当前课程知识点:Medical Nursing > Unit 6 Care of Patients with Digestive System Diseases > Chapter 3 Care of Patients with Hepatic Cirrhosis > Etiology and clinical manifestation of hepatic cirrhosis
同学们好
今天我们要和大家一起学习的是肝硬化
肝硬化是一个什么样的疾病呢
它是一种由不同病因引起的
慢性 进行性 弥漫性肝病
病理特点
广泛的肝细胞变性坏死
再生结节形成
纤维组织增生
正常肝小叶结构破坏
和假小叶形成 这是它的病理特征
临床早期症状不明显
后期主要表现为
肝功能损害的和门静脉高压
可以有多系统受累
晚期常出现
消化道出血 感染
肝性脑病等严重并发症
目前 世界各国的年发率
25至400每10万
患者以青壮年男性多见
35至50岁为发病高峰年龄
并发症出现时死亡率高
据国外报道
慢性肝病和肝硬化
在总人口死因中位居第12
在25至44岁年龄组中位居第7
在45至64岁年龄组死因中位居第5
病毒感染主要指肝炎病毒
在咱们国家
肝硬化最常见的原因是病毒感染
大约占到60%至80%
而肝炎病毒中主要指乙 丙 丁型肝炎病毒的单独或重叠感染
可引起肝硬化
而且重叠感染较单独感染更易引起肝硬化
但是大家知道 甲 戊型肝炎病毒这两种肝炎病毒是不会引起肝硬化的
第二个原因呢
慢性酒精中毒可引起肝硬化 大约占15%
女性较男性更易发生酒精性肝病
这是西方国家肝硬化的
主要病因
但正在成为我国
继肝炎病毒感染后另一主要病因
第三个原因就是 血吸虫的反复和长期感染
它会引起肝纤维化和门脉高压
称为血吸虫病性肝纤维化
病理改变和临床表现的侧重方面
和肝炎后肝硬化不一样
还有第四类呢 就是非酒精性脂肪性肝炎
70%原因不明的肝硬化可能由这样一个因素引起
危险因素包括肥胖 糖尿病 高甘油三脂血症
其它可能引起肝硬化的因素有
药物或化学毒物损害
比如说异烟肼 磷 砷等
原发或继发引起的胆汁淤滞
循环障碍 比如心衰
还有免疫障碍 像免疫性肝炎
遗传或代谢障碍 比如说
铜 铁 代谢产物沉积 酶缺乏等
隐源性肝硬化在各种病因引起的肝硬化当中 约占5% 10%
各种病因引起的肝硬化
其病理变化和发展演变过程是基本一致的
它的特征是
广泛的肝细胞变性坏死
正常的肝小叶结构破坏
残存肝细胞形成再生结节
纤维组织弥漫性增生
汇管区之间
以及汇管区和肝小叶中央静脉之间由纤维间隔相互连接
形成假小叶
假小叶因为没有正常的血液供应系统
可以再发生肝细胞缺氧 坏死
和纤维组织增生
上述病理变化逐步进展
造成肝内血管扭曲 受压 闭塞
而致血管床缩小
肝内门静脉 肝静脉和肝动脉小分支之间
发生异常吻合而形成短路
导致肝血液循环紊乱
这些肝内血管网结构异常
而导致更加严重的血液循环障碍
是形成门静脉高压的病理基础
并且使肝细胞缺氧
和营养障碍加重
促使肝硬化病变进一步发展
正常门静脉压取决于
门静脉血流量 Q 及血流阻力 R
具体来说 门静脉高压形成的机制有下面几个
第一 阻力 R 增加
硬化形成后 门静脉流出受阻
门静脉压力增高
当大于1.96kPa时
可导致侧枝循环的建立与重新开放的途径
第二 门静脉系血流量 Q 增加
由于肝功能损害
导致循环中血管扩张物质水平上升
致使内脏血管扩张 充血
最终引起门静脉血流增加
腹水的形成主要有以下3个机制
第一 门静脉系压力增加与低蛋白血症
肝细胞坏死和纤维化形成
肝脏正常结构特点被破坏
使门静脉系血流阻力增加
那么静水压升高
肝功能损害使白蛋白浓度降低
胶体渗透压下降
此共同的作用
使组织液不能回流到血管内
经脏层腹膜溢入腹腔 形成腹水
第二 肝淋巴液生成增多
发生在肝血窦后部位的压迫使
血浆经窦旁间隙进入肝淋巴管增加
超过胸导管引流能力时
那么经肝包膜和肝门淋巴管
溢入腹腔
腹水形成的第三个机制是内分泌因素的影响
继发性醛固酮 抗利尿激素 ADH 增多
以及前列腺素 心房肽等降低
均是使腹水加重和维持的重要因素
肝硬化的病程发展通常比较缓慢
可以潜伏3至5年或者更长的时间
临床上根据
是否出现腹水 上消化道出血
或者肝性脑病等并发症
分为代偿期
和失代偿期
肝硬化
那么它有什么样的临床表现呢
肝功能代偿期的话
早期无明显症状或症状较轻
大多以
乏力 食欲不振 低热等为主要的表现
可能通常还伴有腹胀 恶心
厌油腻 上腹部隐痛 腹泻等
症状大多都是呈间歇性的
常常因为劳累或者伴发病而出现
经过休息或者治疗可以缓解
体格检查的话
患者的营养状况一般或消瘦
肝轻度大 质地偏硬 轻压痛
脾轻至中度大
实验室检查显示肝功能多正常
如果患者病程进展到了失代偿期的话
它的主要表现就是两大块内容
一个是肝功能减退的临床表现
一个是门静脉高压所导致的
全身多系统症状和体征
那么我们来看全身表现
一般状况较差
常常出现营养不良 精神不振 皮肤黝黑 黄疸等
消化系统症状方面
食欲不振是最常见的症状
记住了 食欲不振
进食后伴有上腹饱胀
有时还会有恶心不适 腹胀
腹胀的原因可能是腹水及胃肠积气
还有腹泻 腹泻的原因可能是
对脂肪和蛋白质耐受差所导致的
需要注意的是常见的腹胀不适 可能与
低钾血症 胃肠积气 肝脾肿大和腹水有关
我们要去鉴别开来
血液系统方面
由于肝合成凝血因子减少 脾功能亢进
和毛细血管脆性增加
导致凝血功能障碍
常常有出血倾向和贫血
代谢内分泌紊乱表现
因为雌激素增多
因为雌激素是在肝脏灭活
肝功能下降雌激素会增多 而雄激素和糖皮质激素减少
因而出现肝掌 蜘蛛痣 毛细血管扩张
男性乳房发育 女性闭经 月经不调 不孕
水钠潴留
另外 肝脏对胰岛素灭活减少
会导致糖尿病患病率增加
肝硬化的时候
门静脉血流量增多并且门静脉阻力升高
导致门静脉压力增高
门静脉高压症有三大临床表现
脾大
侧支循环建立和开放 腹水
门静脉高压会导致脾静脉压力增高
脾淤血而肿胀
一般是轻度 中度肿大
有时可能为巨脾
上消化道出血的时候
脾脏可暂时缩小
待出血停止并补足血容量后
脾脏再度增大
门脉高压三主症之二 侧枝循环建立与重新开放
食管 胃底静脉曲张 腹壁 脐周静脉曲张 痔静脉扩张
腹水是肝硬化功能失代偿期
最为显著的临床表现
记住了 最为显著的临床表现
腹水出现以前
常常有腹胀 以饭后明显
大量腹水的时候腹部会隆起 腹壁绷紧发亮
患者行动困难
可以发生脐疝 膈肌抬高
出现呼吸困难 心悸等
部分患者伴有胸腔积液
主要是由于门静脉压力增高
血浆胶体渗透压降低
肝淋巴液生成过多
有效循环血量不足等原因引起
肝脏的结构也会发生变化
多数类型的晚期肝硬化
肝脏常较正常有不同程度的缩小
肝脏触诊时肝脏常不能触及
形成“肝小脾大”的基本腹部触诊结果
一般没有压痛
但在肝细胞进行性坏死
或者并发肝炎和肝周围炎的时候
可能有压痛与叩击痛
肝硬化这种常见的疾病
