Symptoms: 1. Chronic cough 2. Sputum: white mucus or serous foamy sputum, occasionally with blood. 3. Shortness of breath or difficulty breathing (the hallmark symptom of COPD) 4. Others: weight loss, loss of appetite

Signs: 1. Inspection: The anteroposterior diameter of the thorax increases, the intercostal space widens - barrel chest 2. Palpation: Bilateral tremor weakened 3. Percussion: The lungs are too voiceless and the heart dullness is narrowed. 4. Auscultation: The breath sounds in both lungs are weakened, the respiratory period is prolonged, and the heart sounds are distant. Some patients can hear crackles or rales.

1. Pulmonary function monitoring: after inhaling bronchodilators, FEV1/FVC <70%, total lung capacity, functional residual capacity, and residual capacity increase, and vital capacity decreases 2. X-ray: thickened and disordered lung texture 3. CT: COPD small airway lesions can be seen 4. Blood gas analysis: hypoxemia, hypercapnia, acid-base balance disorder, respiratory failure 5. Others: When combined with bacterial infection, peripheral blood leukocytes increase and the nucleus shifts to the left.

Lung function is persistently limited, and FEV1/FVC <70% after inhalation of bronchodilators is the limit for determining the presence of persistent airflow limitation.

Complications: chronic respiratory failure, spontaneous pneumothorax, chronic cor pulmonale

Stable period treatment: ① Education and management (quit smoking) ② Bronchodilators: β2 adrenergic receptor agonists (albuterol, salmeterol), anticholinergics, theophylline drugs ③Glucocorticoids ④ Expectorants ⑤Other drugs ⑥Long-term home oxygen therapy ⑦Rehabilitation treatment

Treatment for acute exacerbation: ① Bronchodilators; ② Low-flow oxygen; ③ Antibiotics; ④ Glucocorticoids; ⑤ Mechanical ventilation

Anatomical classification: Lobar pneumonia, lobular pneumonia, interstitial pneumonia

Cause classification: bacterial pneumonia, pneumonia caused by atypical pathogens, viral pneumonia, fungal pneumonia, pneumonia caused by other pathogens

Category of disease environment: community-acquired pneumonia, nosocomial pneumonia

Cause and pathogenesis: Streptococcus pneumoniae

Pathology: congestive phase, red hepatoid degeneration phase, gray hepatoid degeneration phase, dissipation phase

Clinical manifestations:

laboratory tests

treat

Pathogen: Staphylococcus aureus

Symptoms: Sudden onset, high fever, chills, chest pain, purulent sputum, Signs: moist rales scattered in both lungs

Other laboratory signs: increased leukocytes in peripheral blood and increased proportion of neutrophils Chest X-ray shows segmental or lobar consolidation, early stage cavities, and lobular infiltration with single or multiple fluid cysts.

Treatment: Use sensitive antibiotics

Etiology and pathogenesis: Streptococcus pneumoniae

Clinical manifestations: fatigue, headache, sore throat; muscle aches, cough, paroxysmal dry cough, severe at night, and thick phlegm may also be produced

Laboratory tests: The total number of white blood cells is normal or slightly increased, and about 2/3 of the patients have positive agglutination tests.

Treatment: Macrocyclic ester antibiotics are preferred (erythromycin, azithromycin)

Etiology and pathogenesis: Chlamydia pneumoniae

Clinical manifestations: Insidious onset, mild symptoms, accompanied by fever, chills, myalgia, dry cough, non-pleuritic chest pain, and headache

Diagnosis: tuberculosis respiratory symptoms and systemic symptoms, X-ray examination, etiology and serology tests

Treatment: Macrocyclic ester antibiotics are the first choice

Causes: Common influenza viruses A and B, adenovirus, and parainfluenza virus

Clinical manifestations: acute onset, fever, headache, body aches, and fatigue

Laboratory tests: white blood cell count is normal, slightly high, or low Chest X-ray shows increased lung markings, ground-glass shadows, small patchy infiltrates or extensive infiltrates

Treatment: mainly symptomatic treatment, oxygen therapy when necessary

Inhalation lung abscess: The pathogen inhales pathogenic bacteria (Streptococcus pneumoniae, Staphylococcus aureus) through the mouth and nasopharynx.

secondary lung abscess

Hematogenous lung abscess: due to skin trauma infection, furuncle, otitis media or osteomyelitis

Biochemical examination: leukocytosis, neutrophils above 90%, nuclear shift to the left, and often toxic particles

Microbiological examination: sputum culture

Imaging examination: X-ray: large, dense and fuzzy inflammatory infiltration shadows with unclear edges; CT mostly shows a round-like thick-walled abscess cavity, and there may be a fluid level in the abscess cavity.

fiberoptic bronchoscopy

Symptoms: Cough and phlegm, shortness of breath, palpitations after activity, difficulty breathing, fatigue and decreased work endurance

Signs: There may be varying degrees of cyanosis, dry or moist rales, P2>A2, systolic murmur in the tricuspid valve area or increased cardiac pulsation under the xiphoid process.

