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# System prepended metadata

title: 病概記憶點(期中)

---

# 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):


![](https://i.imgur.com/Lw4MhNV.jpg)
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


![](https://i.imgur.com/exGH4J4.jpg)


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

![](https://i.imgur.com/zbidVbR.png)

![](https://i.imgur.com/rgVZd1R.jpg)


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
* 
![](https://i.imgur.com/nKd5rvU.png)

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
            * ![](https://i.imgur.com/YNY2A3b.png)
            * 
* 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