abdominal

• adj.

• 腹腔の、腹部の

関

abdomen、abdominal cavity、abdominis、belly、celiac、coeliac、peritoneal cavity、ventral

　 　 　

WordNet

1. the muscles of the abdomen (同)abdominal_muscle, ab
2. of or relating to or near the abdomen; "abdominal muscles"
3. the region of the body of a vertebrate between the thorax and the pelvis (同)venter, stomach, belly
4. swell out or bulge out (同)belly out
5. a part that bulges deeply; "the belly of a sail"
6. the underpart of the body of certain vertebrates such as snakes or fish
7. a protruding abdomen (同)paunch
8. the hollow inside of something; "in the belly of the ship"
9. toward or on or near the belly (front of a primate or lower surface of a lower animal); "the ventral aspect of the human body"; "the liver is somewhat ventral in position"; "ventral (or pelvic) fins correspond to the hind limbs of a quadruped"
10. belonging to or prescribed for celiac disease; "a celiac diet"

PrepTutorEJDIC

1. (比較変化なし)腹の,腹部の
2. 腹部,腹;(昆虫の)腹部
3. 『腹』,腹部(abdomen) / 胃 / (物の)内側,内部(inside) / ふくれた部分,胴 / 前面[部],下面[部] / …'を'ふくらませる　ふくらむ
4. 腹の,腹部の
5. 腹[腔]の,腸にある

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/05 17:09:50」(JST)

wiki en

[Wiki en表示]

Abdomen
The analogous gross morphologies of a human and an ant
Latin	Abdomen
Origin
Insertion	Human rib cage Human vertebral column
Artery
Nerve
Actions	Movement and support for the torso Assistance with breathing Protection for the inner organs Postural support

The abdomen (less formally called the belly, stomach, or tummy), in vertebrates such as mammals, constitutes the part of the body between the thorax (chest) and pelvis. The region enclosed by the abdomen is termed the abdominal cavity. In arthropods it is the posterior tagma of the body; it follows the thorax or cephalothorax. Anatomically, the abdomen stretches from the thorax at the thoracic diaphragm to the pelvis at the pelvic brim. The pelvic brim stretches from the lumbosacral angle (the intervertebral disk between L5 and S1) to the pubic symphysis and is the edge of the pelvic inlet. The space above this inlet and under the thoracic diaphragm is termed the abdominal cavity. The boundary of the abdominal cavity is the abdominal wall in the front and the peritoneal surface at the rear.

Vertebrates

In vertebrates, the abdomen is a large cavity enclosed by the abdominal muscles, ventrally and laterally, and by the vertebral column dorsally. Lower ribs can also enclose ventral and lateral walls. The abdominal cavity is upper part of the pelvic cavity. It is attached to the thoracic cavity by the diaphragm. Structures such as the aorta, superior vena cava and esophagus pass through the diaphragm. Both the abdominal and pelvic cavities are lined by a serous membrane known as the parietal peritoneum. This membrane is continuous with the visceral peritoneum lining the organs. The abdomen in vertebrates contains a number of organs belonging, for instance, to the digestive tract and urinary system.

Abdominal organs

• Digestive tract: Stomach, small intestine, large intestine with cecum and appendix
• Accessory organs of the digestive tract: Liver, gallbladder and pancreas
• Urinary system: Kidneys and ureters - but technically located in retroperitoneum - outside peritoneal membrane
• Other organs: Spleen

Abdominal organs can be highly specialized in some animals. For example the stomach of ruminants (a suborder of mammals) is divided into four chambers - rumen, reticulum, omasum and abomasum.

Terminology

A scaphoid abdomen is when the abdomen is sucked inwards. In a newborn it may represent a diaphragmatic hernia.

Human abdomen

Functionally, the human abdomen is where most of the alimentary tract is placed and so most of the absorption and digestion of food occurs here. The alimentary tract in the abdomen consists of the lower esophagus, the stomach, the duodenum, the jejunum, ileum, the cecum and the appendix, the ascending, transverse and descending colons, the sigmoid colon and the rectum. Other vital organs inside the abdomen include the liver, the kidneys, the pancreas and the spleen.