Symptoms: dyspnea worsens, especially at night, often headaches, insomnia, loss of appetite, daytime drowsiness, even apathy, delirium, shortness of breath, palpitations, lack of appetite, nausea

Signs: Obvious cyanosis, bulbar conjunctival congestion, edema, jugular venous distension, rapid heart rate, arrhythmia, subxiphoid and systolic murmur

The formation of pleural effusion is related to the absorption of pleural blood supply and lymphatic drainage.

Increased hydrostatic pressure within pleural capillaries increased pleural permeability Decreased colloid osmotic pressure in pleural capillaries Parietal pleural lymphatic drainage disorder damage Iatrogenic

Symptoms: It is not obvious when the amount of effusion is less than 0.3~0.5L. When there is a large amount of effusion, palpitations and dyspnea are obvious, often accompanied by chest pain or cough.

Signs: There are no obvious signs in a small amount of effusion, or pleural friction may be palpable and pleural friction sounds may be heard; in moderate to large amounts of effusion, the affected side's chest will be full, tactile fremitus will be weakened, local percussion dullness, and breath sounds will decrease or disappear.

Diagnostic thoracentesis and pleural effusion examination: appearance and odor, cells, pH and glucose, pathogens, proteins, lipids, enzymes X-ray and radionuclide examination: a small amount of pleural effusion, the costophrenic angle becomes blunt; when a large amount of effusion occurs, the chest on the affected side is dense, and the trachea and mediastinum are pushed to the healthy side. Ultrasonography Pleural needle biopsy Thoracoscopic or thoracotomy biopsy Bronchoscopy

Tuberculous pleurisy: ① General treatment ② Fluid extraction treatment ③ Anti-tuberculosis treatment ④ Glucocorticoids

Symptoms: Before the onset of the disease, patients have triggers such as holding heavy objects, holding back their breath, and strenuous physical activity. Most of them have a sudden onset, sudden chest pain, acupuncture-like or knife-like pain on one side; the duration is short, followed by chest tightness and dyspnea.

Signs: In a small amount of pneumothorax, the signs are not obvious. In a large amount of pneumothorax, the trachea is displaced to the unaffected side, the chest on the affected side is bulged, respiratory movement and tactile vibrato are weakened, and there is a voiceless or tympanic sound upon percussion.

chest Chest CT: Very low-density gas shadow appears in the chest, accompanied by varying degrees of lung atrophy. Pneumothorax volume assessment

Difficulty breathing Cyanosis Psychological and neurological symptoms: confusion, mania, coma, convulsions Circulatory system manifestations: Most patients have tachycardia, which in severe cases can lead to myocardial damage, peripheral circulatory failure, decreased blood pressure, and arrhythmias. Digestive and urinary system manifestations: elevated alanine aminotransferase and plasma urea nitrogen may occur in some cases

Keep airway open Oxygen therapy: Oxygen concentration - try to reduce the oxygen concentration as much as possible while ensuring that PaO2 quickly increases to 60mmHg or the pulse volume and blood oxygen saturation reaches more than 90% Oxygen device (nasal cannula or nasal prongs, mask, nasal main flow oxygen therapy) Positive pressure mechanical ventilation and extracorporeal model oxygenation Cause treatment general supportive care

Dyspnea and: labored breathing accompanied by prolonged expiration, which may develop into shallow and rapid breathing in severe cases

Nervous symptoms: As PaCO2 increases, it may first be excited and then suppressed. Exciting symptoms include insomnia, irritability, agitation, insomnia at night and sleepiness during the day. Do not use sedatives or hypnotics at this time.

Circulatory system manifestations: peripheral surface vein filling, skin congestion, warmth and sweating, elevated blood pressure, and increased cardiac output.