特别是病毒性肝炎盛行的我国 值得引起大家的高度关注
同时临床特征也比较明显
大多都有全身表现
消化系统表现
以及失代偿期的门静脉高压的表现
特别是门脉高压的三主征
脾大 侧支循环建立与开放 腹水这三大特征
需要我们认真去记住
需要我们积极发现病因 早期诊断
以便早治疗早控制
今天的课就到这里
谢谢大家
-Introduction to Medical Nursing
--Introduction to Medical Nursing
--Introduction to Medical Nursing
-Chapter 1 Overview of Respiratory System Diseases
--Overview of Respiratory System Diseases
--Overview of Respiratory System Diseases
--Overview of Respiratory System Diseases
-Chapter 2 Care of Patients with Pneumonia
--Overview of pneumonia
--Streptococcal Pneumonia
--Other types of pneumonia
--The quality and color of sputum
--Care of Patients with Pneumonia
-Chapter 3 Care of Patients with Lung Abscess
--Introduction of lung abscess
--Introduction of lung abscess
--Treatment and nursing of lung abscess
--Treatment and care of nursing abscess
--Care of Patients with Lung Abscess
-Chapter 4 Care of Patients with Pulmonary Tuberculosis
--Etiology and pathogenesis of pulmonary tuberculosis
--Etiology and pathogenesis of pulmonary tuberculosis
--Clinical manifestation of pulmonary tuberculosis (I)
--Clinical manifestation of pulmonary tuberculosis (I)
--Clinical manifestation of pulmonary tuberculosis (II)
--Clinical manifestation of pulmonary tuberculosis (II)
--Treatment and nursing of pulmonary tuberculosis
--Treatment and nursing of pulmonary tuberculosis
--Care of Patients with Pulmonary Tuberculosis
-Chapter 5 Care of Patients with Chronic Obstructive Pulmonary Disease
--Care of patients with chronic bronchitis
--Care of patients with chronic bronchitis
--Care of patients with chronic bronchitis
--Introduction of chronic obstructive pulmonary disease
--Introduction of chronic obstructive pulmonary disease
--Care of chronic obstructive pulmonary disease
--Care of chronic obstructive pulmonary disease
--Oxygen
--Care of Patients with Chronic Obstructive Pulmonary Disease
-Chapter 6 Care of Patients with Bronchial Asthma
--Etiology and pathogenesis of bronchial asthma
--Etiology and pathogenesis of bronchial asthma
--Clinical manifestation of bronchial asthma
--Clinical manifestation of bronchial asthma
--Treatment and nursing of bronchial asthma
--Treatment and nursing of bronchial asthma
--Care of Patients with Bronchial Asthma
-Chapter 7 Care of Patients with Chronic Pulmonary Heart Disease
--Etiology and pathogenesis of chronic pulmonary heart disease
--Etiology and pathogenesis of chronic pulmonary heart disease
--Treatment and nursing of chronic pulmonary heart disease
--Treatment and nursing of chronic pulmonary heart disease
--Care of Patients with Chronic Pulmonary Heart Disease
-Chapter 8 Care of Patients with Primary Bronchogenic Carcinoma
--Etiology and pathogenesis of primary bronchogenic carcinoma
--Etiology and pathogenesis of primary bronchogenic carcinoma
--Clinical manifestation and auxiliary examination
--Clinical manifestation and auxiliary examination
