Texts for listening comprehension

Listen to the texts twice and give the answers to the following questions:

1. What can weight loss signify?

2. What pathologic conditions are associated with weight loss?

3. The weight loss is relatively slow in ….

4. The patients with … often gain weight.

5. Weight loss is more severe in ….

6. The most extreme degree of weight loss occurs in ….

 

Weight Loss

Significant loss of weight occurs in many gastrointestinal disorders. When pain is the principal complaint, weight loss of much magnitude is associated with relatively few disorders. Weight loss can signify a reduction in caloric intake, an increase in caloric loss, or malignancy.

Any intra-abdominal disease in which the pain is exacerbated by eating leads to weight loss. Most patients attempt to get around the problem by eating frequent small meals, by avoiding offending foods and beverages, and by eating soothing foods like milk products which are calorically dense. These maneuvers work quite well when the source of pain is gastritis or gastric ulcer so that weight loss is relatively slow and small in those disorders. A patient with duodenal ulcer often gains weight because such foods generally relieve the pain quite well.

When the source of pain is the pancreas or biliary tree these maneuvers do not work, so that weight loss is more severe. The most extreme degree of weight loss associated with abdominal pain which occurs in carcinoma of the pancreas; this reflects the combined effects of a reduced caloric intake and of the malignancy. An equally extreme degree of weight loss occurs in intestinal ischemia because eating anything inevitably causes pain.

Give the answers to the following questions:

1. What is the medullary nausea center activated by?

2. What diseases of gastrointestinal tract is nausea associated with?

3. It is more common in ….

4. It is rare in ….

5. It is uncommon in ….

 

Nausea and Vomiting

The medullary nausea center is activated by both somatic and autonomic inputs so you must establish that the nausea is indeed related to the abdominal pain by asking about a temporal relationship.

Nausea accompanies many causes of abdominal pain. It occurs with both malignant and inflammatory disease of intra-abdominal organs but it is more common with disease of the upper gastrointestinal tract than the lower. It is rare in esophageal disease, very common in gastric and small intestinal disease, and uncommon in colonic disease. Nausea also accompanies disease of the solid organs and peritoneum.

Nausea seems to be particularly associated with distension of the gut. Thus the development of nausea during the course of well-established abdominal pain suggests that an initially nonobstructive lesion has extended to produce obstruction.

Give the answers to the following questions:

What common symptoms are presented by the patients with carcinoma of the stomach?

What may physical examination reveal?

What is the age and complaints of the patients with the suspected carcinoma?

 

Neoplasm

Carcinoma of the stomach causes symptoms similar to those of gastric ulcer inflammation as the tumor progresses the pain is less regular, remissions do not occur, the appetite disappears and there is progressive loss of weight. The diagnosis should be suspected in any patient complaining of persistent indigestion for the first time in middle or late life. Physical examination may reveal evidence of weight-loss, a lump in the epigastrium or signs of spread to other parts.

TEST YOURSELF

1. What diseases belong to the gastrointestinal disorders?

2. How are they classified?

3. What factors are considered to be predisposing in the development of gastrointestinal pathology?

4. What are the most common symptoms of gastrointestinal diseases?

5 What diagnostic tests are used for assessment of gastric patients?

6. What data may be presented by these investigations?

7. How do age, sex, nationality influence the incidence of gastrointestinal disorders?

8. Discuss the ways of prevention of gastrointestinal tract diseases.

 

 

UNIT IV HEPATOBILIARY DISORDERS

Skim the text and speak on the localization, structure and functions of the organs of hepatobiliary system.

Reviewing Anatomy and Physiology

The liver is the largest internal organ in the human body, weighing slightly more than 3 lb (1.200 to 1.600 g) in the average adult. It’s also one of the busiest, performing well over 100 separate functions. The most important of these are the formation and secretion of bile; detoxification of harmful substances; storage of vitamins; metabolism of carbohydrates, fats, and proteins; and productions of plasma proteins. This remarkably resilient organ serves as the body’s warehouse and is absolutely essential to life.

The gallbladder is a pear-shaped organ that lies in the fossa on the underside of the liver and is capable of holding 50 ml of bile. Attached to the large organ above by connective tissue, the peritoneum, and blood vessels, the gallbladder is divided into four parts: the fundus, or broad inferior end; the body, which is funnel-shaped and bound to the duodenum; the neck, which empties into the cystic duct; and the infundibulum, which lies between the body and the neck and sags to form Harmann’s pouch. The hepatic artery supplies both the cystic and hepatic ducts with blood, which drains out of the gallbladder through the cystic vein. Rich lymph vessels in the submucosal layer also drain the gallbladder as well as the head of the pancreas.