Oxygen therapy positive pressure mechanical ventilation Anti-infective respiratory stimulants Correct acid-base balance imbalance

Left heart failure, right heart failure and total heart failure acute and chronic heart failure Heart failure with reduced ejection fraction, heart failure with preserved ejection fraction

Basic cause: myocardial damage (myocardial infarction, chronic myocardial ischemia, inflammation and immune myocardial damage; myocardial damage caused by endocrine and metabolic diseases) Overload of the heart (hypertension, aortic stenosis, heart valve insufficiency insufficient ventricular preload Causes: infection, arrhythmia, increased blood volume, excessive physical exertion or emotional agitation; improper treatment

Frank-Starling mechanism Neurohumoral mechanisms (increased sympathetic nerve excitability, RAAS activation, changes in other humoral factors ventricular remodeling

Left heart failure: Symptoms: ① Different degrees of dyspnea (exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, acute pulmonary edema) ② Cough, sputum, and hemoptysis; ③ Fatigue, tiredness, decreased exercise tolerance, Dizziness, palpitation and other organs; ④ Symptoms of oliguria and renal damage Signs: moist rales in the lungs, cardiomegaly, and relative mitral regurgitation

Right heart failure: Symptoms: ① Gastrointestinal symptoms: abdominal distension, lack of appetite, nausea and vomiting; ② exertional dyspnea Signs: ① Edema; ② Jugular venous signs (enhanced, filling, and distended jugular vein pulses); ③ Hepatomegaly; ④ Cardiac signs: significant enlargement of the right ventricle.

Level I: Patients with heart disease have no restrictions on their daily activities and general activities do not cause fatigue; they have heart failure symptoms such as dyspnea. Level II: Patients with heart disease have mild limitations in physical activity, no conscious symptoms at rest, and symptoms of heart failure may occur during normal activities. Level III: Patients with heart disease whose physical activities are significantly limited and lower than usual activities will cause symptoms of heart failure. Level IV: Heart disease patients cannot engage in any physical activity and have symptoms of heart failure even at rest, which worsen after activity.

Laboratory tests: natriuretic peptide, troponin, routine examination electrocardiogram Echocardiography, X-ray examination, cardiac magnetic resonance, coronary angiography, cardio-pulmonary exercise test

Bronchial asthma, pericardial effusion, constrictive pericarditis, cirrhosis, abdominal effusion with lower extremity edema

General treatment: lifestyle management, rest and activity, treatment of cause

Drug therapy: diuretics (loop diuretics, thiazide diuretics, potassium-sparing diuretics) RAAS inhibitors (ACEI, ARB, ARNI, aldosterone receptor antagonists, renin inhibitors); β-receptor antagonists, positive Sexual inotropic drugs (digital drugs, phosphodiesterase inhibitors)

Acute left heart failure: Myocardial contractility is significantly reduced, cardiac load is aggravated, resulting in a sudden drop in cardiac output, a sudden increase in pulmonary circulation pressure, and an increase in peripheral circulation resistance. Acute right heart failure: a sharp decrease in right ventricular myocardial contractility or a sudden increase in right ventricular preload, and a sharp decrease in right ventricular blood output

Sudden severe dyspnea, forced sitting, ashen complexion, cyanosis, profuse sweating, irritability, frequent coughing, and coughing up pink frothy sputum Main manifestations of cardiogenic shock: persistent hypotension, systolic blood pressure falling to 90mmHg for more than 30 minutes, accompanied by tissue hypoperfusion, clammy skin, paleness, and cyanosis

General treatment: ① Position: semi-recumbent or upright sitting position, legs drooping ②Oxygen inhalation: high-flow nasal cannula oxygen supply ③Preparation for treatment, intravenous channel opening, indwelling urinary catheter, ECG monitoring, and transcutaneous blood oxygen saturation monitoring

Drug treatment: ① Morphine; ② Rapid diuresis; ③ Aminophylline; ④ Digitalis drugs

vasoactive drugs

Mechanically assisted circulatory support device

Adult sinus rhythm has a frequency of more than 100 beats/minute

Treatment: Treatment of the cause and removal of predisposing factors, combined with β-blockers and non-dihydropyridine calcium channel blockers if necessary

Adult sinus rhythm has a frequency of less than 60 beats/minute

Asymptomatic sinus bradycardia does not require treatment; if symptoms of insufficient cardiac output occur, atropine or isoproterenol can be used

The sinus node cannot generate impulses

Electrocardiogram: No P wave occurs during the interval that is significantly longer than the normal PP interval, or neither P wave nor QRS wave appears. There is no multiple relationship between the long PP interval and the basic sinus PP interval.

When sinus arrest lasts for too long (>3s) and no escape beat occurs, the patient may experience amaurosis, temporary disturbance of consciousness, or dizziness.

A delay or block in the conduction of impulses from the sinoatrial node to the atria

Types

The sinoatrial node causes conduction dysfunction and produces a variety of comprehensive manifestations of arrhythmias.

Causes: annulus fibrosus and infiltration, sclerosis and degeneration, amyloidosis, hypothyroidism, infection

Clinical manifestations: episodic dizziness, amaurosis, palpitations, fatigue, decreased exercise tolerance, and in severe cases, angina pectoris, heart failure, and temporary disturbance of consciousness.

treat

Atrial activation originating in any part of the atrium other than the sinoatrial node

Clinical manifestations: palpitations, some patients have symptoms of chest tightness, fatigue, and a conscious feeling of stopping.