The abdominal wall is split into the posterior (back), lateral (sides), and anterior (front) walls.

Muscles

Henry Gray (1825–1861). Anatomy of the Human Body with a modern example of a human male abdomen below

There are three layers of the abdominal wall. They are, from the outside to the inside: external oblique, internal oblique, and transverse abdominus. The first three layers extend between the vertebral column, the lower ribs, the iliac crest and pubis of the hip. All of their fibers merge towards the midline and surround the rectus abdominus in a sheath before joining up on the opposite side at the linea alba. Strength is gained by the criss-crossing of fibers, such that the external oblique are downward and forward, the internal oblique upward and forward, and the transverse horizontally forward.

The transversus abdominis muscle is flat and triangular, with its fibers running horizontally. It lies between the inner oblique and the underlying transversalis fascia. It originates from Poupart's ligament, the inner lip of the ilium, the lumbar fascia and the inner surface of the cartilages of the six lower ribs. It inserts into the linea alba behind the rectus abdominis.

The rectus abdominis muscles are long and flat. The muscle is crossed by three tendinous intersections called the linae transversae. The rectus abdominis is enclosed in a thick sheath formed, as described above, by fibers from each of the three muscles of the lateral abdominal wall. They originate at the pubis bone, run up the abdomen on either side of the linea alba, and insert into the cartilages of the fifth, sixth, and seventh ribs. In the region of the groin, the inguinal canal, a passage through the layers. This gap is where the testes can drop through the wall and where the fibrous cord from the uterus in the female runs. This is also where weakness can form, and inguinal hernias.

The pyramidalis muscle is small and triangular. It is located in the lower abdomen in front of the rectus abdominis. It originates at the pubic bone and is inserted into the linea alba halfway up to the umbilicus.

Functions

The abdominal muscles have different important functions. They assist in the breathing process. Moreover, these muscles serve as protection for the inner organs. Furthermore, together with the back muscles they provide postural support and are important in defining the form. When the glottis is closed and the thorax and pelvis are fixed, they are integral in the cough, urination, defecation, childbirth, vomit, and singing functions. When the pelvis is fixed, they can initiate the movement of the trunk in a forward motion. They also prevent hyperextension. When the thorax is fixed, they can pull up the pelvis or the lower limbs, and finally they can bend the vertebral column sideways and assist in the trunks rotation. The transverse abdominus muscle is the deepest muscle, therefore, it cannot be touched from the outside. It can greatly affect the body posture. The internal obliques are also deep and also affect body posture. Both of them are involved in rotation and lateral flexion of the spine and are used to bend and support the spine from the front. The external obliques are more superficial and they are also involved in rotation and lateral flexion of the spine. Also they stabilize the spine when upright. The rectus abdominus muscle is not the most superficial abdominal muscle. The tendonous sheath extending from the external obliques cover the rectus abdominus. The Rectus abdominus is the muscle that very fit people develop into the 6-pack ab look. Although, it should really be an 8 pack as there are 4 vertical sections on each side. The 2 bottom sections are just above the pubic bone and usually not visible, hence, the 6 pack abs. The rectus abdominals' function is to bend one's back forward (flexion). The main work of the abdominal muscles is to bend the spine forward when contracting coencentrically.

Exercise

Main article: Abdominal exercise

Being a key element to support the spine and contribute to a good posture, it is important to properly exercise the abdominal muscles together with the back muscles as when weak or overly tight they can suffer painful spasms as well as injuries. When properly exercised, these muscles contribute to improve posture and balance, reduce the likelihood of back pain episodes, reduce the severity of back pain, protect against injury by responding efficiently to stresses, help avoid some back surgeries, and help healing from a back problem or after spine surgery. Also, when strengthened, the abdominal muscles provide flexibility as well.

The abdominal muscles can be worked out by practicing disciplines of general body strength such as Pilates, yoga, T'ai chi, and jogging among others. There are also specific routines to target each of these muscles.

Organs

The relations of the viscera and large vessels of the abdomen, seen from behind.

