急 腹 症
1.It is as much an intellectual exercise to tackle the problems of bellyache as to work on the human genome.
—— Hugh Dudley
【译文】研究腹痛像研究人类基因一样都是一个相当烧脑的活儿。
【点评】可见腹痛的学问之深奥！
2.Two things surgeons fear the most are God and Peritonitis.
—— Henri Monder, 1885——1962
【译文】外科医生最怕两件事，一是上帝，二是腹膜炎。
【点评】真不能低估了“腹膜炎”的复杂性。
3.It's this damned belly that gives a man his worst troubles.
—— Homer, 1050——850 BC
【译文】就是这该死的肚子给我们带来多少麻烦！
【点评】是啊，每天有多少医生在诊室里为这“区区小肚”绞尽脑汁！
4.A good surgeon evaluating acute abdominal pain is equivalent to a highly sensitive and specific laboratory test.
—— Cliffon K.Meador
【译文】一个优秀外科医生对急性腹痛病情的判断不输于高敏感和高特异性的实验室检查。
【点评】有时候，再先进的辅助检查都不如有经验的外科医生到患者床边一次认真的“望、触、叩、听”。
5.An acute surgical abdomen is when a good surgeon says it is an acute surgical abdomen.
—— Cliffon K.Meador
【译文】所谓外科急腹症就是当一名优秀的外科医生说“这就是外科急腹症”的那种状况。
【点评】经验丰富的外科医生对急腹症的感觉常常是只能意会难以言传的，这绝对不是故弄玄虚！年轻外科医生要多到床边去体验这种感觉。
6.The flat abdomen is a good abdomen.
—— George G.A.Decker
【译文】腹部平坦就是好腹部。
7.When belly with bad pains doth swell, it matters nought what else goes well.
—— Saadi, 1184——1291
【译文】当剧烈腹痛伴有腹胀时，患者其他方面再好也等于零。（doth是does的另一种形式，译者注 ）。
8.The general rule can be laid down that the majority of severe abdominal pains which ensue in patients who have been previously fairly well, and which last as long as six hours, are caused by conditions of surgical import.
—— Zachary Cope, 1881——1974
【译文】有一条基本规律可记住，那就是以前相当健康的人突发剧烈腹痛且持续长达六小时之久的患者，其中多数必有重要的外科情况。
9.There can be no question that in acute abdominal disease it is of the utmost importance to diagnose early.
—— Zachary Cope, 1881——1974
【译文】毫无疑问，急腹症的早期诊断至关重要。
10.Never let the skin stand between you and the diagnosis.
【译文】永远不要让皮肤成为阻碍你获取诊断的屏障。
【点评】有经验的外科医生就是有这样一双能穿透这层皮肤的透视眼。
11.Severe, acute abdominal pain always requires a surgical consultation.
—— Cliffon K.Meador
【译文】严重的急性腹痛总是需要请外科会诊。
12.It is a curious but well-known fact that many who are taken with abdominal pain in the daytime endure till evening before they feel compelled to send for a doctor.(https://www.daowen.com)
—— Zachary Cope, 1881——1974
【译文】一个奇怪但众所周知的事实是，许多人白天的腹痛一直持续到晚上，他们才不得不去看医生。
13.Pains occurring about the stomach, the more superficial they are, the more slight are they; and the less superficial, the more severe.
—— Hippocrates, 460——377 BC
【译文】腹痛时，疼痛越浅表，病情越轻，反之，越深则问题越严重。
14.There are two categories if emergent surgical patients: with peritonitis in the abdomen and with peritonitis in the head.
—— Denis M.Arkhipov
【译文】外科急诊患者有两大类：一是腹部有腹膜炎，一是脑袋中有腹膜炎。
15.When in front of an acute abdomen, consider ectopic pregnancy, think always about it, thinking about it again is not enough, and still go on thinking about it.
—— Henri Monder, 1885——1962
【译文】面对急腹症，永远不要忘记异位妊娠，哪怕再三考虑这种可能也不过分。
16.There are only three things needing immediate diagnosis in abdominal surgery: intestinal strangulation, peritonitis and a ruptured aneurysm.
