Medical English 專欄(一)

THE DIGESTIVE SYSTEM

(I)               Case

Juan, a 58-year-old recent immigrant from Latin America, developed severe severe upper abdominal pain the day before coming to the emergency room. X-rays showed air in his abdomen, and in the operating room he was found to have a hole in his duodenum, the first part of the small intestine, just past his stomach outlet, caused by a perforated peptic ulcer. The hole was surgically closed and he recovered well. He afterward carefully followed the postoperative recommendation to avoid the danger of a recurrent ulcer.

(II)           Q & A

Q: You look very pale. Do you have any trouble?

A: 1. My stomach hurts.

   2. I have frequent heart burn.

   3. I have no appetite and difficulty swallowing.

   4. My stomach aches when I drink coffee or alcohol.

   5. My stool has turned black.

   6. My stool is stained with blood.

   7. I am nauseous and vomiting. I burp too much.

Q: Do you have an appointment?

A: 1. No. But I would like to see the doctor right away.

   2. It is urgent. I feel weak and very uncomfortable.

   3. No. But I feel severe pain in my abdomen. It worries me.

   4. No. But I think it is urgent. Please do help.

(III)        What did she say?

Helen’s ulcers today are nothing but a memory – an awful memory. “I’d be hungry, but I couldn’t eat. I’d have these bad pains in my stomach, stinging kinds of pains that would last sometimes for about an hour. And I’d wake up during the night with the pain – just about every night.”

“The doctors at first gave me the drug Tagamet, which I’d take for about three to four months. The ulcers would go away, but then within a month they would usually come back.”

“I used to get upset a lot at my husband when he was drinking. When I’d get upset, that’s when the pain would start”.

(IV)        Stomach Pain & Peptic Ulcer

Stomach pain can take many forms, varying from a vague feeling of indigestion or discomfort to a distinct burning, wave- like pain in the central part of your upper abdomen that may move through to your back. Discomfort can be worse between meals and at night, and may be relieved by eating or by antacids, which temporarily buffer the acid.

Belching, vomiting, hiccups, and stomach distension may be signs of underlying stomach disease, affecting the stomach’s motility and outflow. Loss of appetite, weight loss, or anemia may be your first sign. Bleeding from the stomach may produce a tar-hued stool, or vomiting of bright red blood or “coffee grounds” – colored material.

Bleeding is the most common ulcer complication requiring surgery, and the leading cause of death in ulcer patients. If your ulcer eats into your intestinal wall’s tiny blood vessels, a slow ooze of blood, evidenced by black, tar-like stools, can develop. If one of your larger arteries is penetrated, bleeding can be massive, making your stools maroon or red, and causing you to vomit bright red blood.

          

(V)           Habits that head off ulcers

(A)  Discard your cigarette

You have three reasons to quit smoking.

1.      People who smoke get more ulcers.

2.      People who smoke have ulcers that heal more slowly.

3.      people who smoke get their ulcers back more quickly.

(B)   Check your medicines

Do not take aspirin, ibuprofen, or naproxen. Try acetaminophen instead.

(C)   Think about what you put in your mouth.

1.      Try eating smaller, more frequent meals.

2.      Avoid coffee, tea, cola, and other products that contain caffeine.

3.      Avoid spicy or greasy foods, that seem to bring on symptoms.

4.      Limit your alcohol intake.

(D)  Keep calm

Learn to relax and manage stress.

(VI)        Vocabularies

                    Peptic ulcer

                         Gastritis

                         Appendicitis

                         Enterocolitis

                         Hemorrhoid

                         Heart burn

                         Diarrhea

                         Constipation

                         Hepatitis

                         Cirrhosis

                         Gallstone

                         Pancteatitis

                         Tarry stool

(VII) Dialogues

P: What seem to be my friend’s trouble, Doctor?

D: It’s duodenal ulcer, caused by hyperacidity.

P: How about her liver and gallbladder? She had acute hepatitis several years ago. Besides, part of her bile duct was removed last year.

D: The laboratory report shows nothing wrong with her gallbladder. Her liver, however, doesn’t function normally.

P: What is the cause of that?

D: I don’t really know. We can only say that malnutrition is the most common cause. Alcoholism, drug addiction, toxic and infectious agents can also produce liver disease. She doesn’t drink wine, does she?

P: No. What should she do now for fast recovery?

D: There is no royal way to fast recovery. She’ll recover only in a slow manner. I’ll give her tablets. She has to take them regularly.

P: Does he have a fatty liver?

N: Yes. It has been demonstrated that alcoholic beverages may produce a fatty liver. However, decreased removal of fat related to deficiency of protein appears to be the most critical factor.

P: What should he do?

N: It’s nothing serious. An appropriate diet and proper exercise are helpful.