ECG characteristics

Treatment: Usually no treatment is required; treatment should be given when there are obvious symptoms or supraventricular tachycardia due to premature atrial contractions

Tachycardia that originates in the atria and does not require maintenance by the atrioventricular node

Causes: coronary heart disease, digitalis poisoning, chronic lung disease

Clinical manifestations: palpitations, dizziness, chest tightness, breathlessness, fatigue and other symptoms

ECG characteristics

treat

Cause: Commonly seen in organic heart disease such as rheumatic heart disease, coronary heart disease, and hypertension

Clinical manifestations: angina and congestive heart failure

ECG characteristics

treat

Cause: Often occurs in patients with organic heart disease

Clinical manifestations: angina pectoris, atrial fibrillation complicated by thrombosis

ECG characteristics

treat

Retrograde P waves are produced, and the QRS wave shape is normal.

A rhythm formed by the continuous occurrence of escape beats in the atrioventricular junction zone

Electrocardiogram: Normal QRS wave skirt, frequency 40~60 beats/min, retrograde P wave may be present

Related to increased tissue autonomy or triggering activities in the atrioventricular junction zone

Heart rate 70~150 beats/min, heart rhythm is usually normal, QRS wave is normal

Treatment: Treatment of the cause

clinical manifestations

ECG characteristics

treat

A premature heartbeat that occurs below the bifurcation of the bundle of His and depolarizes the myocardium prematurely.

clinical manifestations

ECG characteristics

Three or more consecutive ectopic heartbeats originating from the special conduction system below the branches of the His bundle or the ventricular myocardium

clinical manifestations

ECG characteristics

Treatment: beta-blockers, amiodarone

Coronary atherosclerosis, cranial atherosclerosis, renal atherosclerosis, mesenteric atherosclerosis, extremity atherosclerosis

General preventive measures: actively control some risk factors related to the disease, have a reasonable diet, appropriate physical labor and sports activities (reasonable arrangements for work and life, promote smoking cessation and limit alcohol Drug therapy: Adjustment of blood lipid drugs, antiplatelet drugs, thrombolytic drugs and anticoagulant drugs, and corresponding treatment of ischemic symptoms Interventional and surgical treatments

① Occult or asymptomatic coronary heart disease; ② Angina pectoris; ③ Ischemic heart disease; ④ Myocardial infarction; ⑤ Sudden death

Pathogenesis: When coronary arteries are stenotic or partially occluded, their blood flow is reduced and the blood supply to the myocardium is relatively fixed.

clinical manifestations

Auxiliary inspection

treat

Etiology and pathogenesis: platelet aggregation based on rupture or erosion of unstable atherosclerotic plaques, concurrent thrombosis, spasmodic constriction of coronary arteries, and microvascular embolism

clinical manifestations

treat

Symptoms: The onset is insidious and may be asymptomatic in the early stage. The main symptoms are dyspnea during activity and decreased activity tolerance.

Signs: enlargement of the heart, weakened heart sounds on auscultation, audible third or fourth heart sounds, a galloping rhythm when the heart rate accelerates, and sometimes a systolic murmur can be heard at the apex of the heart.

Chest X-ray: enlarged heart shadow, cardiothoracic ratio >50% Electrocardiogram: poor R wave progression, intraventricular block, and left bundle branch block Echocardiogram: Mild enlargement of the left ventricle; later, all cardiac chambers were enlarged cardiac magnetic resonance Coronary angiography and cardiac catheterization Blood and serology tests endocardial biopsy

Treatment of causes and aggravating factors: control the infection, strictly limit or quit drinking, and actively search for the cause of the disease Drug treatment for heart failure: ACEI or ARB drugs, beta-blockers, mineralocorticoid receptor antagonists, diuretics, digitalis

Symptoms: The most common ones are exertional dyspnea and fatigue, and 1/3 of patients may have exertional chest pain.

Signs: Mild enlargement of the heart, audible fourth heart sound

Chest X-ray: The heart shadow can be normal in size or the left ventricle can be enlarged Electrocardiogram: The main manifestations are QRS complex left ventricular high voltage, inverted T wave and abnormal q wave. Echocardiography: asymmetric ventricular hypertrophy without ventricular cavity enlargement Cardiac MRI, cardiac catheterization and coronary angiography, endomyocardial biopsy

Drug therapy: ① Reduce left ventricular outflow tract obstruction ② Treat heart failure ③ Treat atrial fibrillation

Non-drug treatment: ① surgical treatment ② alcohol septal ablation ③ pacing treatment

Laboratory tests: BNP is significantly elevated in patients with restrictive cardiomyopathy Electrocardiogram: Abnormal QRS complex and ST-T changes Echocardiogram: biatrial enlargement and ventricular hypertrophy X-ray, CTA, CMR cardiac catheterization Endocardial biopsy

There is no specific treatment, mainly to avoid fatigue, respiratory infection and other factors that aggravate heart failure.