【译文】腹部外科有三种需要立刻诊断的情况：即肠绞窄、腹膜炎和动脉瘤破裂。
【点评】急腹症病情纷繁复杂、千变万化，不可能期望一个急诊外科医生在短时间内一一查明真相，但必须善于识别一些提示我们应该及时剖腹探查的重要征象和表现，这样才能避免重大失误。
17.The temptation is often very strong to temporize and "see how things are in the morning".
—— Zachary Cope, 1881——1974
【译文】拖延总是有如此大诱惑——“看看明早的情况吧”。
【点评】拖延是缺乏直面问题的底气。
18.The aim is to operate only when necessary but not to delay a necessary operation.
—— Moshe Schein
【译文】我们的目标是不做非必要的手术但绝不延误必要的手术。
【点评】当出手时就出手。
19.Continuity of care is a "sin qua non" in the optimal care of the acute abdomen, Such patients need to be frequently re-assessed by the same clinician who should be a surgeon.But why we be re-inventing the wheel? Why don't we learn? The place for the patient with acute abdominal conditions is on the surgical floor, surgical ICU, or in the OR and under the care of a surgeon——yourself! Do not shake off your responsibilities.
—— Moshe Schein
【译文】急腹症最佳处理的一个“必要条件”是诊疗与照护的连续性，这些患者经常需要由同一位临床医生，当然最好是外科医生，给予重新评估。但为什么我们还要多此一举，为什么不吸取教训呢？将急腹症患者留在外科病房、外科重症监护病房，或者手术室由外科医生——你自己亲自照料！不要逃避你的责任。
20.Never give up in acute disease.
—— Mark M.Ravitch, 1910——1989
【译文】面对急症，不要轻言放弃。
【点评】疾病的诊断与观察应该是多维的，密切关注病情随“时间轴”的变化而发生的变化对急腹症的诊断和治疗都特别重要。因此，在强调“不要轻易放弃急症患者”的前提下，由同一医生“连续照料患者”尤为重要，因为只有同一医生才可能对同一患者的一些主观感觉的动态变化做出更为细微的判断，譬如患者的神情、腹壁的张力、肢体末梢皮肤温度、弹性的变化等，这些对病情的准确判断都有着很重要的作用。
21.For the abdominal surgeon it is a familiar experience to sit，ready scrubbed and gowned, in a corner of the quiet theatre, with the clock pointing midnight … In a few minutes the patient will be wheeled in and another emergency laparotomy will commence.This is the culmination of a process which began a few hours previously with the surgeon meeting with and examining the patient，reaching a diagnosis, and making a plan of action.
【译文】腹部外科医生再熟悉不过的场景是：午夜时分，坐在手术室的一角，准备刷手、穿长袍……几分钟后患者被推了进来，另一台急诊剖腹手术将开始。而为最终这一关键时刻做铺垫的是开始于几小时前的会诊、检查患者、明确诊断以及制定手术方案等等工作。
【点评】这简直就是一个急诊外科医生活报剧的剧本！
22.This is what makes emergency abdominal surgery so exciting and demanding: the ever looming surprises and anxiety about whether you are able, or not, to tackle it competently.
—— Moshe Schein
【译文】腹部外科急诊如此令人兴奋并要求苛刻的原因是：考验你能否出色胜任这项工作的惊喜和焦虑总在不断朝你紧逼过来。
【点评】这难道不是“痛并快乐着”的最好注解吗？
23.Hippocrates was right and an example of that is: a day or two of relatively superficial pain and tenderness on one side of the abdomen or the other and then when a rash appears in just that area: the problem stops being an acute abdomen with its sick, dying and dead types of problems; it has become shingles: which is pain for a while (month) and so quite survivable!
【译文】希波克拉底是对的，有一个例子是：腹部一侧或另一侧出现持续一两天，相对表浅的疼痛和压痛，然后当皮疹出现在那个区域时，那些曾考虑过的与本次急性腹痛相关的什么病、会不会致死以及如何致死的种种问题都一笔勾销了，原来只不过是一个带状疱疹：它是一种要持续一段时间，甚至一个月之久的疼痛，并且罕有致命的！
【点评】不能明确诊断的腹痛要想到这个病。