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试述卵黄管发育异常的分类与临床表现。

答案

参考答案:

卵黄管发育异常的分类与临床表现:

①卵黄管未闭(脐肠瘘,卵黄管瘘):是卵黄管没有闭合,形成回肠末端与脐间的瘘管。脐部可见鲜红色黏膜,中央有小孔,间歇排出黏液、肠气、胆汁样液或粪便。漏出的粪便刺激周围皮肤产生湿疹样变。

②脐窦:系卵黄管的脐端未闭,遗留较短的盲管。表面有圆形的凸起,有黏膜覆盖,黏膜分泌少量黏液。窦道久不愈合后皮肤糜烂,容易并发感染。

③脐茸(脐息肉):是卵黄管脐端有残留的黏膜,形成息肉样的红色突起,表面有少量黏液和血浆样液。

④卵黄管囊肿:卵黄管的两端闭塞,中间部分保留原有的内腔形成,囊腔积聚有囊壁分泌的黏液。囊肿位于脐部下方,一般无自觉症状,界限清楚,大小不等,可以活动。

⑤美克尔憩室:卵黄管退化不全,其肠端未闭合,末端回肠的肠系膜附着缘对侧有憩室样突起。病儿平时健康,憩室可引起反复的脐周或右下腹疼痛。迷生的胃黏膜组织分泌盐酸及胃蛋白酶腐蚀憩室黏膜产生溃疡,偶能发生溃疡的大出血。病儿突然有暗紫色血便,随后转变成鲜红色血便,出血量可达数百毫升。大量出血后病儿有休克、面色苍白、脉搏细速,血红蛋白可降至20%~30%。憩室出血无固定规律,多在2~3天后自行停止,数周后又反复出血。出血可以不合并呕吐、腹痛等症状。憩室发生炎症、溃疡后可以突发穿孔,病儿有呕吐、剧烈腹痛伴发腹肌紧张,病情迅速恶化。

完形填空

Lillian Hanson, a college student, expects to graduate in about two years. What makes Mrs. Hanson different from her classmates is her    46   --73 years old.  She has been studying at college, a few courses at a time, for 27 years.

When Lillian Hanson graduated from high school, she went to the   47   to borrow money for further education. The banker gave her   48   encouragement. He didn't think that a country girl should borrow money to go to college. He thought she should be    49   doing housework or should work on the farm.     50   Lillian Hanson went home and raised a family of nine children instead of going to college.

Mrs. Hanson    51   forgot the dream of getting higher education. When the children

grown up, she   52   again and succeeded. In the class on her first day, when she introduced herself and   53   why she was there and what her aims were, all the other students   54  give her a warm welcome.

Mrs. Hanson finds that the   55   part of going back to school at her age is sitting in class long periods of time. However, she often says she will stick to her dream no matter how difficult it is.

小题1:A. age                           B. interest                      C. accent

小题2:A. club                          B. school                      C. bank

小题3:A. much                                B. no                         C. a little

小题4:A. at college                B. at home                     C. in the office

小题5:A. After                           B. But                         C. So

小题6:A. never                         B. already                      C. often

小题7:A. stopped                         B. tried                        C. refused

小题8:A. regretted                       B. guessed                     C. explained

小题9:A. stood up                       B. ran away                    C. broke out

小题10:A. best                        B. hardest                     C. easiest

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