chest

• n.

• 胸部、胸

関

breast、pectoral、pectoral region、thoraces、thoracic、thorax

　 　

WordNet

1. box with a lid; used for storage; usually large and sturdy
2. meet at breast level; "The runner breasted the tape"
3. the part of an animals body that corresponds to a persons chest
4. either of two soft fleshy milk-secreting glandular organs on the chest of a woman (同)bosom, knocker, boob, tit, titty
5. the front of the trunk from the neck to the abdomen; "he beat his breast in anger" (同)chest
6. meat carved from the breast of a fowl (同)white_meat
7. part of an insects body that bears the wings and legs
8. the part of the human torso between the neck and the diaphragm or the corresponding part in other vertebrates (同)chest, pectus
9. the middle region of the body of an arthropod between the head and the abdomen
10. of or relating to the chest or thorax; "pectoral organ" (同)thoracic
11. an adornment worn on the chest or breast (同)pectoral medallion
12. either of two large muscles of the chest (同)pectoral_muscle, pectoralis, musculus pectoralis, pecs
13. the lower ranges of the voice in speaking or singing (同)chest_voice, chest tone
14. breed of small Manchester terrier (同)toy Manchester terrier
15. thick in the chest; "a deep-chested breed of dog"

PrepTutorEJDIC

1. (ふた付きのじょうぶな)『大箱』,ひつ / 《米》たんす(=chest of drawers) / (…の)たんすいっぱい《+『of』+『名』》 / 『胸[部]』,肺
2. 『胸』,『胸部』;(服の)胸部 / 『乳房』,乳 / 《文》胸中,心紳 / …'を'胸に受ける,胸に受けて進む / …‘に'雄々しく立ち向かう
3. (人間や動物の)胸,胸部 / (昆虫の)胸部
4. 胸の,胸部の / 胸部
5. 胸の,胸部の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/02/03 14:36:20」(JST)

wiki en

[Wiki en表示]

This article is about the thorax or chest. For other uses of "thorax", see Thorax (disambiguation). For other uses of "chest", see Chest (disambiguation).

Thorax Chest
X-ray image of the chest showing the internal anatomy of the rib cage, lungs and heart as well as the inferior thoracic border–made up of the diaphragm.
Surface projections of the organs of the trunk, with the thorax or chest region seen stretching down to approximately the end of the oblique lung fissure anteriorly, but more deeply it its lower limit rather corresponds to the upper border of the liver.
Details
Latin	thorax
Greek	θώραξ
Anatomical terminology

The thorax or chest (Greek: θώραξ, Latin: thorax) is a part of the anatomy of humans and various other animals located between the neck and the abdomen.The thorax includes the thoracic cavity and the thoracic wall. It contains organs including the heart, lungs and thymus gland, as well as muscles and various other internal structures. Many diseases may affect the chest, and one of the most common symptoms is chest pain.

Structure

In humans and other hominids, the thorax is the chest region of the body between the neck and the abdomen, along with its internal organs and other contents. It is mostly protected and supported by the rib cage, spine, and shoulder girdle.

Contents

An X-ray of a human chest area, with some structures labeled

The contents of the thorax include the heart and lungs and the thymus gland); the (major and minor pectoral muscles, trapezius muscles and neck muscle); internal structures such as the diaphragm, esophagus, trachea and a part of the sternum known as the xiphoid process), as well as the content of the thoracic abdomen (stomach, kidney/adrenal, pancreas, spleen, and lower oesophagus). Arteries and veins are also contained – (aorta, superior vena cava, inferior vena cava and the pulmonary artery); bones (the shoulder socket containing the upper part of the humerus, the scapula, sternum, thoracic portion of the spine, collarbone, and the rib cage and floating ribs).

External structures are the nipples.

The area exposed by open-necked shirts, the 'V of the chest' is sometimes the location of a light-induced skin disease polymorphous light eruption.

The chest

In the human body, the region of the thorax between the neck and diaphragm in the front of the body is called the chest. The corresponding area in an animal can also be referred to as the chest.