The biliary duct system provides a passage for bile from the liver to the intestine and regulates bile flow. The gallbladder itself collects, concentrates, and stores bile. The normally functioning gallbladder also removes water and electrolytes from hepatic bile, increases the concentration of the larger solutes, and reduces its pH. In gallbladder disease, bile becomes more alkaline, altering bile salts and cholesterol and predisposing the organ to stone formation.

 

PART I

List of words to be learned.

bile [bail] - n, желчь;

bilirubin [ֽbili'ru:bin] - n, билирубин, красный желчный пигмент;

catarrh [kə'ta:] - n, катар, воспаление;

epigastrium [ֽepi'gæstriəm] - n, надчревье;

flatulence ['flætjuləns] - n, метеоризм;

hypochondrium [ֽhaipəu'kondriəm] - n, подреберье;

jaundice ['dʒo:ndis] - n, желтуха; syn. icterus ['ikterəs]

lassitude ['læsitju:d] - n, утомление, усталость, апатия;

pruritus [pruə'raitəs] - n, зуд, syn. itching ['it∫iŋ]

steatorrhea [ֽsti:ətə'riə] - n, стеаторея, жировые испражнения;

distend [di'stend] - v, расширять;

obstruct [əb'strkt] - v, закупоривать.

 

Mind the pronunciation.

аscitis [ə'saiti:z]

сholecystitis [ֽkolisi'staitis]

сholelithiasis [ֽkolili'θaiəsis]

сirrhosis [sə'rəusis]

pancreatitis [ֽpæŋkriə'taitis]

 

Ex.1. Match the words with their descriptions and translate them.

Ascites, bile, flatulence, jaundice, pruritis, steatorrhea.

- gas or air which collects in the stomach or intestines causing discomfort;

- a condition in which fat is passed in the faeces;

- a thick bitter brownish yellow fluid produced by the liver, stored in the gallbladder and used to digest fatty substances and neutralize acids;

- an irritation of the skin which makes a person want to scratch;

- unusual accumulation of fluid from the blood in the peritoneal cavity, occurring in heart and kidney failure or as a result of malignancy;

- a condition in which there is an excess of bile pigment in the blood, and in which the pigment is deposited in the skin and the whites of the eyes, which have a yellow color.

Ex.2. Make up word-combinations and translate them.

abdominal

pubic (лобковый)

hypogastrium (подчревье)

hypochodrium region

inguinal (паховый)

umbilical (пупочный)

epigastrium (надчревье)

infectious/ short incubation

allergic

viral

congenital/ fetal hepatitis

radial

focal

serum/ long incubation

toxic/ drug-induced

stone-free/ calculus-free

secondary/ accompanying

gangrenous cholecystitis

catarrhal

acute

calculus

floating (блуждающая)

nodular (бугристая)

smooth (гладкая) liver

cystic

enlarged

hemolytic

mechanical

obstructive (обcтрукционная) jaundice

hepatic

physiologic (of the new-born)

 

Ex.3. Give Russian equivalents:

Umbilical region, drug-induced hepatitis,, gangrenous cholecystitis, nodular liver, obstructive jaundice, increased bilirubin level, stone formation, bile duct blockage,
cholelithiasis, sluggishness in the gallbladder.

Ex .4. Give English equivalent :

Кожный зуд, боль в подреберье, выраженная желтуха, вздутие живота, токсический гепатит, легкая утомляемость, увеличенная печень, усиление боли при физической нагрузке, застой в желчном пузыре, желчекаменная болезнь.

 

Ex.5. Mind the prefixes. Make up your own sentences with these words:

de- [di:] – prefix - removal or loss

 

decalcification, decompensation, decompression,

defibrillation, deformation, dehydration, detoxication

 

mal- [mæl] - prefix - bad or unusual

 

malnutrition, malocclusion, malposition, malfunction, malabsorbtion malformation, malnourished

 

Ex.6. Complete the sentences and translate them.

1. Nonviral inflammation of the liver (toxic or drug-induced hepatitis) is a form of hepatitis that usually results from (действия химических веществ или лекарств).

2. In most patients, signs and symptoms resemble those of viral hepatitis: (отсутствие аппетита, тошнота, рвота, желтуха, боль в брюшной области, зуд).

3. Hepatitis A usually results from ingestion of (зараженной пищи, молока или воды).

4. Jaundice is characterized by (желтым цветом кожи и слизистых оболочек).

5. Pruritis is developed due to irritation of (нервных рецепторов, высокого содержания желчных кислот в крови и тканях).

6. Obstructive jaundice occurs when (желчный проток закупорен камнем или опухолью).

7. One out of every 10 patients with gallstones disease develops gallstones (в общем желчном протоке).

8. In gallbladder disease, bile becomes more alkaline, altering bile salts and cholesterol and predisposing (орган к образованию камней).

9. Other effects of obstruction-(зуд, статорея, кровотечение могут сопутствовать желтухе).

10. (Резкий приступ боли в эпигастральной области) indicates gallbladder inflammation or obstruction of bile out flow by a stone.