The abdomen contains most of the tubelike organs of the digestive tract, as well as several solid organs. Hollow abdominal organs include the stomach, the small intestine, and the colon with its attached appendix. Organs such as the liver, its attached gallbladder, and the pancreas function in close association with the digestive tract and communicate with it via ducts. The spleen, kidneys, and adrenal glands also lie within the abdomen, along with many blood vessels including the aorta and inferior vena cava. Anatomists may consider the urinary bladder, uterus, fallopian tubes, and ovaries as either abdominal organs or as pelvic organs. Finally, the abdomen contains an extensive membrane called the peritoneum. A fold of peritoneum may completely cover certain organs, whereas it may cover only one side of organs that usually lie closer to the abdominal wall. Anatomists call the latter type of organs retroperitoneal.

Surface landmarks

Surface projections of the organs of the trunk, from which organ locations are derived mainly from vertebra levels, ribs and the ilium.

In the mid-line a slight furrow extends from the ensiform cartilage/xiphoid process above to the pubic symphysis below, representing the linea alba in the abdominal wall. At about its midpoint sits the umbilicus or navel. On each side of it the broad recti muscles stand out in muscular people. The outline of these muscles is interrupted by three or more transverse depressions indicating the lineae transversae. There is usually one about the ensiform cartilage, one at the umbilicus, and one between. It is the combination of the linea alba and the linea transversae which form the abdominal "six-pack" sought after by many people.

The upper lateral limit of the abdomen is the subcostal margin formed by the cartilages of the false ribs (8, 9, 10) joining one another. The lower lateral limit is the anterior crest of the ilium and Poupart's ligament, which runs from the anterior superior spine of the ilium to the spine of the pubis. These lower limits are marked by visible grooves. Just above the pubic spines on either side are the external abdominal rings, which are openings in the muscular wall of the abdomen through which the spermatic cord emerges in the male, and through which an inguinal hernia may rupture.

One method by which the location of the abdominal contents can be appreciated is to draw three horizontal and two vertical lines.

Horizontal lines

Front of abdomen, showing markings for duodenum, pancreas, and kidneys.

• The highest of the former is the transpyloric line of C. Addison, which is situated halfway between the suprasternal notch and the top of the pubic symphysis, and often cuts the pyloric opening of the stomach an inch to the right of the mid-line. The hilum of each kidney is a little below it, while its left end approximately touches the lower limit of the spleen. It corresponds to the first lumbar vertebra behind.
• The second line is the subcostal line, drawn from the lowest point of the subcostal arch (tenth rib). It corresponds to the upper part of the third lumbar vertebra, and it is an inch or so above the umbilicus. It indicates roughly the transverse colon, the lower ends of the kidneys, and the upper limit of the transverse (3rd) part of the duodenum.
• The third line is called the intertubercular line, and runs across between the two rough tubercles, which can be felt on the outer lip of the crest of the ilium about two and a half inches (60 mm) from the anterior superior spine. This line corresponds to the body of the fifth lumbar vertebra, and passes through or just above the ileo-caecal valve, where the small intestine joins the large.

Vertical lines

The two vertical or mid-Poupart lines are drawn from the point midway between the anterior superior spine and the pubic symphysis on each side, vertically upward to the costal margin.

• The right one is the most valuable, as the ileo-caecal valve is situated where it cuts the intertubercular line. The orifice of the vermiform appendix lies an inch lower, at McBurney's point. In its upper part, the vertical line meets the transpyloric line at the lower margin of the ribs, usually the ninth, and here the gallbladder is situated.
• The left mid-Poupart line corresponds in its upper three-quarters to the inner edge of the descending colon.

The right subcostal margin corresponds to the lower limit of the liver, while the right nipple is about half an inch above the upper limit of this viscus.

Regions

9-region scheme

Surface lines of the front of the thorax and abdomen.