The shape of the chest does not correspond to that part of the thoracic skeleton that encloses the heart and lungs. All the breadth of the shoulders is due to the shoulder girdle, and contains the axillae and the heads of the humeri. In the middle line the suprasternal notch is seen above, while about three fingers' breadth below it a transverse ridge can be felt, which is known as the sternal angle and this marks the junction between the manubrium and body of the sternum. Level with this line the second ribs join the sternum, and when these are found the lower ribs can often be counted. At the lower part of the sternum, where the seventh or last true ribs join it, the ensiform cartilage begins, and above this there is often a depression known as the pit of the stomach.

Bones

The bones of the thorax, called the "thoracic skeleton" is a component of the axial skeleton.

It consists of the ribs and sternum.The ribs of the thorax are numbered in ascending order from 1-12. 11 & 12 are known as floating ribs because they have no anterior attachment point in particular the cartilage attached to the sternum, as 1-7 are, and therefore are termed "floating". Whereas ribs 8-10 are termed false ribs as their costal cartilage articulates with the rib aboves costal cartilage.

Anatomical landmarks

The anatomy of the chest can also be described through the use of anatomical landmarks. The nipple in the male is situated in front of the fourth rib or a little below; vertically it lies a little external to a line drawn down from the middle of the clavicle; in the female it is not so constant. A little below it the lower limit of the great pectoral muscle is seen running upward and outward to the axilla; in the female this is obscured by the breast, which extends from the second to the sixth rib vertically and from the edge of the sternum to the mid-axillary line laterally. The female nipple is surrounded for half an inch by a more or less pigmented disc, the areola. The apex of a normal heart is in the fifth left intercostal space, three and a half inches from the mid-line.

Clinical significance

Different types of diseases or conditions that affect the chest include pleurisy, flail chest, atelectasis, and the most common condition, chest pain. These conditions can be hereditary or caused by birth defects or trauma. Any condition that lowers the ability to either breathe deeply or to cough is considered a chest disease or condition.

Injury

Injury to the chest (also referred to as chest trauma, thoracic injury, or thoracic trauma) results in up to ¼ of all deaths due to trauma in the United States.

The major pathophysiologies encountered in blunt chest trauma involve derangements in the flow of air, blood, or both in combination. Sepsis due to leakage of alimentary tract contents, as in esophageal perforations, also must be considered. Blunt trauma commonly results in chest wall injuries (e.g., rib fractures). The pain associated with these injuries can make breathing difficult, and this may compromise ventilation. Direct lung injuries, such as pulmonary contusions (see the image below), are frequently associated with major chest trauma and may impair ventilation by a similar mechanism.

Pain

Chest pain can be the result of multiple issues including respiratory problems, digestive issues, musculoskeletal complications. The pain can trigger cardiac issues as well. Not all pain that is felt is associated with the heart, but it should not be taken lightly either. Symptoms can be different depending on the cause of the pain. While cardiac issues cause feelings of sudden pressure in the chest or a crushing pain in the back, neck and arms, pain that is felt due to non cardiac issues gives a burning feeling along the digestive tract or pain when deep breaths are attempted. Different people feel pains differently for the same condition. Only a patient truly knows if the symptoms are mild or serious.

Chest pain may be a symptom of myocardial infarctions. If this condition is present in the body, the person feels discomfort in the chest that is similar to a heavy weight placed on the body. Sweating, shortness of breath, lightheadedness, and irregular heartbeat can also be experienced. If heart attack occurs, the bulk of damage is caused during the first six hours, so getting the proper treatment quickly as possible is important. Some people, especially those who are elderly or have diabetes, may not have typical chest pain but may have many of the other symptoms of a heart attack. It is important that these patients and their care givers have a good understanding of heart attack symptoms.

Non-cardiac causes of chest pain

Just like with a heart attack, not all chest pain is suffered because of a condition involving the heart. Chest wall pain can be experienced after an increase in activity. Persons who add exercise to their daily routine generally feel this type of pain at the beginning. It is important to monitor the pain to ensure that it is not a sign of something more serious. Pain can also be experienced in persons who have an upper respiratory infection. This virus is also accompanied by fever and cough. Shingles is another viral infection that can give symptoms of chest or rib pain before a rash develops. Injuries to the rib cage or sternum is also a common cause of chest pain. It is generally felt when deep breaths are taken or during cough.

