食道下1/3)
* 少見:黑色素瘤、淋巴瘤
胃炎:
* 急性胃炎(acute gastritis):
* over use NSAID(ex:阿斯匹靈)
* 抽菸、酗酒、全身性感染、壓力
* 無症狀到大量出血及血便
* 慢性胃炎(chronic gastritis):
* 幽門桿菌(Helicobacter pylori->70%)、自體免疫、酗酒、抽菸
* 自體免疫胃炎病患血中，有對抗壁細胞(periatal cell)的抗體，和惡性貧血相關
* 症狀較輕微，但與慢性消化潰瘍，胃癌相關

Gastric tumor
* Epithalial Tumor(上皮腫瘤)
* Adenocarcinoma(佔胃惡性腫瘤90-95)
* 致病:環境、個體、遺傳
* lymphoma(5%)

與幽門桿菌有關的疾病:
慢性胃炎、胃癌、淋巴瘤，消化性潰瘍(Peptic Ulcer Disease,PUD)
->抗幽門桿菌藥物

![Uploading file..._p5y5l34p7]()

憩室病(diverticular disease):
* 先天性憩室 Meckel diverticular 好發於小腸
* 後天性憩室 好發於乙狀結腸(sigmoid colomn)
* 成因:局部肌肉層薄弱、腔內壓力增加
* 不須治療可自愈

諉膜性結腸炎(psuedomembranous colitis)
* 在服用廣效性抗生素後，改變腸道菌相，造成艱難梭狀桿菌(Clostridium difficile)滋長，分泌毒素引起黏膜壞死
* 常見於成年，造成慢性腹瀉



1022:Neoplasia

命名(良性):字尾-OME
123

29
Sacroma:肉瘤
* a maligant惡性的 neoplasm腫瘤 of mesenchymal間質 origin
*

Dysplasia:
* Disordered growth
* Metaplasia

Metastasis(轉移)

85%癌症是可以用改變生活型態預防的
抽菸->肺部鱗狀細胞癌、食道癌、口腔癌

HBV/HCV
hepatocellular carcinoma(hepatoma)

p53tumor suppressor gene

命名
良惡性
致癌物和產生的癌症

1015

25
direct defection
immunologic(infection-induced)

Large Vessel Vasculitis血管炎
* Giant cell (temperal) arteritis
* assotiated with polymyalgia rheumatica(风湿性多肌痛)
* >50y
* Nodular thickening
* diplopia複視 or visual loss
* Takayasu arteritis動脈炎
* <50 female
* involve aortic arch
* pulseless disease

Medium-Sized Vessel Vasculitis:
* polyarteritis nodosa(classic polyarteritis nodosa)結節性多動脈炎
* 不會造成小血管的arteritis->glomerulonephritis
* muscular a.->kidney,heart,liver
* multi-system disease ->malaise,fever,
* Kawasaki disease(川崎病->小孩)
* <4y

Small Vessel Vasculitis:
* Wegener granulomatosis
* c-ANCA
* >40y
* Triad
* acute necrotizing granulomas in respiratory tracts
* necrotizing glomerulonephritis腎絲球腎炎

* lung
* Chrug-Strauss syndrome
* eosinophil-rich
* assotiated with asthema
* p-ANCA
* Microscopic polyangitis
* p-ANCA

Thromboangititis obliterans閉鎖性細支氣管炎(buerger disease):
* heavy smoker

Heart Disease:
* Congental
* Ventricular Septal Defect(心室中膈缺損)-VSD
* 1st
* Left to Right Shunt
* ASD、VSD
* late cyanosis(發紺) and heart fialure
* shunt reverse
* 右心hypertrophy
* R to L shunt
* Tetralogy of Fallot
* subpulmonary stenosis
*

* Ischemic
* angina pectoris 心絞痛(stable->unstable->MI):
* Stable angina(典型心絞痛):
* reductioncoronary perfution(75%)
* Prinzmetal or variable angina(變異性心絞痛)
* coronary art. spasm
* Myocardial Infraction(心肌梗塞)
* Death of Cardiac mus.
* coronary artherosclerosis and superimpose thrombosis
* 
*
* Systamic(left-side) Hypertensive Heart Disease
* LV hypertrophy without other causes
* Pulmonary(right-side) Hypertensive Heart Disease
* Cor pulmonale(肺心症)
* Acute ex:massive pulm. embolism(肺栓塞):
* RV dilation without RV hypertrophy
* Chronic ex:pulm. HT,COPD:
* RV hypertrophy with RV dilation

* Hypertensive
* Valvular
* NonIschemical (primary) myocardial disease

1008