Symptoms: dyspnea, cough, hemoptysis, thromboembolism, hoarseness, difficulty swallowing, loss of appetite, bloating, nausea

Signs: Mitral valve appearance-bizygomatic cyanosis; Heart sounds: An elevated first heart sound can be heard at the apex of the heart, which is like a beating. Open valve sounds, P2 hyperactivity and splitting can also be heard. Heart murmur: a low-key, rumble-like murmur in mid-to-late diastole in the apical region, with an increasing pattern

X-ray examination: enlarged hilus, blurred edges, thickened lung texture, and enlarged left atrium Electrocardiogram: mitral P wave, QRS complex showing right axis deviation and right ventricular hypertrophy. Echocardiography: The anterior leaflet of the mitral valve shows "city wall-like" changes

General treatment: prophylactic antirheumatic fever treatment, long-term or even lifelong use of benzathine penicillin Treatment of complications: sitting position, diuretics to reduce pulmonary artery pressure, ventricular rate control, embolism prevention Surgical treatment: percutaneous mitral valvuloplasty, mitral valve separation, artificial valve replacement

Symptoms: acute - only mild exertional dyspnea, severe left heart failure, acute pulmonary edema Chronic - fatigue, reduced activity tolerance, exertional dyspnea, orthopnea

Signs: The apical beat is hyperdynamic, lifting-like beat, P2 hyperactivity, and the fourth heart sound may appear in the apical area. Holosystolic blowing murmur in the apical region ≥ grade 3/6

X-ray examination: left atrium and left ventricle were significantly enlarged, Electrocardiogram: In mild cases, the electrocardiogram is normal, but in severe cases, left ventricular hypertrophy and strain may be present. Echocardiogram:

Medical treatment: reduce reflux volume, lower pulmonary veins, increase cardiac output Surgical treatment:

Symptoms: dyspnea, angina, syncope

Signs: The heart boundary is normal or slightly enlarged to the left, and a lifting-like pulse can be palpated in the apex area. First heart sound normal Rough and loud jet murmur in the 1st to 2nd intercostal space on the right edge of the sternum, grade 3/6 or above

X-ray examination: The heart shadow is generally not large, and its shape may change slightly. Electrocardiogram: increased QRS complex voltage with mild ST-T changes Echocardiogram: Aortic valve leaflets thickened and echo enhanced

Medical Treatment: Prevention of Endocardial Infection Surgical treatment: ① artificial valve replacement ② aortic valve shunt under direct vision ③ percutaneous aortic valve balloon formation ④ percutaneous aortic valve replacement

Symptoms: Paroxysmal dyspnea and orthopnea at night, inability to lie down, sweating all over the body, frequent coughing, irritability, and confusion

Signs: The heart boundary expands to the lower left The first heart sound is weakened and the second heart sound in the aortic area is weakened or disappeared. The diastolic murmur in the aortic area is a high-pitched descending sigh-like murmur. Peripheral vascular signs: increased systolic arterial blood pressure, decreased diastolic blood pressure, and widened pulse pressure

X-ray examination: left ventricle is significantly enlarged, heart and waist are deepened, and "boot-shaped heart" Electrocardiogram: left ventricular hypertrophy and strain with left axis deviation Echocardiography: rapid high-frequency vibration of the anterior mitral valve leaflet during diastole

Medical treatment Surgical treatment

Symptoms: pain behind the sternum and precordium, which can radiate to the neck; pain in the left shoulder and left arm that is sharp in nature and related to respiratory movements, and can be aggravated by coughing and deep breathing

Signs: pericardial rub, rough high-frequency sound like scratching

Serological examination: elevated white blood cell count, elevated C-reactive protein, and accelerated erythrocyte sedimentation rate Electrocardiogram: ST segment is arched and elevated downward. Chest X-ray: enlarged heart shadow echocardiogram cardiac magnetic resonance imaging pericardiocentesis

Treatment of the cause, relief of cardiac tamponade and symptomatic supportive treatment

Symptoms: dyspnea, orthopnea, shallow breathing, pale complexion, cyanosis

Signs: apical pulse weakened, heart percussion dullness expanded to both sides

Cardiac tamponade: sinus tachycardia, decreased blood pressure, decreased pulse pressure, and significantly increased venous pressure