Atelectasis

Another non cardiac cause of chest pain is atelectasis. It is a condition that suffered when a portion of the lung collapses from being airless. When bronchial tubes are blocked, this condition develops and causes patients to feel shortness of breath. The most common cause of atelectasis is when a bronchi that extends from the windpipe is blocked and traps air. The blockage may be caused by something inside the bronchus, such as a plug of mucus, a tumour, or an inhaled foreign object such as a coin, piece of food, or a toy. It is possible for something outside of the bronchus to cause the blockage.

Pneumothorax

Pneumothorax is the condition where air or gas can build up in the pleural space. It can occur without a known cause or as the result of a lung disease or acute lung injury. The size of the pneumothorax changes as liquid builds up, so a medical procedure can drain the liquid with a needle. If it is untreated, blood flow can be interrupted and cause a drop in blood pressure known as tension pneumothorax. It is possible for smaller cases to clear up on their own. Symptoms of this condition are often felt only on one side of the lung or as a shortness of breath.

Other animals

The trilobite body is divided into three major sections, a cephalon with eyes, mouthparts and sensory organs such as antennae, a thorax of multiple similar segments (that in some species allowed them to roll up into a ball), and a pygidium, or tail section.

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 thorax (from the Greek θώραξ thorax "breastplate, cuirass, corslet") is a division of an animal's body that lies between the head and the abdomen.

In tetrapods

In mammals, the thorax is the region of the body formed by the sternum, the thoracic vertebrae, and the ribs. It extends from the neck to the diaphragm, and does not include the upper limbs. The heart and the lungs reside in the thoracic cavity, as well as many blood vessels. The inner organs are protected by the rib cage and the sternum.

In arthropods

Main article: Thorax (insect anatomy)

In insects and the extinct trilobites, the thorax is one of the three main divisions (or tagmata) of the creature's body, each of which is in turn composed of multiple segments. It is the area where the wings and legs attach in insects, or an area of multiple articulating plates in trilobites. In most insects, the thorax itself is composed of three segments; the prothorax, the mesothorax, and the metathorax. In extant insects, the prothorax never has wings, though legs are always present in adults; wings (when present) are restricted to at least the mesothorax, and typically also the metathorax, though the wings may be reduced or modified on either or both segments. In the Apocritan Hymenoptera, the first abdominal segment is fused to the metathorax, where it forms a structure known as the propodeum. Accordingly, in these insects, the functional thorax is composed of four segments, and is therefore typically called the mesosoma to distinguish it from the "thorax" of other insects.

Each thoracic segment in an insect is further subdivided into various parts, the most significant of which are the dorsal portion (the notum), the lateral portion (the pleuron; one on each side), and the ventral portion (the sternum). In some insects, each of these parts is composed of one to several independent exoskeletal plates with membrane between them (called sclerites), though in many cases the sclerites are fused to various degrees.

Addtional Images

• Thorax. Anterior view.

• Thorax. Anterior view.

See also

This article uses anatomical terminology; for an overview, see anatomical terminology.

• Barechestedness
• Chest hair
• Pectus carinatum
• Pectus excavatum
• Thoracic cavity
• Toplessness

References

External links

• Sam Gon III. "A guide to the Orders of Trilobites". Retrieved August 23, 2005. 

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 成人における胸痛の診断的アプローチ diagnostic approach to chest pain in adults
• 2. 成人における胸痛の鑑別診断 differential diagnosis of chest pain in adults
• 3. 小児における身体的診察：胸部および腹部 the pediatric physical examination chest and abdomen
• 4. 筋骨格系の胸痛の臨床的評価 clinical evaluation of musculoskeletal chest pain
• 5. Causes of nontraumatic chest pain in children and adolescents

English Journal

• Other asthma considerations.