--Treatment and nursing of primary bronchogenic carcinoma
--Treatment and nursing of primary bronchogenic carcinoma
--Care of Patients with Primary Bronchogenic Carcinoma
-Chapter 9 Care of Patients with Pleural Effusion
--Etiology, pathogenesis and clinical manifestations
--Etiology, pathogenesis and clinical manifestations
--Treatment and nursing of pleural effusion
--Treatment and nursing of pleural effusion
--Determination of the nature of pleural effusion
--Care of Patients with Pleural Effusion
-Chapter 10 Care of Patients with Respiratory Failure and Acute Respiratory Distress Syndrome
--Etiology and pathogenesis of respiratory failure
--Etiology and pathogenesis of respiratory failure
--Treatment and nursing of respiratory failure patients
--Treatment and nursing of respiratory failure patients
--Care of Patients with Respiratory Failure
--Introduction of acute respiratory distress syndrome
--Introduction of acute respiratory distress syndrome
--Treatment and nursing of acute respiratory distress syndrome
--Treatment and nursing of acute respiratory distress syndrome
--Care of Patients with Respiratory Failure
--Care of Patients with Acute Respiratory Distress Syndrome
-Unit Test: Respiratory System
-Unit Assignment: Respiratory System
-Chapter 1 Care of Patients with Cardiovascular System Diseases
--Overview of Cardiovascular System
--Overview of Cardiovascular System
--Overview of Cardiovascular System
-Chapter 2 Care of Patients with Heart Failure
--Overview of heart failure
--Chronic heart failure (1)
--Chronic heart failure (2)
--Acute heart failure
-Chapter 3 Care of Patients with Arrhythmia
--Overview of arrhythmia
--Sick sinus syndrome
--Supraventricular tachycardia
--Supraventricular tachycardia
--Atrial fibrillation
--Ventricular tachycardia
--Atrioventricular block
--Nursing care of patients with arrhythmia
--Nursing care of patients with arrhythmia
-Chapter 4 Care of Patients with Coronary Artery Disease
--Overview of coronary heart disease
--Overview of coronary heart disease
--Stable angina pectoris
--Unstable angina pectoris
--Acute myocardial infarction (1)
--Acute myocardial infarction (1)
--Acute myocardial infarction (2)
--Acute myocardial infarction (2)
--Acute myocardial infarction (3)
--Acute myocardial infarction (3)
--Difference between angina pectoris and myocardial infarction
-Chapter 5 Care of Patients with Hypertension
--Primary hypertension (1)
--Primary hypertension (2)
--Safe nursing for patients with hypertension
-Chapter 6 Care of Patients with Myocardial Diseases
--Myocardial Diseases (1)
--Myocardial Diseases (2)
--Myocardial Diseases (3)
-Unit Assignment: Cardiovascular System
-Chapter 1 Overview of Digestive System
--Overview of digestive system(I)
--Overview of digestive system(I)
--Overview of digestive system(II)
--Overview of digestive system(II)
--Overview of Digestive System
-Chapter 2 Care of Patients with Peptic Ulcer