X-ray examination: The heart shadow increases to both sides and looks like a flask. Electrocardiogram: P wave can be seen with low QRS voltage and large amounts of fluid exudation. Echocardiogram: Fluid between the visceral and parietal pericardium is visible throughout the cardiac cycle.

pericardiocentesis drainage

Symptoms: Mainly related to decreased cardiac output and systemic circulation congestion, myocardium, exertional dyspnea, decreased activity tolerance, and fatigue

Signs: increased jugular venous pressure, often smaller pulse pressure, weakened or absent apical pulse

Check with X first: the heart shadow is slightly enlarged and appears triangular or spherical, and there may be pericardial calcification. Electrocardiogram: tachycardia, low QRS voltage, flat or inverted T wave Echocardiogram, cardiac CT, MRI

pericardiectomy

Clinical classification: ① Acute glomerulonephritis ② Rapidly progressive glomerulonephritis ③ Chronic glomerulonephritis ④ Asymptomatic hematuria or proteinuria ⑤ Nephrotic syndrome

Pathological classification: ① Mild glomerular lesions ② Focal segmental glomerular lesions ③ Diffuse glomerulonephritis

Immune response: humoral immunity, (circulating immune complex deposition, in situ immune complex formation, autoantibodies) cellular immunity Inflammatory response: inflammatory cells, inflammatory mediators, non-immune factors

Mainly beta-hemolytic streptococci infection

Type I (anti-glomerular basement membrane type) Type II (immune complex type) Type III (low immune deposition type)

Intensive therapy ① Plasma exchange ② Methylprednisolone shock

Support symptomatic treatment

massive proteinuria hypoalbuminemia Edema Hyperlipidemia

Minimal change nephropathy: No obvious glomerular changes under light microscopy, fatty degeneration can be seen in the proximal tubular epithelial cells

Mesangial proliferative glomerulonephritis: Diffuse proliferation of glomerular mesangial cells and mesangial matrix can be seen under light microscopy

Focal segmental glomerulosclerosis: The lesions are focal and segmentally distributed under light microscopy, showing sclerosis of the affected segments, corresponding to tubular atrophy and interstitial fibrosis.

Membranous nephropathy: Diffuse glomerular nephrosis can be seen under light microscopy. In the early stage, only a small number of scattered Ferythrophilic granules are seen on the epithelial side of the glomerular basement membrane.

Mesangial capillary glomerulonephritis: The pathological changes under light microscopy are diffuse and severe proliferation of mesangial cells and mesangial matrix.

Infection, thrombosis and embolism, acute kidney injury, protein and fat metabolism disorders

Hepatitis B virus-related nephritis, lupus nephritis, Henoch-Schonlein purpura nephritis, diabetic nephropathy, renal amyloidosis

General treatment: proper rest, avoidance of public places and infection prevention

Symptomatic treatment: diuresis and swelling (thiazide diuretics, loop diuretics, osmotic diuretics), reducing proteinuria

Immunosuppressive treatment: glucocorticoids (prednisone), cytotoxics (cyclophosphamide, chlorambucil), calcineurin inhibitors, mycophenolate mofetil

Acute pyelonephritis: systemic symptoms: fever, chills, headache, body aches, nausea and vomiting, body temperature usually above 38°C Urinary system symptoms: frequent urination, urgency, painful urination, difficulty urinating Low back pain: Low back pain varies in degree, mostly dull pain or soreness Chronic pyelonephritis: clinical manifestations are complex, with atypical systemic and urinary system local manifestations

① Insufficient effective blood volume ② Decreased cardiac output ③ Dilation of systemic blood vessels ④ Constriction of renal arteries ⑤ Impaired renal blood flow autonomic regulation response

metabolic acidosis Water and sodium metabolism disorders Potassium metabolism disorders Calcium and phosphorus metabolism disorders Magnesium metabolism disorders

Hypertension and left ventricular hypertrophy heart failure uremic myocarditis pericardial lesions Vascular calcification and atherosclerosis

Composed of bacteria, fungi, viruses, etc.

Function: ① Metabolic function (can secrete complex proteases, has redox effect, can promote the decomposition of components in food, and decompose, metabolize and transform endogenous and exogenous other substances ②Nutrition function: Synthesize a variety of vitamins, amino acids, peptides, exercise fatty acids, and microbial metabolites to promote the absorption of minerals and nutrients. ③Host immune function: regulates the development and maturation of host immune organs ④Intestinal defense function: It is an important part of the intestinal mucosal barrier

Cholecystokinin, somatostatin, intestinal vasoactive peptide, substance P

It plays an important and complex regulatory role in the secretion, motility, material transport, immunity and intestinal epithelial cell repair of the gastrointestinal tract.