 

病毒性肝炎的防治

病毒性肝炎的防治                                                      蔡順宗醫師

肝臟有四大特點 : 1. 肝臟是人體最忙的器官,人體是個巨大又復雜的化工廠，肝臟是這個化工廠的“處理中心”。由於肝臟太忙，耗能太大，所以需要有足夠的營養來維持它。　2. 肝臟是人體最勇於犧牲自己的器官,肝臟是進入人體有毒有害物質的“解毒工廠”, 對受到污染的大氣、飲水、食物以及使用的藥物, 肝臟都要奮不顧身地前去排毒解毒，保全身體。3. 肝臟是人體最為沈默的器官,肝臟任勞任怨，每天做最多的事，幹最苦的事，哪怕是有病了，也不會抱怨，不喊一聲痛，由於肝臟的這種特性, 導致我們忽視了肝病的存在，致使肝病越來越重，甚至癌變。4、 肝臟是人體最易受到傷害的器官,由於肝臟又忙又累，又面對有毒有害物質的侵襲，又任勞任怨，所以肝臟最容易受到傷害，患病也最難治。

                                       

大家知道病毒性肝炎，肝纖維化，脂肪肝，酒精肝，藥物性肝損害及肝硬化，肝癌等肝病是當今社會威脅臺灣人健康的主要疾病之一。

今天跟各位先進報告的重點在 病毒性肝炎 , 一般所謂的人類病毒性肝炎共分A、B、C、D、E等五種，其中A型與E型肝炎是經由口腔傳染,  而  B、C、D型肝炎是經由體液傳染（主要是血液）。

　　病毒性肝炎:  

         A型病毒肝炎  :     

          它是經由 被A型肝炎病毒汙染的食品、飲水而「經口傳染」, 或肛交感染。潛伏期約二至四星期，症狀有發燒、出汗、畏寒、倦怠、噁心、嘔吐、食欲不振, 黃膽等 . 若不幸感染A型肝炎, 絕大部分的病人都可痊癒，不會變成慢性肝炎、肝硬化或肝癌等後遺症。極少病人會變成猛爆性肝炎而死亡。                                                                                                                       A型肝炎抗體有兩種，一種是IgG anti-HAV，此抗體若為陽性，表示曾感染過A型肝炎，且對A型肝炎病毒已有免疫力或抵抗力，不怕A型肝炎病毒的感染。若IgM anti-HAV抗體陽性表示目前感染急性A型肝炎。

預防為改善個人衛生習慣，注意飲水及食品衛生，絕不生食。飯前、便後、及拿食物前需正確用肥皂洗手，現在已有A型肝炎疫苗可供預防注射 , 效果很好，也相當安全。

　

        Ｂ型病毒性肝炎 :      

         台灣成人中，約有 90%曾受到 B型肝炎的感染，其中約有 15~20% 的人成為帶原者。若在新生兒感染,  約90％會成為慢性帶原者;  在台灣地區，約有一半的帶原者是由慢性帶原的母親在生產的過程中（周產期），將B 型肝炎病毒傳染給新生兒而來的 ;  若5歲以下幼兒感染，約25～50％會成為慢性帶原者；若成人感染則成為慢性帶原者之危險性約在5％以下。台灣地區約有三百萬名 B 型肝炎帶原者, 臺灣則以病毒基因型adw為主; 所謂 B型肝炎帶原者，是指一個人受到 B 型肝炎病毒感染後，身體未能將病毒清除，B型肝炎病毒持續存活於人之血液及肝細胞內大於6個月，這時候血液中持續可測得 B 型肝炎表面抗原(HBsAg)。                                                                                                                                                         台灣每年約有8千人死於肝癌，80％的肝細胞癌與B型肝炎病毒感染有關，大部份幼兒感染個案極可能在成人時引起慢性肝炎，肝硬化，或是原發性肝細胞癌。                                                                                                                                  B型肝炎的 傳染途徑為體液,或血液,或精液 ; 可分垂直感染(母親傳給小孩),及水平感染( 由共用牙刷、刮鬍刀、針筒及不安全的性行為, 紋身或身體穿刺 等方式傳染)  ;  至於手牽著手，共用餐具或水杯，接吻，擁抱，咳嗽，打噴嚏，或哺乳期等 並不能傳播病毒。                  它的潛伏期（病毒進入人體後到發生臨床症狀的期間）平均約二個月或更久，進入人體的病毒量越多時潛伏期可能越短。當病毒進入人體後,  B型肝炎病毒不會直接殺死肝細胞，而 是藉由人體毒性T淋巴球的免疫機轉,  而導致遭受到B型肝炎病毒感染的肝細胞壞死 ,當 毒性T淋巴球欲除去B型肝炎病毒的同時，肝細胞也就跟著壞死。                                              急性B型肝炎的臨床症狀為黃疸、茶色尿、腹脹、噁心,食慾不振, 體重減輕等。                慢性帶原者需要定期接受肝功能、B型肝炎標記( HBsAg,  Anti-HBs,  HBeAg,  Anti-HBe,  AntiHBc, HBVDNA等 )、甲型胎兒蛋白及腹部超音波檢查, 平時也應避免 飲酒、服藥、吃補藥等能使肝炎惡化的因素。急性病毒性Ｂ型肝炎感染者,大部分會自然痊癒 . 無症狀且肝功能正常的帶原者，無須治療。                                                                                                                對於肝肝功能不正常的慢性B型肝炎帶原者,  若a.  HBe抗原陽性, ALT >= 2倍正常值上限 ;  b.  HBe抗原陰性 , HBV DNA陽性且ALT >= 2倍正常值上限 ; c.   代償良好之活動性肝硬化 ; d.  代償失調之活動性肝硬化 ; e.  40歲以上且肝切片顯示有顯著肝纖維化 ; f.  接受免疫抑制劑或化學藥物治療者, 則需積極接受干擾素和抗病毒藥物 (  如: 干安能 (lamivudine)  , 干適能 (adefovir dipivoxil) ,貝樂克 (entecavir) , 喜必福 (telbivudine) , Tenofovir ) 的 治療,  因為抗病毒治療可使肝纖維化逆轉而減少,  且可減少肝病發展成重度肝纖維化, 肝硬化, 和肝癌 。