• Aguilar PR, Walgama ES, Ryan MW.SourceDepartment of Internal Medicine, Washington University, 660 Euclid, PO Box 8052, St. Louis, MO 63110, USA.
• Otolaryngologic clinics of North America.Otolaryngol Clin North Am.2014 Feb;47(1):147-60. doi: 10.1016/j.otc.2013.08.015. Epub 2013 Nov 1.
• Asthma is a heterogeneous syndrome of cough, wheeze, dyspnea, and chest tightness. However, in a subset of patients, these symptoms may indicate a different underlying disease process with variable responsiveness to classic asthma therapies. Disease may progress while practitioners attempt conventio
• PMID 24286688

• Exercise-induced Bronchoconstriction.

• Parsons JP.SourceWexner Medical Center, The Ohio State University, 201 Davis Heart/Lung Research Institute, 473 West 12th Avenue, Columbus, OH 43210, USA. Electronic address: jonathan.parsons@osumc.edu.
• Otolaryngologic clinics of North America.Otolaryngol Clin North Am.2014 Feb;47(1):119-26. doi: 10.1016/j.otc.2013.09.003. Epub 2013 Oct 5.
• Exercise-induced bronchoconstriction (EIB) occurs commonly in patients with asthma but also can affect individuals without asthma. EIB is particularly common in populations of athletes. Common symptoms include cough, dyspnea, chest tightness, and wheezing; however, there can be a variety of more sub
• PMID 24286685

• What is Asthma? Pathophysiology, Demographics, and Health Care Costs.

• Maslan J, Mims JW.SourceWake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
• Otolaryngologic clinics of North America.Otolaryngol Clin North Am.2014 Feb;47(1):13-22. doi: 10.1016/j.otc.2013.09.010. Epub 2013 Nov 1.
• Asthma is an obstructive pulmonary disorder with exacerbations characterized by symptoms of shortness of breath, cough, chest tightness, and/or wheezing. Symptoms are caused by chronic airway inflammation. There are multiple cell types and inflammatory mediators involved in its pathophysiology. The
• PMID 24286675

• A teen with chest pain.

• Blake JM.SourceDivision of Pediatric Cardiology, Children's Hospital of Michigan, Wayne State University, School of Medicine, 3901 Beaubien, Detroit, MI 48201-2119, USA. Electronic address: jblake2@dmc.org.
• Pediatric clinics of North America.Pediatr Clin North Am.2014 Feb;61(1):17-28. doi: 10.1016/j.pcl.2013.09.008. Epub 2013 Oct 18.
• Chest pain is a frequent symptom and complaint in the teenage population. There are many common, benign causes of chest pain. However, it can create tremendous anxiety in the mind of the patient and family members and sometimes it can be perplexing even for the primary providers especially if there
• PMID 24267455

Japanese Journal

• A Case of pulmonary tumor thrombotic microangiopathy improved by the treatment with prednisolone

• Tomizawa Yoshio,Yatomi Misakiyo,Iwashina Masanori,Yoshii Akihiro,Yoshino Reiko,Takei Kousuke,Kuwako Tomohito,Tomizawa Mai,Kondo Makoto,Saito Ryusei
• The KItakanto medical journal = 北関東医学 63(3), 253-255, 2013-08-01
• … Chest XR and CT showed ground-glass shadows in the bilateral lung fields,gastric adenocarcinoma was demonstrated by gastrointestinal fiber scopy and biopsy,and poorly differentiated　carcinoma　cells　were　detected　in　the　pulmonary　arterial　blood　by　pulmonary　wedge aspiration　cytology　on　cardiac　catheterization. …
• NAID 120005315275

• Septic Pulmonary Embolism Induced by Dental Infection

• Shiota Yutaro,Taniguchi Akihiko,Yuzurio Syota,Horita Naokatsu,Hosokawa Shinobu,Watanabe Yoichi,Tohmori Hidetoshi,Ono Tetsuya
• Acta Medica Okayama 67(4), 253-258, 2013-08-00
• … Eight patients had chest pain (88.9%), 5 had a preceding toothache (55.6%) and 3 had preceding gingival swelling (33.3%). … SPE induced by dental infection has prominent clinical characteristics such as male preponderance, chest pain, preceding toothache, and mild clinical course. …
• NAID 120005315587