Sugar: hydrolyzed by pancreatic amylase into disaccharides, part of which supplies energy to the body; part of which is stored in the form of glycogen in the liver and muscles. Fat: After emulsification by bile salts in the small intestine, it is digested by pancreatic lipase into monoglycerides, fatty acids and cholesterol, and then absorbed into the portal vein in the upper intestine. protein

Oxidation, reduction, hydrolysis, combination

Liver cells produce bile, and secretion begins in the bile canaliculi; the general gallbladder can hold 20~50ml of bile

Typical symptoms: Reflux and heartburn.

Atypical symptoms: chest pain, which can radiate to the precordium, back, neck, shoulders, and behind the ears, difficulty swallowing, and foreign body sensation behind the sternum.

Stress, drugs, alcohol, trauma and physical factors

Discomfort, fullness, dull pain, burning pain in the middle and upper abdomen, and may also present with lack of appetite, belching, pantothenic acid, and nausea

Treatment for the cause: Hp-related gastritis (antibiotics, PPI, bismuth) Symptomatic treatment

Caused by swallowing strong acid, strong alkali, arsenic, phosphorus, mercury chloride

For corrosive gastritis, temporary fasting, parenteral nutrition, and close monitoring should be

Compound ulcer: refers to gastric and duodenal ulcers, more common in men

Pyloric ulcer: pain occurs soon after meals, and complications such as pyloric obstruction, bleeding and perforation are prone to occur

Retrobulbar ulcer: an ulcer that occurs in the descending and horizontal segments of the duodenum. The ulcers are mostly on the posteromedial wall. The pain can radiate to the right upper quadrant and back.

Huge ulcer: an ulcer with a diameter >2cm, the pain can be severe and stubborn

Ulcers in the elderly and childhood ulcers

Refractory ulcers: ulcers that have not healed despite regular anti-ulcer treatment

Abdominal pain: mostly located in the right lower abdomen or around the umbilicus, with intermittent attacks, aggravation after meals, and often accompanied by borborygmi Changes in bowel habits: The stools are pasty, often without pus and blood, and without tenesmus. Abdominal wall mass: mostly located in the right lower abdomen, in the middle mass, relatively fixed Systemic symptoms and manifestations of extraintestinal tuberculosis

Laboratory tests: The erythrocyte sedimentation rate is significantly accelerated, and a small amount of pus cells and red blood cells are seen in the stool. CT, X-ray barium enema Colonoscopy: mucosal congestion, edema, and ulcer formation in the ileocecal area and other areas

Anti-tuberculosis chemical drug treatment Symptomatic treatment Surgical treatment: Indications ① Complete intestinal obstruction or incomplete intestinal obstruction that fails medical treatment ② Acute intestinal perforation, or chronic intestinal perforation fistula that cannot be closed after medical treatment ③ Massive intestinal bleeding that cannot be effectively stopped by active rescue ④ Diagnosis is difficult and requires laparotomy

Exudative type: peritoneal bleeding, edema, surface covered with fibrin exudate Proliferative type: A large amount of fibrous tissue proliferation and protein deposition make the peritoneum and mesentery significantly thickened cheese type

Systemic symptoms: low-grade fever, night sweats, flaccid fever or residual fever Abdominal pain: located around the umbilicus, lower abdomen or entire abdomen, persistent or paroxysmal dull pain Abdominal palpation: There is often a rubbing sensation Abdominal distention, abdominal effusion: accompanied by abdominal distension Abdominal wall mass: more common in adhesion type or cheese type Diarrhea: usually 3 to 4 times/min, and the stools are mostly paste-like.

Blood test: Mild to moderate anemia may be present Tuberculin test and gamma-interferon release test Ascites Abdominal imaging tests Laparoscopy

1. Anti-tuberculosis chemical drug treatment 2. If there is a large amount of abdominal effusion, the abdominal effusion can be appropriately drained to relieve symptoms. 3. Surgical treatment 4. Patient education

Environmental factors, genetic factors, intestinal microecology, immune imbalance

Digestive system: diarrhea, mucus, pus and bloody stools, abdominal pain, bloating, loss of appetite, nausea and vomiting, Mild and moderate patients only have tenderness in the left lower abdomen, while severe patients have obvious tenderness, abdominal muscle tension, tenderness, and rebound tenderness.