--Etiology and clinical manifestation of peptic ulcer
--Etiology and clinical manifestation of peptic ulce
--Treatment and nursing of peptic ulcer
--Treatment and nursing of peptic ulcer
--Care of Patients with Peptic Ulcer
-Chapter 3 Care of Patients with Hepatic Cirrhosis
--Etiology and clinical manifestation of hepatic cirrhosis
--Etiology and clinical manifestation of hepatic cir
--Treatment and nursing of hepatic cirrhosis
--Treatment and nursing of hepatic cirrhosis
--Care of Patients with Hepatic Cirrhosis
-Chapter 4 Care of Patients with Hepatic Encephalopathy
--Etiology and pathogenesis of hepatic encephalopathy
--Etiology and pathogenesis of hepatic encephalopath
--Clinical manifestation,treatment and nursing of hepatic encephalopathy
--Clinical manifestation,treatment and nursing of he
-- Care of Patients with Hepatic Encephalopathy
-Chapter 5 Care of Patients with Upper Gastrointestinal Hemorrhage
--Upper gastrointestinal hemorrhage(I)
--Upper gastrointestinal hemorrhage(I)
--Upper gastrointestinal hemorrhage(II)
--Upper gastrointestinal hemorrhage(II)
--Upper gastrointestinal hemorrhage(Ⅲ)
--Upper gastrointestinal hemorrhage(Ⅲ)
--Upper gastrointestinal hemorrhage
--Care of Patients with Upper Gastrointestinal Hemorrhage
-Unit Test: Digestive System
-Unit Assignment: Digestive System
-Chapter 1 Overview of Urinary System
--Overview of Urinary System
-Chapter 2 Care of Patients with Glomerular Diseases
--Care of Patients with Glomerular Diseases
--Care of Patients with Glomerular Diseases
--Care of Patients with Glomerular Diseases
--Acute Glomerulonephritis
-- Rapidly Progressive Glomerulonephritis
--Rapidly Progressive Glomerulonephritis
--Rapidly Progressive Glomerulonephritis
--Chronic Glomerulonephritis
-Chapter 3 Care of Patients with Nephrotic Syndrome
--Nephrotic Syndrome
-Chapter 4 Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
--Care of Patients with Urinary Tract Infection
-Chapter 5 Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Care of Patients with Chronic Renal Failure
--Unit Assignment: Urinary System
-Chapter 6 Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
--Care of Patients with Systemic Lupus Erythematosus
-Chapter 1 Overview of Hematologic System
--Overview of hemopoietic system diseases (I)
--Overview of hemopoietic system diseases (I)
--Overview of hemopoietic system diseases (II)
--Overview of hemopoietic system diseases (II)
--Overview of hemopoietic system diseases (I)
--Overview of hemopoietic system diseases (II)
-Chapter 2 Overview of Anemia
--Overview of Anemia
-Chapter 3 Care of Patients with Iron Deficiency Anemia
--Overview,etiology and pathogenesis,clinical manifestation,auxiliary examination and diagnosis of iron deficiency anemia
--Treatment and nursing of iron deficiency anemia
--Treatment and nursing of iron deficiency anemia
-Chapter 4 Care of Patients with Aplastic Anemia