• 医療ケア関連肺炎に関する前向き疫学調査

• 水口 真理,落合 亜貴子,党 雅子,日谷 明裕,相良 博典,春木 宏介
• Dokkyo journal of medical sciences 40(2), 79-85, 2013-07-25
• 医療ケア関連肺炎(HCAP)は,ATS/IDSAの肺炎のガイドライン(2005年)にて提唱された概念である.当院におけるHCAPの特徴を明らかにする目的で前向き研究を行った.2010年1〜12月に獨協医科大学越谷病院呼吸器内科に市中肺炎で入院した患者を対象とした.HCAPと市中肺炎(CAP)の判断にあたっては, HCAP疑い因子の有無をアンケートにより調査した.それ以外の介入は行わず,背景因子,肺 …
• NAID 110009606243

• Necrotizing Pneumonia due to Femoral Osteomyelitis Caused by Community-acquired Methicillin-resistant Staphylococcus aureus

• Iwanaga Naoki,Fukuda Yuichi,Nakamura Shigeki,Imamura Yoshifumi,Miyazaki Taiga,Izumikawa Koichi,Kakeya Hiroshi,Yanagihara Katsunori,Soda Hiroshi,Tashiro Takayoshi,Kohno Shigeru
• Internal Medicine 52(13), 1531-1536, 2013-07-01
• … A chest X-ray of a young healthy African-American man with acute respiratory failure revealed bilateral multiple nodular shadows in the lungs, while community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) was detected in blood and sputum cultures. … Magnetic resonance imaging showed osteomyelitis of the left thigh, and computed tomography revealed bilateral cavitary lesions in the chest, indicating necrotizing pneumonia with pulmonary embolism caused by osteomyelitis as a result of infection with CA-MRSA. …
• NAID 120005311925

Related Links

• 美容室CHEST(チェスト)｜神戸(三宮/居留地/岡本/栄町/姫路)

神戸（三宮・居留地・岡本・栄町・姫路）の美容室 CHEST(チェスト)。ヘアカットをはじめ、ヘッドスパ(AVEDA、ケラスターゼなど)、メイク、フェイシャルエステ、ネイルなどのサービスでお客様のなりたいヘアスタイルを実現いたします。

• 美容室 CHEST(チェスト)三宮店

CHEST(チェスト)三宮店。最新のヘアスタイルやメイクアップ、ネイルメニューなどをご紹介しています。 ... 2013年11月30日 居留地店スタイリストの二柳がｽﾀｲﾙﾌｫﾄｺﾝﾃｽﾄ1次を通過 皆様のイイね&… 2013年11月30日

• chestの意味 - 英和辞書 - goo辞書

chestとは。意味や和訳。[名]1(1) 胸（郭）(thorax)（ breastはchestの前部）；肺chest trouble肺病a chest coldせき（の出る）かぜa chest protector（野球で審判・捕手の）プロテクターthe hair on ones chest胸毛have chest X-rays ...

Related Pictures

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★リンクテーブル★

リンク元	「100Cases 60」「100Cases 96」「thoracic」「pectoral」「胸」
拡張検索	「open-chest」「Manchester operation」「Manchester手術」

「100Cases 60」

　　[★]

attend

vt.

～に出席/参列する、(学校に)行く(go toより堅い語)

The normal ECG and chest X-ray when he attended hospital after an episode do not rule out an intermittent conduction problem.

(結果として)～に伴う

～に同行/同伴する、付き添う、仕える。往診する。～の世話をする、～に気をつける、見張る

vi.

出席/参列/出勤する(at)

留意/注目/傾聴する(to)。身を入れる、勢力を注ぐ、心を傾注する(to)。世話をする、気を配る(to)

仕える、付きそう(on)。(危険・困難などが)伴う(on)

productive

• adj

• 生産的な、生産力を有する(⇔unproductive
• (擦過が)他作の。(土地などが)多産の、豊富に算出する
• [叙述](～を)引き起こす、もたらす(of)
• (事業などが)利益をもたらす、営利的な。良い結果をもたらす、実りの多い
• (言語)(接辞などが)生産性のある
• (医学)(咳が)喀痰を伴う。(炎症が)増殖性の

outflow

• n.

• 流出/流出物。流出量

• vi.