These three horizontal and two vertical lines divide the abdomen into nine "regions." (Note that "hypo" means "below" and "epi" means "above", while "chond" means "cartilage" (in this case, the cartilage of the rib) and "gast" means stomach. The reversal of "left" and "right" is intentional, because the anatomical designations reflect the position on the patient. )

right hypochondriac/hypochondrium	epigastric/epigastrium	left hypochondriac/hypochondrium
right lumbar/flank/latus/lateral	umbilical	left lumbar/flank/latus/lateral
right inguinal/iliac	hypogastric/suprapubic	left inguinal/iliac

4-region scheme

Another way of dividing the abdomen is by using 4 quadrants:

right upper quadrant (RUQ)	left upper quadrant (LUQ)
right lower quadrant (RLQ)	left lower quadrant (LLQ)

Invertebrates

In the worker ant, the abdomen consists of the propodeum fused to the thorax and the metasoma, itself divided into the narrow petiole and bulbous gaster.

The invertebrate abdomen is built up of a series of upper plates known as tergites and lower plates known as sternites, the whole being held together by a tough yet stretchable membrane.

The abdomen contains the insect's digestive tract and reproductive organs, it consists of eleven segments in most orders of insects though the eleventh segment is absent in the adult of most higher orders. The number of these segments does vary from species to species with the number of segments visible reduced to only seven in the common honeybee. In the Collembola (Springtails) the abdomen has only six segments.

The abdomen is sometimes highly modified. In Apocrita (bees, ants and wasps), the first segment of the abdomen is fused to the thorax and is called the propodeum. In ants the second segment forms the narrow petiole. Some ants have an additional postpetiole segment, and the remaining segments form the bulbous gaster. The petiole and gaster (abdominal segments 2 and onward) are collectively called the metasoma.

Unlike other Arthropods, insects possess no legs on the abdomen in adult form, though the Protura do have rudimentary leg-like appendages on the first three abdominal segments, and Archaeognatha possess small, articulated "styli" which are sometimes considered to be rudimentary appendages. Many larval insects including the Lepidoptera and the Symphyta (Sawflies) have fleshy appendages called prolegs on their abdominal segments (as well as their more familiar thoracic legs), which allow them to grip onto the edges of plant leaves as they walk around.

See also

• Opisthosoma
• Metasoma
• Abdominal trauma
• Abdominal fat

References

External links

•  "Abdomen". Collier's New Encyclopedia. 1921. 

UpToDate Contents

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• 1. 成人における腹痛の鑑別診断 differential diagnosis of abdominal pain in adults
• 2. 小児および思春期における急性腹症の原因 causes of acute abdominal pain in children and adolescents
• 3. 成人における腹痛に対する診断的アプローチ diagnostic approach to abdominal pain in adults
• 4. 小児および思春期の慢性腹痛の評価 evaluation of the child and adolescent with chronic abdominal pain
• 5. 急性腹症を有する小児の緊急評価 emergent evaluation of the child with acute abdominal pain

English Journal

• Air conditioner operation behaviour based on students' skin temperature in a classroom.

• Song GS, Lim JH, Ahn TK.SourceDepartment of Architecture, Bucheon University, 424 Simgok-dong Wonmi-gu, Bucheon-si Geongki-do 420-735, Republic of Korea.
• Applied ergonomics.Appl Ergon.2012 Jan;43(1):211-6. Epub 2011 Jun 12.
• A total of 25 college students participated in a study to determine when they would use an air conditioner during a lecture in a university classroom. The ambient temperature and relative humidity were measured 75?cm above the floor every minute. Skin temperatures were measured every minute at seve
• PMID 21665190

• Hydrotherapy for the treatment of pain in people with multiple sclerosis: a randomized controlled trial.

• Castro-Sanchez AM, Mataran-Penarrocha GA, Lara-Palomo I, Saavedra-Hernandez M, Arroyo-Morales M, Moreno-Lorenzo C.SourceDepartment of Nursing and Physical Therapy, University of Almeria (UAL), Carretera de Sacramento s/n, 04120 Almeria, Granada, Spain.
• Evidence-based complementary and alternative medicine : eCAM.Evid Based Complement Alternat Med.2012;2012:473963. Epub 2011 Jul 14.
• Background. Multiple sclerosis (MS) is a chronic demyelinating neurological disease. Several studies have reported that complementary and alternative therapies can have positive effects against pain in these patients. Objective. The objective was to investigate the effectiveness of an Ai-Chi aquatic
• PMID 21785645

• Adipokines as possible new predictors of cardiovascular diseases: a case control study.