--Definition, etiology,clinical manifestation,auxiliary examination and diagnosis of aplastic anemia
--Definition, etiology,clinical manifestation,auxiliary examination and diagnosis of aplastic anemia
--Treatment and nursing of aplastic anemia
--Treatment and nursing of aplastic anemia
--Care of Patients with Aplastic Anemia
-Chapter 5 Care of Patients with Hemolytic Anemia
--Nursing of patients with hemolytic anemia
--Nursing of patients with hemolytic anemia
--Care of Patients with Hemolytic Anemia
-Chapter 6 Care of Patients with Hemorrhagic Diseases
--Overview of hemorrhagic diseases
--Overview of hemorrhagic diseases
--Nursing of patients with idiopathic thrombocytopenic purpura
--Nursing of patients with idiopathic thrombocytopenic purpura
--Nursing of patients with anaphylactoid purpura
--Nursing of patients with anaphylactoid purpura
--Overview of hemorrhagic diseases
--Nursing of patients with idiopathic thrombocytopenic purpura
--Nursing of patients with anaphylactoid purpura
-Chapter 7 Care of Patients with Leukemia
--Definition, etiology and classification of leukemia
--Definition, etiology and classification of leukemia
--Definition and clinical manifestation of acute leukemia
--Definition and clinical manifestation of acute leukemia
--Auxiliary examination of acute leukemia
--Auxiliary examination of acute leukemia
--Nursing of acute leukemia(I)
--Nursing of acute leukemia(II)
--Nursing of acute leukemia
--Definition ,clinical manifestation and auxiliary examination of chronic myeloid leukemia
--Definition ,clinical manifestation and auxiliary examination of chronic myeloid leukemia
--Treatment and nursing ofchronic myeloid leukemia
--Treatment and nursing ofchronic myeloid leukemia
--Care of Patients with Leukemia
-Chapter 8 Care of Patients with Lymphoma
--Definition ,clinical manifestation, auxiliary examination,treatment and nursing of lymphoma
--Definition ,clinical manifestation, auxiliary examination,treatment and nursing of lymphoma
--Care of Patients with Lymphoma
-Unit Test: Hematologic System
-Unit Assignment: Hematologic System
-Chapter1 Overview of Endocrine ystem
--Overview of Endocrine System
--Overview of Endocrine System
--Overview of Endocrine System
-Chapter2 Care of Patients with Hypercortisolism
--Care of Patients with Hypercortisolism 1
--Care of Patients with Hypercortisolism 1
--Care of Patients with Hypercortisolism 2
--Care of Patients with Hypercortisolism2
--Care of Patients with Hypercortisolism
--Care of Patients with Hypercortisolism
-Chapter3 Care of Patients with Hyperthyroidism
--Care of Patients with Hyperthyroidism 1
--Care of Patients with Hyperthyroidism 1
--Care of Patients with Hyperthyroidism 2
--Care of Patients with Hyperthyroidism 2
--Care of Patients with Hyperthyroidism
--Care of Patients with Hyperthyroidism
-Chapter4 Care of Patients with Diabetes Mellitus