 

Ex.7. Translate the sentences from Russian into English .

1. Хронический гепатит - это диффузное поражение печени.

2. Основными причинами хронического гепатита являются острый вирусный гепатит (типа А,В, "ни А, ни В"), вирусные инфекции, интоксикации, особенно алкоголизм, а также заболевания других органов.

3. Токсико-аллергические гепатиты развиваются как в результате прямого токсического воздействия на клетки, так и вследствие их повышенной чувствительности.

4. При хроническом гепатите отмечаются легкая утомляемость, тупые боли в правом подреберье, усиливающиеся при физической нагрузке, кожный зуд, желтуха склер и кожных покровов.

5. Алкоголь оказывает непосредственное повреждающее действие на печень.

6. При пальпации у больных циррозом печень увеличена, плотная и бугристая.

7. Механическая (обтурационная) желтуха развивается вследствие закупорки желчного или печеночного протока камнем или опухолью.

8. Вследствие недостаточной фильтрации билирубина крови через пораженную печень в желчь появляются желтуха, потемнение мочи, осветление кала.

9. Никотин, алкоголь, переедание (особенно жирной пищи), торопливая еда, прием горячей или слишком холодной пищи способствуют возникновению заболеваний желудочно-кишечного тракта.

GRAMMAR

Absolute Participle Construction.

( Самостоятельный причастный оборот ).

Существует два вида причастных оборотов: 1) зависимый причастный оборот, соответствующий русскому деепричастному обороту; 2) независимый причастный оборот, который не имеет аналога в русском языке.

Examples:

1. Knowing business English well enough Victor Dolgov could write the business letter without any difficulty. - Зная достаточно хорошо деловой английский язык, Виктор Долгов смог написать деловое письмо без всяких затруднений. (зависимый причастный оборот)

2. The weather being fine, we are going to look at a small family-run restaurant in the village next week. - Если погода будет хорошая, то мы собираемся на следующей неделе заглянуть в небольшой семейный ресторанчик в деревне.

(независимый причастный оборот)

Если в английском языке в состав причастного оборота входит существительное или местоимение в именительном падеже и следующее за ним причастие, то такой оборот называется самостоятельным. При этом существительное/местоимение играет роль подлежащего, а причастие - сказуемого.

Перевод: если оборот стоит в начале предложения, то он переводится обстоятельственным придаточным предложением с союзами так как, послетого как, если и др. Если стоит в конце предложения, то переводится самостоятельным предложением с союзами: при этом, а, и, причём.

Самостоятельный причастный оборот отделяется от главной части предложения запятой.

Examples:

1. The doctor being experienced, the operation did not last long. - Так как врач был опытный, операция длилась недолго.

2. The boy being very ill, the doctor sent him to hospital. - Так как мальчик был сильно болен, доктор направил его в больницу.

3. The owner was fined by the Customs, the goods being confiscated. - Владелец был оштрафован таможенниками, а товар был конфискован.

Ex.1. Choose sentences with Absolute participle construction and translate them.

1. The patient having survived the operation well, the danger of peritonitis was eliminated.

2. In 1880 the prominent Russian scientist S. Botkin having advanced the idea of an infectious origin of catarrhal jaundice, proved his suggestions by such facts as the involvement in this pathologic process not only of the liver but also of the nervous system, the kidneys, the enlargement of spleen, etc.

3. The abdominal incision having been made and the stomach opened, the ulcer was found to involve the posterior wall of the stomach.

4. The digestion being considerably impaired, the patient constantly complained of epigastric pains.

5. The work having been completed, Mr. Jones left London for Moscow.

 

Ex.2. Translate the following sentences from English into Russian.

1. The patient being admitted to the hospital, the doctor on duty examined him in the reception ward.

2. The female having been hospitalized, the generalized abdominal pain was controlled in three hours.

3. Generalized abdominal pain having increased, the doctor asked the nurse to give the patient another injection.

4. Of the total number of patients forty-eight have been relieved of digestive symptoms, four having died of other pathologic conditions.

5. The doctor's report being wordy, the conference dragged on until late at night.

 

Ex.3. Translate the following sentences from Russian into English.

1. После того как операция завершилась, врач вышел из операционной.

2. Так как не было высокой температуры, больной чувствовал себя лучше.

3. Так как наружное кровотечение было сильным, больной был отправлен в больницу немедленно.

4. Так как профессор был болен, лекция была отложена.

5. Если условия позволят, мы будем испытывать новое оборудование завтра.

PART II

In many cases, a careful physical examination and patient's history can detect hepatic disease. Its cardinal signs: jaundice (a result of increased serum bilirubin levels), ascites, right upper quadrant abdominal pain, lassitude, anorexia, nausea and vomiting.