• Pala L, Monami M, Ciani S, Dicembrini I, Pasqua A, Pezzatini A, Francesconi P, Cresci B, Mannucci E, Rotella CM.SourceSOD of Endocrinology, AOUC, 50139 Florence, Italy.
• Journal of nutrition and metabolism.J Nutr Metab.2012;2012:253428. Epub 2011 Aug 22.
• Background and Aims. The secretion of several adipocytokines, such as adiponectin, retinol-binding protein 4 (RBP4), adipocyte fatty acid binding protein (aFABP), and visfatin, is altered in subjects with abdominal adiposity; these endocrine alterations could contribute to increased cardiovascular r
• PMID 21869928

Japanese Journal

• Inhibition of surgical trauma-enhanced peritoneal dissemination of tumor cells by human catalase derivatives in mice.

• Nishizaki Chika,Nishikawa Makiya,Yata Tomoya,Yamada Toshiyuki,Takahashi Yuki,Oku Masahide,Yurimoto Hiroya,Sakai Yasuyoshi,Nakanishi Kenji,Takakura Yoshinobu
• Free radical biology & medicine 51(3), 773-779, 2011-08-01
• … To inhibit surgical trauma-enhanced peritoneal dissemination, human catalase (hCAT) derivatives, i.e., hCAT-nona-arginine peptide (hCAT-R9) and hCAT-albumin-binding peptide (hCAT-ABP), were designed to increase the retention time of the antioxidant enzyme in the abdominal cavity after intraperitoneal administration. … Cauterization of the cecum of mice with a hot iron, an experimental model of surgical trauma, induced abdominal adhesions. …
• NAID 120003255726

• Enteric duplication cyst of the pancreas with duplicated pancreatic duct

• Fujishiro Jun,Kaneko Michio,Urita Yasuhisa,Hoshino Noriko,Jinbo Takahiro,Sakamoto Naoya,Suzuki Hideo,Komuro Hiroaki,藤代 準,瓜田 泰久,鈴木 英雄,小室 広昭,金子　道夫
• Journal of pediatric surgery 46(8), e13-e16, 2011-08
• … A 7-year-old girl with severe acute abdominal pain was found to have a large cyst that was smoothly communicating with the dilated pancreatic duct in the pancreatic tail. …
• NAID 120003339038

• 9回の転移巣摘除術後に出現した子宮平滑筋肉腫副腎転移の1例

• 関 雅也,今尾 哲也,天野 俊康,竹前 克朗
• 泌尿器科紀要 57(8), 435-438, 2011-08
• … She underwent abdominal total hysterectomy andbilateral salpingo-oophorectomy for uterine leiomyosarcoma 19 years ago. …
• NAID 120003324594

Related Links

• abdominal - WordReference 英和辞書

abdominal - WordReference English-Japanese Dictionary.

• abdominal - ウィクショナリー日本語版

abdominal. 出典: フリー多機能辞典『ウィクショナリー日本語版（Wiktionary）』. 移動： 案内, 検索 ... abdominal (比較級 more abdominal, 最上級 most abdominal). 腹の。 腹部の。 abdominal pain - 腹痛: abdominal muscles - 腹筋: abdominal cavity - ...

Related Pictures

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★リンクテーブル★

リンク元	「100Cases 14」「100Cases 82」「ventral」「peritoneal cavity」「celiac」
拡張検索	「total abdominal hysterectomy」

「100Cases 14」

　　[★]

☆case14　複視

■glossary

diplopia n. 複視

筋力低下、筋無力、筋脱力 muscle weakness, muscular weakness

sunken

vt. sinkのpp.

adj.

沈没した、沈んだ、水中の

沈下した、一段低いところにある

落ち込んだ、くぼんだ

3,4-ジアミノピリジン 3,4-diaminopyridine 3,4-DAP K+チャネル阻害薬;ランバート・イートン筋無力症治療

■症例

43-year-old woman

cheif complaint: diplopia

present history: diplopia and holding her head up ; more marked in the evenings, for the last 3 months. difficulty of chewing. voice has become quieter. weight loss (3kg / 6months). non-smoker. drinks about 15 units/week. no regular medication.

past history: no significant previous medical illnesses.

family history: lives with her husband and three children.