--Care of Patients with Diabetes Mellitus1
--Care of Patients with Diabetes Mellitus 1
--Care of Patients with Diabetes Mellitus2
--Care of Patients with Diabetes Mellitus 2
--Care of Patients with Diabetes Mellitus 3
--Care of Patients with Diabetes Mellitus 3
--Care of Patients with Diabetes Mellitus 4
--Care of Patients with Diabetes Mellitus 4
--Care of Patients with Diabetes Mellitus 5
--Care of Patients with Diabetes Mellitus 5
--Care of Patients with Diabetes Mellitus
--Care of Patients with Diabetes Mellitus
-Unit Review: Endocrine System
--Unit Assignment: Endocrine System
--Unit Test: Endocrine System
-Chapter 1 Overview of Infectious Diseases
--Overview of Infectious Diseases 1
--Overview of Infectious Diseases 1
--Overview of Infectious Diseases 1
--Overview of Infectious Diseases 2
--Overview of Infectious Diseases 2
--Overview of Infectious Diseases 2
--Overview of Infectious Diseases
-Chapter 2 Care of Patients with Viral Hepatitis
--Care of Patients with Viral Hepatitis 1
--Care of Patients with Viral Hepatitis 1
--Care of Patients with Viral Hepatitis 1
--Care of Patients with Viral Hepatitis 2
--Care of Patients with Viral Hepatitis 2
--Care of Patients with Viral Hepatitis 2
--Care of Patients with Viral Hepatitis 3
--Care of Patients with Viral Hepatitis 3
--Care of Patients with Viral Hepatitis 3
--Care of Patients with Viral Hepatitis 4
--Care of Patients with Viral Hepatitis 4
--Care of Patients with Viral Hepatitis 4
--Care of Patients with Viral Hepatitis
-Chapter 3 Care of Patients with Hemorrhagic Fever with Renal Syndrome
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 1
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2
--Care of Patients with Hemorrhagic Fever with Renal Syndrome 2
-Chapter 4 Care of Patients with Acquired Immune Deficiency Syndrome
--Care of Patients with Acquired Immune Deficiency Syndrome 1
--Care of Patients with Acquired Immune Deficiency Syndrome 1
--Care of Patients with Acquired Immune Deficiency Syndrome 1
--Care of Patients with Acquired Immune Deficiency Syndrome 2
--Care of Patients with Acquired Immune Deficiency Syndrome 2
--Care of Patients with Acquired Immune Deficiency Syndrome 2
-Chapter 5 Care of Patients with Rabies
--Care of Patients with Rabies 1
--Care of Patients with Rabies 1
--Care of Patients with Rabies 1
--Care of Patients with Rabies 2
--Care of Patients with Rabies 2
--Care of Patients with Rabies 2
--Care of Patients with Rabies
-Chapter 6 Care of Patients with Epidemic Encephalitis B
--Care of Patients with Epidemic Encephalitis B 1
--Care of Patients with Epidemic Encephalitis B 1
--Care of Patients with Epidemic Encephalitis B 2
--Care of Patients with Epidemic Encephalitis B 2
--Care of Patients with Epidemic Encephalitis B
-Chapter 7 Care of Patients with Epidemic Cerebrospinal Meningitis
--Care of Patients with Epidemic Cerebrospinal Meningitis 1
