临床带教与英文查房 | 胆石症

小白老师说：Bedside teaching is seen as one of the most important modalities in teaching a variety of skills for the medical profession, which greatly improves certain clinical diagnostic skills in medical students and residents.

Gallstone Disease 胆石症

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In the Doctor’s Office 在医生办公室

Chief Resident : Your attention, guys. Now begins the morning meeting. Dr. Clark, how did things go last night?

住院总医师：大家请注意了，现在晨会开始。Clark 医生，昨晚有什么事吗?

**Resident：**I didn’t get much sleep last night. The emergency room was really hopping. An old friend visited us again in this morning with abdominal pain. Remember Mrs. Jones? We took out her appendix several months ago. She came back with a sudden onset of severe right upper abdominal pain referring towards the shoulder blade, which has been lasting from midnight till now.

住院医师：昨晚没怎么睡。急诊室真忙。今天一大早，我们的一个老病人来了，主诉腹痛。还记得 Jones 太太吗？几个月前，我们给她做了阑尾切除术。她这次是因为突然的右上腹剧烈疼痛并伴有向肩胛部放射来我院就诊。这种情况从半夜持续到现在了。

**Chief Physician：**What did she have for dinner?

主任医师：她昨晚吃了什么？

**Resident：**Fried pork chops. She might have biliary colic from a gallstone, I think. She’s had a few attacks of pain like it before but never that severe.

住院医师：炸猪排。我觉得像是由胆结石引起的胆绞痛。她以前也发生过几次类似的疼痛，但是没有这次严重。

**Chief Physician：**What did you find during examination?

主任医师：你体检时发现什么了吗？

**Resident：**Well, she’s got a fever, and a slight jaundice. While the abdomen felt very tender, with a positive Murphy’s sign.

住院医师：嗯，她有发热，还有一点轻微黄疸，腹部很柔软，Murphy 征阳性。

**Chief Physician：**Now sounds to me like we had better see her before going to the operating room.

主任医师：我觉得在进手术室前最好先看一下这个病人。

**Chief Resident：**OK. The patient now is in the emergency center.

住院总医师：好，病人在急诊中心。

In the Emergency Center 在急诊中心

**Chief Physician：**Hello, Mrs. Jones. Nice to see you again, but not under these circumstances. Your look told me the pain is really hanging on. I have known about your story from Dr. Clark. It sounds like you have had a gallbladder attack.

主任医师：你好啊，琼斯太太，见到你很高兴，当然最好不是在这种情况下见面。你看起来真的很痛。Clark 医生刚跟我说了你的情况，我考虑是胆囊病变发作了。

**Patient：**Oh, just like my mother and grandmother. You know, they both had their gallbladders removed.

病人：噢，那就跟我的祖母和母亲一样了，她们都把胆囊给切除了。

**Chief physician：**You have had a few episodes like this before, haven’t you?

主任医师：你以前也有过类似的疼痛发作是吧?

**Patient：**Yes. In fact, they lasted for only an hour or so. I didn’t want to bother you with it, since I thought it was just gas.

病人：是的，但以前疼痛只持续 1 个小时左右就好了。我想这只是小毛病，也没来看过。

**Chief physician：**Have you noticed any change in the color of your urine or stool?

主任医师：你注意过你的小便或大便的颜色有什么变化吗?

**Patient：**I noticed that my urine was dark when I gave a sample to the nurse a few minutes ago.

病人：几分钟前，我留小便样本给护士时，发现小便颜色比较深。

**Chief Physician：**That figures, since you look a bit jaundiced, and the dark color is likely due to bile backing up in your circle system and coming out in the urine. If you hung out there a few more days, your stool would become white, since the bile couldnt be expelled. Then we might think of whether there was an obstruction in your bile duct. Thank goodness you have come not too late. Take it easy. We’ll do some examinations for you.

主任医师：是的，因为你看起来有点黄疸。尿的颜色深很可能是因为胆汁回流到血，随循环而从尿液排出。如果不治疗，大便就可能会变成白色，因为身体里的胆汁不能排出，这时候我们就要考虑是否有胆管阻塞了。还好你来得不算太晚。别紧张，我们现在给你做一下检查。

**Patient：**OK. Thank you.

病人：好的，谢谢你。

**Chief Physician：**Dr. Clark, please do the examination, will you?

主任医师：Clark 医生，请你做一下体检。

**Resident：**OK.

实习医师：好的。

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