・診察 examination

looks well.

organ systems: normal; cardiovascular, respiratory, and abdominal systems.

muscle power; grossly normal. decrease after testing a movement repetitively.

motor function: normal; tone, coordination, reflexes and sensation.

bilateral ptosis. exacerbated by prolonged upward gaze

eye: normal; pupillary reflexes, eye movements, and funduscopy

■答え

diagnosis: myathenia gravis

differential diagnoses:

CASES

上位and/or下位運動ニューロン motor neurone disease　運動ニューロン疾患：線維束性攣縮。進行例では筋力低下

筋 muscular dystrophy　筋ジストロフィー：ある種の筋肉が選択的に筋力低下する。家族歴がある。

筋 dystrophia myotonica　強直性筋ジストロフィー：咬筋、側頭筋、胸鎖乳突筋の筋萎縮、四肢遠位端の筋萎縮。顔貌が特徴的(前頭部脱毛、無表情、窪んだ頬)。家族歴ある。筋電図が診断に有用(急降下爆撃音)。

筋 polymyositis　多発筋炎：普通は皮疹と関節痛が出現。CKが上昇。筋生検が診断に有用

筋 myopathy　ミオパチー：甲状腺中毒性ミオパチー、甲状腺機能低下症によるミオパチー、クッシング症候群によるミオパチー、アルコール性のミオパチー

神経筋接合部？ non-metastatic associations of malignancy (paraneoplastic syndrome(傍腫瘍性症候群 = 腫瘍随伴症候群)のこと)：胸腺腫の症例の10%に重症筋無力症がみられる。ランバート・イートン筋無力症症候群は小細胞癌と関連がある。

HIM.2674

• 神経筋接合部 congenital myasthenia syndrome　先天性筋無力症症候群
• 神経筋接合部 drug-induced myasthenia　薬剤性筋無力症

Treatment with penicillamine (used for scleroderma or rheumatoid arthritis) may result in true autoimmune MG, but the weakness is usually mild, and recovery occurs within weeks or months after discontinuing its use.

　重症筋無力症の誘発：ペニシラミン(強皮症や関節リウマチの治療に用いられる)。

　　mildだし、薬剤の中断で改善する。

Aminoglycoside antibiotics or procainamide can cause exacerbation of weakness in myasthenic patients; very large doses can cause neuromuscular weakness in normal individuals.

　重症筋無力症の悪化：アミドグリコシド系抗菌薬、プロカインアミド

　　MGの患者の筋脱力が悪化する。

• 神経筋接合部 Lambert-Eaton myasthenic syndrome　ランバート・イートン筋無力症症候群：全身の筋肉が冒されるが、特に下肢の近位筋が冒される。MGと同じように～70%の患者で脳神経所見(眼瞼下垂、複視など)が認められる。MGと違うのは(1)反射が消失・減弱すること、(2)自律神経系の変化(口渇、勃起不全)を生じる、(3)神経刺激検査で漸増(waxing)が見られることである。病因は神経筋接合部のP/Q type calcium channelsに対する抗体の出現であり、85%の患者で見いだされる。治療はMGのように血漿交換や免疫抑制薬が使われる。3,4-DAPやpyridostigmineは症状に対する治療のために用いる。前者は運動神経の終末部でカルシウムチャネルをブロックし活動電位を延長させる。後者はアセチルコリンエステラーゼを阻害してシナプスにおける神経伝達物質の濃度を上げる。
• 精神疾患 neurasthenia　神経衰弱症：歴史的な用語。器質的な障害を伴わない筋無力症のような脱力を伴う症候群。患者は筋脱力や疲労を訴えてやってくる。筋肉の検査では器質的変化は認めないが"jerky release"あるいは"give-away weakness"が認められる。患者の主訴は反復動作による筋力低下よりむしろ疲労や感情鈍麻である。
• 内分泌疾患 hyperthyroidism　甲状腺機能亢進症：MGが疑われる患者にはthyroid function testをルーチンにやる。甲状腺機能異常は筋無力症の筋力低下を大きくすることがある。
• 神経筋接合部 botulism　ボツリヌス症：ボツリヌス毒素はシナプス前膜からの神経伝達物質の開口分泌を妨げる。症状はbulbar weakness (複視、構音障害、嚥下困難)。感覚障害はない。深部腱反射は初期には保たれている。進行すれば反射は見られなくなる。筋脱力は全身性。呼吸困難に陥ることがある。精神状態は正常。自律神経症状(麻痺性イレウス、便秘、urinary retention、瞳孔の散大、瞳孔の反応性低下、口渇)。確定診断は血清中の毒素の検出だけど、見つかることはまれ。神経伝導検査(nerve conduction studies)：compound muscle action potentials (CMAPs)の低下。高頻度の刺激で振幅が増加。治療：intubation for airway protection、呼吸補助、aggressive inpatient supportive care(e.g., nutrition, DVT prophylaxis)。馬の抗毒素を検査結果が帰ってくる前に投与する(？)。
• 上位運動ニューロン intracranial mass lesions　頭蓋内占拠病変：複視はintracranial mass lesionが外眼筋の神経を圧迫することにより生じる。
• 筋 progressive external ophthalmoplegia　進行性外眼筋麻痺：外眼筋の筋脱力を伴う。四肢の近位筋の筋力低下やそのほかの全身症状を伴うことがある。ミトコンドリアの異常を有する。