--Care of Patients with Epidemic Cerebrospinal Meningitis 1
--Care of Patients with Epidemic Cerebrospinal Meningitis 2
--Care of Patients with Epidemic Cerebrospinal Meningitis 2
--Care of Patients with Epidemic Cerebrospinal Meningitis
-Chapter 8 Care of Patients with Cholera
--Care of Patients with Cholera
--Care of Patients with Cholera
--Care for patients with cholera
-Chapter 9 Care of Patients with Bacillary Dysentery
--Care of Patients with Bacillary Dysentery
--Care of Patients with Bacillary Dysentery
--Care of Patients with Bacillary Dysentery
-Chapter 10 Care of Patients with Schistosomiasis
--Care of Patients with Schistosomiasis 1
--Care of Patients with Schistosomiasis 1
--Care of Patients with Schistosomiasis 2
--Care of Patients with Schistosomiasis 2
--Care for patients with schistosome
-Chapter 11 Care of Patients with COVID-19
--Care of Patients with COVID-19
--Care of Patients with COVID-19
-Chapter 12 Psychological Coping Modes to the Epidemic of COVID-19
--Psychological Coping Modes to the Epidemic of COVID-19
--Psychological Coping Modes to the Epidemic of COVID-19
-Unit Test: Infectious Diseases
--Unit Test: infective disease
-Unit Assignment: Infectious Diseases
--Unit Assignment: Infectious Diseases
-Chapter 1 Overview of Nervous System Diseases
--Overview of Nervous System Diseases(I)
--Overview of Nervous System Diseases(I)
--Overview of Nervous System Diseases(I)
--Overview of Nervous System Diseases(II)
--Overview of Nervous System Diseases(II)
--Overview of Nervous System Diseases(II)
-Chapter 2 Care of Patients with Facial Neuritis
--Care of Patients with Facial Neuritis
--Care of Patients with Facial Neuritis
--Care of Patients with Facial Neuritis
-Chapter 3 Care of Patients with Cerebrovascular Diseases (Episode 1)
--Overview of Cerebral Vascular Diseases (I)
--Overview of Cerebral Vascular Diseases (I)
--Overview of Cerebral Vascular Diseases (I)
--Overview of Cerebral Vascular Diseases(II)
--Overview of Cerebral Vascular Diseases(II)
--Overview of Cerebral Vascular Diseases(II)
--Intracerebral Hemorrhage(I)
--Intracerebral Hemorrhage(II)
--Intracerebral Hemorrhage(II)
--Intracerebral Hemorrhage(II)
-Chapter 4 Care of Patients with Cerebrovascular Diseases (Episode 2)
--Subarachnoid Hemorrhage
--Transient Ischemic Attack
--Cerebral Thrombosis(I)
--Cerebral Thrombosis(II)
-Chapter 5 Care of Patients with Epilepsy
--Care of Patients with Epilepsy(I)
--Care of Patients with Epilepsy(I)
--Care of Patients with Epilepsy(II)
--Care of Patients with Epilepsy(II)
--Care of Patients with Epilepsy
-Chapter 6 Care of Patients with Parkinson Disease
--Care of Patients with Parkinson Disease(I)
--Care of Patients with Parkinson Disease(I)
--Care of Patients with Parkinson Disease(II)
--Care of Patients with Parkinson Disease(II)
--Care of Patients with Parkinson Disease
-Unit Assignment: Nervous System
--Unit Assignment: Nervous System