司考周报》第7期刑法笔记号是对

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1、Tuberculosis(TB)oftheGenitourinaryTract泌尿生殖系结核瑞金医院泌尿外科邵远UrinaryTBAdiseaseofyoungadults.60%between20~40y.Infectingorganism—Mycobacteriumtuberculosis(结核分支杆菌，结核杆菌),TuberclebacilliInfectingRoute(感染途径)Hematogenousroute(血行途径)fromthelungs.Primarysites(初发部位):Kidn

2、ey,Prostate(前列腺)Otherorgansinvolved:directextensionPathogenesis(发病机理)Tuberclebacillihittherenalcortex(肾皮质):Normalresistance(抵抗力):organismdestroyedSufficientvirulence(致病力):clinicalinfectionestablished.PathogenesisTBofkidney:progressesslowly,15~20ytodestro

3、yakidneywithgoodresistance.Noclinicaldisturbanceuntilthecalyces/pelvis(肾盏/肾盂)involved.Pathology(病理)Kidney&Ureter(输尿管)Grossly:asoft,yellowishlocalizedbulge(隆起).Onsection:involvedareafilledwithcheesymaterial(caseation,干酪样物质).Kidney&UreterWallsofpelvis,calyce

4、sandureterthickened.Ulceration(溃疡形成)incalyces.Completeureteralstenosis(输尿管狭窄)Autonephrectomy(肾自截).Bladderurinenormalandsymptomabsent.Kidney&UreterBasiclesion——Tuberclefoci(结核结节)Epithelioidreticulum(上皮样网)PeripheralgiantcellsHealbyfibrosis(纤维化).Kidney&Uret

5、erTBisacombinationofcaseation(干酪样变),cavitation(空洞形成)andhealingbyfibrosis&scarring(纤维化和疤痕愈合).Dependingonvirulencevsresistance.Calcification(钙化):stronglysuggestiveofTB.Secondaryrenalstonesin10%.Leftkidney:autonephrectomyRightKidney:hydronephrosis&ureteralref

6、lux(肾积水&输尿管返流)Contractionofthebladder(膀胱孪缩)左肾萎缩萎缩肾外观Caseation&FibrosisLRenalDysfunctiononIsotopeScan(同位素扫描)Calcification(钙化)BladderTubercleform:white/yellowraisednodules(结节)surroundedbyahaloofhyperremia(充血).Tuberclesbreakdowndeepraggedulcersbladderirrit

7、able.膀胱结核，多个粟粒样黄色小结节膀胱结核，结核性溃疡Diagnosis(诊断)Justsayingyouhadturnedacornerdoesn’tmakeitso.Justsayingthereismassivedestructiondoesn’tmakeitso.__JohnKerryJustsayingthereisTBalsodoesn’tmakeitso.Wemustprovide……Demonstrationoftuberclebacilliinurinebyculture.Diagn

8、osis:Symptoms(症状)NoclassicclinicalpictureofrenalTB.Mostarevesicalin-origin(膀胱起源):burning,frequency(尿频)&nocturia(夜尿),hematuria(血尿)Diagnosis:Signs(体征)Kidney——noenlargement/tenderness(触痛)Externalgenitalia(外生殖器):