• 流出する

obstruction

• n.

• 妨害、障害、支障、差し障り(to)。妨害物、

• obstruction to outflow

the clinical picture suggests obstruction to outflow from the stomach.(この臨床像は胃流出障害を示唆している)

• 閉塞、閉塞症。

obstruction to outflow

流出障害

• ex.

the clinical picture suggests obstruction to outflow from the stomach.(この臨床像は胃流出障害を示唆している)

aqueous outflow from the eye (眼球からの房水流出)

retain

re + tent (tineo=teneo) = to hold back

• vt.

• 保持する、保有する、保留する、持ち続ける、維持する。(使用のために)確保しておく
• (ある場所に)保つ、保持する。(熱などを)保っている、失わないでいる
• 忘れないでいる、覚えている
• (弁護士・気腫・召使いなどを)雇っておく、抱える
• 使用/実行し続ける。(廃止しないで)そのままにしておく

palliation

n.

寛解、緩和

volvulus

腸捻転

bezoar

胃石

malrotation

腸回転異常

intussusception

腸重積

succussion

n.

強く揺り動かすこと、強く揺れること

splash

n.

はね返し、はねかけ。はねかす音。

どっと流れる水。

□unit

1 unit = 10 ml of ethanol

□350ml アルコール5%

350x0.05/10=1.75 unit

http://pohwa.adam.ne.jp/you/hobby/ryori/sake2.html

1unitの量が国によって違う。純エタノール換算で、1英unitは8g=10ml（英糖尿病協会採用の数値）、1米unitは15g（20ml弱：1drinkとも）で、日本では10～14g程度（代謝熱量80Kcalが基準：食品成分表5訂版,2002）や20ないし23g（日本酒1合分）を1unitとしている。日本の医学界では1unit=20g（体積に換算すると25ml）を採用することが多いので、ここでもそれに従う。この基準（1unit=20g=25ml）で計算すると、40度のウィスキー1ショット（＝1オンス：英液量オンスで28.41ml、米液量オンスで29.57ml、日本の1ショットで30ml）が約0.5unitとなる。5度のビールなら500mlでだいたい1unit（この、日本酒1合≒ウィスキーダブル≒ビール500cc≒1unitという関係は、覚えておくと便利かもしれない：ワインなどは日本酒に準じるので、1本750mlがだいたい4unit強である）。

主訴：体重減少

(主訴にまつわる症状)

　・4ヶ月で10kg減少、食欲の減少、嘔吐(頻度：次第に増えてきている。嘔吐物と量：何時間も前に食べたものを多量に嘔吐する)

(主訴以外の症状)

　・一ヶ月前から脱力感(部位：特に下肢で著しい(丘に登ったり、階段を上ったりするとき))

嗜好歴：喫煙 20/day、飲酒 10units/week (ビール 6本弱)

家族歴：なし

既往歴：高血圧(2年間β遮断薬で治療、4ヶ月前に服薬中止)

身体所見 examination

バイタル：82/分、血圧 148/86 mmHg

全身：やせ、体調が悪そう(unwell)。

呼吸器、心血管系に異常なし

腹部：腫瘤触知せず、圧痛なし、振盪音/振水音を認める

検査所見 investigations

低値：ナトリウム、カリウム、クロライド、尿素

高値：重炭酸

Q

1. これらの所見の説明は？

2. もっともな診断は？

A

★

　胃流出路の閉塞　＝　食後の嘔吐　＋　胃の振水音

　高BUN　＋　低CRE　→　脱水

　低Na,Cl,H+　→　嘔吐

　HClの喪失　→　代謝性アルカローシス

　　H：細胞内→外

　　K：細胞外→内

　　従って、低カリウム血症　→　筋力低下・脱力

★

　胃流出路の閉塞の原因：胃癌とか胃潰瘍による瘢痕

　診断には上部消化管内視鏡・生検(組織診)、その後にCT(局所浸潤、転移巣検索)