      C型病毒肝炎 :    

        與B型肝炎的傳播的方式相同，通過接觸受感染者的血液，精液, 體液感染, 平均的潛伏期約七到八週，臨床症狀和B型肝炎極為相似，但是倦怠感、嘔吐及其他全身性的不適較不明顯。例如   :  接受輸血者，共用針頭者、血液透析者、接受器官捐贈者均屬高危險群.它已被公認為引發輸血後急性肝炎的主要原因。大約50-70 % 感染C型肝炎患者將發展為慢性感染, 可能會導致肝硬化 , 肝癌。 臨床上治療慢性C型肝炎為使用干擾素合併雷巴威林(Ribavirin) 。干擾素的主要作用機轉是經由刺激體內的免疫系統，進而抑制病毒複製並使已經遭感染的肝細胞死亡;  Ribavirin則可能透過活化免疫T細胞作用，以抑制病毒複製; 兩者合併使用有加乘的效果。C型肝炎的預防在於避免接觸傳染C型肝炎的途徑；如不必要的打針、共用牙刷、共用刮鬍刀以及重複使用同一針頭做針灸，穿耳洞、刺青等。

       D型病毒肝炎:

        由D型肝炎病毒感染所造成的肝炎就是D型肝炎。D型肝炎病毒是一種缺陷型病毒，所謂缺陷型病毒就是指這種病毒本身，無法製造出完整的病毒顆粒，必須藉助其它的病毒才有辦法製造出完整的病毒。D型肝炎病毒是必須藉助B型肝炎病毒的外套才能造出具有傳染力的完整病毒，只有D型肝炎病毒而沒B型肝炎病毒的幫助，D型肝炎是無法複製的D型肝炎病毒的感染，在臨床上的表現可分為兩大類：1. 同時感染 :  與B型肝炎病毒同時感染, 一個未具抵抗力的人，同時發生急性B型和D型肝炎, 這種比較少見，預後也較好，大多數患者不會變成慢性D型肝炎。2. 添加感染:  也就是體內先有B型肝炎病毒, 再加D型肝炎病毒的感染, 它比同時感染還常見。因此, 慢性B型肝炎的病人, 若發生急性發作，原本穩定的GPT值，突然高起來且超過正常值十倍以上, 就需考慮可能是遭受D型肝炎病毒的添加感染。這種感染預後較不好，大多數的人會變成慢性D型肝炎。

D型肝炎的最佳防治之道，就是不要感染B型肝炎而變成帶原者。已知是B型肝炎帶原者,應避免嫖妓與毒品注射等高風險行為。目前並無特別的藥物可以很有效的治療慢性D型肝炎。若使用治療慢性B型或C型肝炎的干擾素來治療慢性D型肝炎其效果不如治療慢性B型或慢性C型肝炎好。

      E 型病毒肝炎 :

      E 型病毒的感染途徑 為糞-口傳染,  病從口入,  因 飲用被E型肝炎病毒感染的飲用水或食品而感染, 其潛伏期約4- 6星期。 E型肝炎是一種自我限制的疾病，它通常會自行消失，病人完全康復。然而少數病人在被感染期間（通常是幾個星期 )可能會出現急性肝炎的症狀,  如: 噁心、嘔吐、疲倦、黃膽等,  而影響其工作能力。極少數E型肝炎病人發展成嚴重的肝病，約2％會致命。臨床上在孕婦被感染時, 往往較嚴重，可能暴發猛暴性肝衰竭, 特別是在懷孕晚期被感染，有20％左右的死亡率。在免疫功能低下的情況 ,特別是在器官移植患者, E型肝炎可能會導致慢性肝炎,有些還可能會導致肝纖維化和肝硬化。預防E型肝炎，主要還是要注意飲食衛生。