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「100Cases 82」

　　[★]

☆case82　aches and pains

■症例

76歳　女性

主訴：疼痛

現病歴：約10週間、どことも無く調子が悪く感じていた。朝起きたときにぎこちなさを覚える。ベットから出るときに苦労しており、また紙をとくために手を挙げるのが困難であった。膝や指にいくらか痛みがあった。(いつからかは記述されてないが)4kg体重減少してきており、盗汗が認められていた。今回、新たに症状が認められたためGPにかかった。2，3日前から持続性の頭痛が認められていた。

喫煙歴：40年間タバコを吸っていない。

飲酒歴：飲酒はクリスマスの時のみ。

既往歴：生来健康。

生活歴：1人住まいである。

家族歴：

服薬歴：定期的に服用している薬はない。頭痛のためにparacetamolを飲んだが効果はなかった。

身体所見 examination

　顔貌　青白。頭皮全体の触診で顕著な圧痛。血圧　138/84 mmHg。心血管系、呼吸器系、腹部臓器(abdominal systems)に異常を認めない。上肢・下肢の近位筋における筋力低下。神経所見に異常なし

検査所見 investigations

High

WBC 12.2x10^9/L →　12.2x10^3/uL →1.22x10^4/ul

ESR 91 mm/hr

glucose 122.4 mg/dL

ALT(GPT) 85IU/L

AlP 465IU/L

グループ分け前

問診(S)	診察(O)	検査結果(O)
どこともない身体の不調	蒼白	白血球増多
朝のこわばり	頭全体で頭皮の触診による圧痛あり	赤沈亢進
日常動作困難	筋力低下(上下肢の近位筋)	高血糖
指・膝の痛み		ALT(GPT)上昇
4kgの体重減少		ALP上昇
盗汗
持続性の頭痛

グループ分け後

問診(S)	診察(O)	検査結果(O)
どこともない身体の不調	蒼白	白血球増多
朝のこわばり	頭全体で頭皮の触診による圧痛あり	赤沈亢進
日常動作困難	筋力低下(上下肢の近位筋)	高血糖
指・膝の痛み		ALT(GPT)上昇
4kgの体重減少		ALP上昇
盗汗
持続性の頭痛

「ventral」

　　[★]

• 腹側の、腹部の、腹側性の

関

abdomen、abdominal、abdominis、belly、ventrad、ventrally

　 　

「peritoneal cavity」

　　[★] 腹膜腔、腹腔

関

abdominal、abdominal cavity、celiac、coeliac、lesser sac

「celiac」

　　[★]

• adj.

• 腹腔の

関

abdominal、abdominal cavity、coeliac、peritoneal cavity

　 　

「total abdominal hysterectomy」

　　[★]

• 腹式単純子宮全摘術 TAH