　治療法：腫瘍だったら腹腔鏡による腫瘍の摘出術。その他の場合は手術をしたり、薬物療法をしたり、、、

学習ポイント

・嘔吐・嘔気 nausea and vomiting DIF.321, vomitus DIF.449 IMD.351

解剖で考えよう。縦に解剖、横に病因

鼻咽頭　扁桃、外来異物

食道　アカラシア、逆流性食道炎、食道癌　・・・嚥下困難があるはず

胃　胃炎、消化性潰瘍、胃癌、幽門部の病変(ポリープ、癌、潰瘍；胃の出口を閉塞させる)。子供だったら幽門狭窄症

十二指腸：潰瘍、十二指腸炎、Billroth II法による輸出脚の閉塞、Billroth I/II法によるダンピング症候群。胆汁性胃炎も原因となる。

小腸：小腸閉塞(腸重積、腸回転異常症、胃石症、癌腫、限局性回腸炎)

結腸：潰瘍性大腸炎、アメーバ症、腫瘍男。腸間膜動脈血栓症、

消化管全体：Strongyloides, Ascaris, Taenia solium

・β遮断薬の服用中止で何が起こる？

　狭心症や発作性の高血圧。

　なんでやめたんだろう？　→　副作用：(1%程度に)めまい、全身倦怠感、頭痛、徐脈が出現

・振盪音

　腹水や胃内容物の貯留によって聴取される。

・BUN高値、Cre低値

suggest a degree of dehydration

・BUN

==検査値の異常 (異常値の出るメカニズム第5版 p.144)==

===BUN上昇===

• 1. 組織の異化亢進

• 外科的大手術、体内への出血、異型輸血、悪性腫瘍、飢餓時、高熱、高度熱傷、アジソン病のクリーゼ、糖尿病性アシドーシス、甲状腺機能亢進症、膵臓壊死、重症感染症

• 2. 蛋白摂取量の増加
• 3. 消化管出血

• 赤血球・血漿蛋白が腸管内で分解　→　分解されて生成するNH₃が小腸で吸収される　→ BUN↑

• 4. 腎血流量の減少

• 重症心不全、ショック

• 5. 腎障害

• 尿素排泄機能が低下

• 6. 尿路の閉塞

• 腎後性に尿排泄が阻害されると尿素が血液中にうっ滞する。

「100Cases 96」

　　[★]

96

35歳　女性

【主訴】息切れ

【現病歴】6ヶ月から次第に増悪する息切れを訴え来院。息切れは進行しており、今では同年代の人に比べ階段を登ったり平地を歩くのがおそい。3ヶ月間空咳が出現してきている。

【既往歴】喘息(子供の頃、中等度)

【家族歴】父：40歳時に胸部疾患(chest problem)で死亡(と、この患者は思いこんでいる)。

【服用薬】パラセタモール。やせ薬は過去に使ったことがある

【嗜好歴】タバコ：吸わない。飲酒：週に10 units以下。

【職業歴】印刷会社(学校卒業後ずっと)

【生活歴】8歳と10歳の子供がいる。ペットとして自宅にネコとウサギを飼育している。

【身体所見】

バチ指、貧血、チアノーゼは認めない。心血管系正常。呼吸器系で、両側性に肺拡張能低下。胸部打診音、および触覚振盪音は正常。聴診上、両肺の肺底部に呼気終期年発音を聴取する。

【検査所見】

呼吸機能試験

測定値 予測値

FEV1(L) 3.0 3.6-4.2

FVC(L) 3.6 4.5-5.3

FER(FEV1/FVC)(%) 83 75-80

PEF(L/min) 470 450-550

胸部単純X線写真

胸部単純CT(肺野条件)

Q1　診断は？Q2　追加の検査と治療法

(解説)

・6ヶ月から次第に増悪する息切れ

　・本当に6ヶ月から息切れが始まったかは分からない！！実際にはもっと前から存在する可能性を考えよう。

・喘息の既往歴　→　また喘息か・・・

　・聴診上笛音 weezingなく、また呼吸機能検査で閉塞性肺障害は認められず否定的

・職業性喘息　←　肺の疾患では職業歴が重要なんだよ、うん。

　・職業に関連した特定の物質に曝露され引き起こされる気管支喘息。

　・気管支喘息だと閉塞性換気障害でしょっ。

・本症例の病態

　・拘束性病変(restrictive problem)：拡張制限　＋　ラ音(呼気時に閉鎖していた気道の再開通によるラ音。このラ音は(1)肺が硬い＋(2)肺容量低下による起こるんじゃ)