Systemic reactions: fever, malnutrition

Extraintestinal manifestations: peripheral arthritis, erythema nodosum, pyoderma gangrenosum, episcleritis

Blood: Anemia, increased white blood cell count, accelerated erythrocyte sedimentation rate, and increased C-reactive protein Feces: Mucus, pus and blood are often present to the naked eye. Colonoscope X-ray barium enema

Control inflammatory response: aminosalicylic acid preparations (5-aminosalicylic acid, sulfasalazine) glucocorticoids, immunosuppressants

Symptomatic treatment: timely correction of water and electrolyte imbalances, blood transfusion for severe anemia, supplementation of white list for hypoalbuminemia

Surgical treatment: The indications for emergency surgery are those complicated by massive bleeding, intestinal perforation and toxic megacolon that fail to respond to aggressive medical treatment.

Gross morphological characteristics: ① The lesions are segmental ② The mucosa of the lesions presents longitudinal ulcers and cobblestone-like appearance, which may appear as thrush ulcers in the early stage ③ The lesions involve the entire intestinal wall, with thickening and hardening of the intestinal wall and narrow intestinal lumen

Histological characteristics: ① Non-caseating granuloma, composed of epithelial-like cells and multinucleated giant cells, can occur in all layers of the intestinal wall and local lymph nodes ② Fissure ulcers, slit-shaped, can penetrate deep into the submucosal muscle layer, muscle layer and even Serosal layer ③ Inflammation of all layers of the intestinal wall, accompanied by lymphocyte accumulation at the bottom of the lamina propria and submucosa, and widening of the submucosa

Digestive system manifestations: abdominal pain - mostly located in the right lower quadrant or around the umbilicus, intermittent attacks, diarrhea, abdominal mass, fistula formation, and perianal lesions

Systemic manifestations: fever, malnutrition, weight loss, anemia, hypoalbuminemia

Endoscopy: Colonoscopy is the test of choice for Crohn’s disease Imaging examination: CT, MRI

Control inflammatory response: aminosalicylic acids, glucocorticoids, immunosuppressants, antibacterial drugs, biological agents, total enteral nutrition

Symptomatic treatment: correct water and electrolyte imbalance, and blood transfusion can be used in patients with anemia

Surgical treatment: mainly for complications

Decreased liver function: maldigestion, malnutrition, jaundice, bleeding and anemia, endocrine disorders, irregular low-grade fever, hypoalbuminemia

Portal hypertension: formation of portal collateral circulation (esophageal and gastric varices, abdominal wall varices, hemorrhoidal varices, retroperitoneal anastomotic varices, splenorenal shunt) hypersplenism and splenomegaly; peritoneal effusion

Early identification and removal of triggers of HE attacks, nutritional support and treatment, promotion of ammonia metabolism in the body, regulation of neurotransmitters, and blocking of porto-systemic shunts

Biliary tract disease, alcohol, pancreatic duct obstruction, descending duodenal disease, surgery and trauma, metabolic disorders, drugs, infection and systemic inflammatory response, overeating

Pancreatic acute inflammatory disease local complications of pancreas Pathology of multi-organ inflammatory injury caused by acute pancreatitis

Acute abdominal pain: often severe, often located in the left upper abdomen or even the entire abdomen, and in some patients the pain radiates to the back

Acute multiple organ dysfunction and failure: abdominal pain persists, abdominal distension gradually worsens, and circulatory, respiratory, intestinal, liver, and renal failure may occur one after another.

local complications of pancreas

Important serum markers for diagnosing AP: ①Amylase: Serum amylase begins to increase 2 to 12 hours after the onset of illness and begins to decrease at 48 hours ②Lipase: It begins to increase 24 to 72 days after the onset of illness and lasts for 7 to 10 days.

Laboratory test indicators that reflect the pathophysiological changes of AP: white blood cells, C-reactive protein, blood sugar, white blood list, blood calcium, and blood triglycerides

Image changes of pancreas and other organs

Determine the degree of AP: ① Mild acute pancreatitis ② Moderately severe acute pancreatitis ③ Severe acute pancreatitis ④ Critical acute pancreatitis

guardianship

Organ support: fluid resuscitation, respiratory function, intestinal function maintenance, continuous blood purification,

Decreased pancreatic juice secretion: fasting, somatostatin and its analogs

Control inflammation: fluid resuscitation, somatostatin, early enteral nutrition

analgesia

Emergency endoscopic treatment to remove the cause

Prevent and fight infection

Various bile and pancreatic diseases, alcohol, group B coxsackievirus, idiopathic pancreatitis, hypercalcemia

Symptoms: Abdominal pain: recurrent epigastric pain, intermittent at first, then persistent epigastric pain, aggravated when lying down Manifestations of exocrine pancreatic insufficiency: loss of appetite, weight loss, malnutrition, edema Manifestations of pancreatic endocrine insufficiency

Signs: There may be mild tenderness in the abdomen

Abdominal plain X-ray, abdominal ultrasound and endoscopic ultrasound, abdominal CT and MRI,