Ex.1.

1.) Make up questions to ask about patient`s complaints.

Dramatize the dialogue.

Ask if patient has ever had jaundice.

Ask about occupational or other exposure to toxins.

Ask about recent travel or contact with a person who has traveled to areas where hepatic disease is epidemic.

Alcohol consumption, a significant factor in suspected hepatic disease.

Any recent blood transfusions, blood tests, tattoos.

If the patient take any drug that may cause liver damage.

If the patient's weight has fluctuated recently.

 

Ex 2. Study the text and speak on the diagnostic tests used for assessment of gallbladder disease. What data may be revealed by each of them?

Assessing for Gallbladder Disease

During physical examination of a patient with suspected gallbladder disease look for pain, jaundice (a result of blockage of the common bile duct), fever, chills, indigestion, nausea, and intolerance of fatty foods. Numerous tests are available to detect hepatic disease. Perhaps the most useful test is the liver function studies, which measures serum enzymes and other substances. Other useful diagnostic tests include: abdominal X-rays, barium studies, oral cholecystography, percutaneous transhepatic cholangiography, computed tomography scans, liver biopsy.

Ex. 3. Read the text” Hepatitis-Viral” and find in it the answers to the following questions:

1.What is hepatitis?

2. What are the early signs of the disease?

3. Are these symptoms similar to signs of other diseases?

4. What are the late manifestations of the disease?

5. What types of hepatitis are recognized?

6. What are their causes?

7. Why is hepatitis considered to be a potentially serious disorder?

8. What are the main routs of transmission of hepatitis?

9. What should we know about prevention of hepatitis?

Hepatitis - Viral

Inflammation of the liver due to infection with one of the number of viruses known to cause them.

Symptoms: The early phases of hepatitis seem similar to any other viral illness including flu. There is fever, general aches and pains, nausea and vomiting, sometimes sore throat and headache. Loss of appetite is very severe, often way out of proportion to the amount of illness, and cigarettes taste especially bad. After about a week the fever falls, and jaundice appears along with abdominal discomfort, especially in the right upper abdomen. The stools may appear light in the color and the urine dark yellow or brown. There is profound fatigue and weakness, often accompanied by weight loss because of the loss of appetite and vomiting.

Cause: This type of hepatitis is caused by infection of the cells of the liver by certain viruses. There are several distinct types of hepatitis, based on both the course of the disease and the viruses that are found. Hepatitis A, previously called “infectious hepatitis", appears about two or six weeks after contact with someone who has it and lasts from several weeks to several months. Hepatitis B, previously called “serum hepatitis" appears six weeks to six months after contact and can last much longer, with a person carrying the virus from months to years. A recently recognized type of hepatitis, called non-A, non-B hepatitis is known to be caused by a virus, but not by the previously identified kinds. Hepatitis can also be caused by viruses that produce other diseases, such as infectious mononucleosis and cytomegalovirus disease.

Severity of problem : Hepatitis is always a potentially serious disease that can progress to chronic hepatitis or permanent liver damage. It is also a public health hazard, because it is quite contagious and it is often transmitted to others before a person knows he or she is ill.

Contagious? Yes, all forms of Viral Hepatitis are contagious. Hepatitis A virus is found in stool and urine and is passed by contact with contaminated food. It is contagious for as long as two weeks before a person is ill and for several weeks after that. Hepatitis B is most often passed from one person to another through blood transfusions or shared drugs but can also be transmitted through sexual contact and in saliva (Hepatitis B is particularly difficult disease among male homosexuals). Hepatitis B is prevalent in certain groups of Orientals and can be passed from a carrier or infected mother to an unborn or newborn infant. Non-A, non-B Hepatitis is transmitted through blood transfusions and is the most common cause of post-transfusion Hepatitis.

Treatment: There is no specific treatment for viral Hepatitis. Rest, avoidance strenuous activity, a well-balanced, adequate diet and avoidance of substances that can further injure the liver (alcohol, certain drugs) are important.

Prevention : All forms of Viral Hepatitis are preventable by avoiding contact with persons who have the disease, especially by avoiding contact with their secretions. However, this is often not practical. While screening of donated blood will identify certain forms of hepatitis (hepatitis B), other forms cannot yet be identified. Injection of gamma globulin is helpful for people who have had known household exposure to someone with Hepatitis. There is a vaccine available (licensed in 1982) for use in people with particular risk for Hepatitis B.

Discussion: Hepatitis in infants and children (especially Hepatitis A) can be a “silent" illness - that is, the child may have what looks like intestinal flu (acute gastroenteritis) without ever becoming jaundiced. It is only when adults in the household become ill with jaundice that the real disease is identified. Hepatitis A is easily spread in group - care situations where babies are not yet toilet - trained.

Both pain and vomiting are common in gastric and duodenal disease.