・呼吸機能検査の結果

　・中等度の拘束性換気障害(FEV1とFVCの低下、slightly high ratio)

　　→　硬い肺と胸郭を示唆している　→　肺コンプライアンス低下じゃな。

　　→　拡散能低下が予想される。

・胸部単純X線写真

　・小さい肺野、中肺野～下肺野にかけて結節性網状陰影(nodular and reticular shadowing)を認める　←　教科書的には「線状網状影」

・HRCT

　・胸膜下嚢胞形成(subspleural cyst formationの直訳。教科書的には「胸膜直下の蜂巣肺所見」)を伴う線維化

これらの所見→diffusing pulmonary fibrosis(fibrosing alveolitis)

・肺の線維化病変を見たら限局性かびまん性かを見なさい！マジで？

　・びまん性：diffuse fine pulmonary fibrosis

　　・原因：膠原病、薬剤性、中毒性、特発性

　・限局性：例えば肺炎感染後の瘢痕

・IPF

　・まれに家族性の病型有　→　本症例で父がchest problemで無くなっている事と関連があるかもしらん。

　・IPFの良くある病型：UIP　＋　CT上胸膜下に認められる蜂巣肺

　・膠原病に合併する場合、NSIPの様に広い範囲に斑状の病変が出現

　・CT上、ground glass shadowingに見える所はactive cellular alveolitisであり、反応に反応する確率が高いことと関連している。

・追加の検査の目的：原因と合併症の検索、肺生検施行の有無を決定

　・肺生検：経気管支鏡生検は試料が少ないために負荷。VATは良く使用されており、若年の肺組織を得るのに適切な方法。

・治療

　・低用量～中等量の副腎皮質ステロイド　±　免疫抑制薬(アザチオプリン)：数ヶ月経過観察し、反応性を観察。

　　・UIP症例でこのレジメンに対する反応性は乏しく、治療による利益より重大な副作用を起こさないことが重要

　・アセチルシステイン：anti-oxidant

　　・予後を改善するというエビデンス有り

　　・ステロイド＋アザチオプリン＋アセチルシステインというレジメンで用いられることがある

　・肺移植

　　・本症例の様にナウでヤングな患者には適応を考慮しても良い

・予後

　・疾患の進展速度は症例により様々

　・6ヶ月で死亡する急性増悪も起こることがある。

　　Progression rates are variable and an acute aggressive form with death in 6 months can occur.

　・UIP症例では多くの場合2～3年かけて確実に進行していく。

■glossary

clubbing n. バチ指

restrictive ventilatory defect 拘束性換気障害

transfer factor = 拡散能/拡散能力 diffusion capacity

subpleural bleb 胸膜下嚢胞

diffuse fine pulmonary fibrosis びまん性微細肺線維症

warrant vt. (正式)(SVO/doing)S(事)からするとO(事)は「～することは」当然のことである(justify)

relevant adj. 直接的に関連する、関連性のある(to)

ground glass すりガラス

'ground glass' shadowingすりガラス陰影

「thoracic」

　　[★]

• adj.

• 胸部の、胸郭の、胸腔の、胸椎の、胸髄の、胸の

関

breast、chest、pectoral、pectoral region、thoraces、thoracic cavity、thoracic cord、thoracic spinal cord、thoracic spine、thoracic vertebra、thoracic vertebrae、thorax、vertebrae thoracicae

　

「pectoral」

　　[★]

• adj.

• 胸の、胸筋の

関

breast、chest、pectoral muscle、pectoralis、pectoralis muscle、thoracic

　 　 　 　

「胸」

　　[★]

英

chest、breast、thoracic、pectoral

関

胸郭、胸筋、胸腔、胸髄、胸椎、胸部、乳房

「open-chest」

　　[★]

• 開胸の

関

thoracotomy

「Manchester operation」

　　[★] マンチェスター手術

「Manchester手術」

　　[★] マンチェスター手術