食道
食道位於頸部和胸部，為一肌肉管，內襯為複層鱗狀上皮
腹膜
腹膜是一層光滑的漿膜，覆蓋著腹腔內大部分的器官，它分為壁層腹膜和臟層腹膜。壁層腹膜貼附在腹腔壁內面，而臟層腹膜則覆蓋在各個臟器表面。處於腹腔的中央。腹膜反摺構成肝鐮韌帶、小網膜及腸繫膜，肝圓韌帶是肝鐮狀韌帶邊緣部分的退化組織，非腹膜反摺構成。
胰臟只被腹膜（peritoneum）覆蓋住其前表面，因為胰臟位於腹腔後方，深藏於胃的後方。由於其位置較深，因此只有其前表面能夠被臟層腹膜所覆蓋。
腹膜內器官
器官表面均被腹膜包覆，一般器官活動性較大：胃、十二指腸上部、空腸、回腸、盲腸、闌尾、橫結腸、乙狀結腸、脾、卵巢、輸卵管
羅氏徵象 Rovsing’s signs（+）： Rovsing's sign 是用來評估闌尾炎的一個體徵，當壓迫左下腹時，會引起右下腹疼痛。
腹膜間器官
器官表面大部分被腹膜覆蓋的器官：肝膽、升降結腸、直腸上部、膀胱、子宮
腹膜後器官
僅有一面被腹膜覆蓋的器官：十二指腸升結腸、降結腸、直腸下 1/3位於腹膜後、腎上腺、腎、胰臟(解剖位置位於腹上區，位於後腹腔，有內分泌和外分泌的功能；內分泌主要分泌胰島素（insulin）、升糖素（glucagon）、體抑素（somatostatin）；外分泌主要是分泌消化液消化蛋白質、脂肪和澱粉
升結腸造瘻的排便沒有規則性
Bowel movements are irregular in patients with ascending colon colostomy.
胃
位於上腹部，較靠近胸腔，處於膈膜下，稍微偏左，賁門部和食道相接，幽門部和十二指腸相接。
胃壁的肌肉層依其走向由內而外可分為三層：內斜層、中環層和外縱層。
The muscular layer of the stomach can be divided into three layers from the inside out according to its direction: the inner oblique layer, the middle circular layer, and the outer longitudinal layer.
「內斜中環外縱」
內斜層：位於胃壁的最內層，呈斜行走向，主要功能是幫助胃的收縮和蠕動。
The inner oblique layer is located in the innermost layer of the stomach, with a slanting direction. Its main function is to help the stomach contract and move.
中環層：位於胃壁的中間層，呈環行走向，主要功能是幫助胃的收縮和蠕動。
The middle circular layer is located in the middle layer of the stomach, with a circular direction. Its main function is to help the stomach contract and move.
外縱層：位於胃壁的最外層，呈縱行走向，主要功能是幫助胃的排空。
The outer longitudinal layer is located in the outermost layer of the stomach, with a longitudinal direction. Its main function is to help the stomach empty.
胃腺細胞中，黏液頸細胞的分泌物質和大腸杯狀細胞的相似，都是分泌黏液
腸道壁
位於腹腔內，包圍著消化道的組織。
十二指腸
連接在胃的下方，黏膜為單層柱狀上皮，
布氏腺（Brunner's glands）位於十二指腸的黏膜下層，特別是十二指腸附近的第一部分，也就是十二指腸球部。主要分泌鹼性黏液，有保護黏膜層的作用，同時有助於中和來自胃的酸性胃液，以保護腸道免受酸性刺激。
小腸
微粒（micelle）
是一種由脂肪分子、膽鹽和水分組成的球形結構。它們在消化系統中的主要功能是促進脂肪消化和吸收，也可增加脂肪在小腸中的停留時間，從而提高脂肪的消化和吸收效率。
Micelles are spherical structures composed of fatty acids, bile salts, and water. Their main function in the digestive system is to promote the digestion and absorption of fats, and they can also increase the residence time of fats in the small intestine, thereby improving the efficiency of fat digestion and absorption.
脂肪是一種不溶於水的物質，因此很難被人體吸收。微粒可以將脂肪分子包裹起來，使它們變得水溶性，從而更容易被小腸中的絨毛細胞吸收。
Fats are insoluble in water, making them difficult for the body to absorb. Micelles can encapsulate fatty acids, making them water-soluble and easier for villus cells in the small intestine to absorb.
微粒的形成需要膽鹽的幫助。膽鹽是一種由肝臟分泌的物質，它可以降低脂肪表面張力，使脂肪分子聚集在一起。
The formation of micelles requires the help of bile salts. Bile salts are substances secreted by the liver that can lower the surface tension of fats, causing fatty acids to aggregate.
微粒的形成過程如下：
The process of micelle formation is as follows:
膽鹽在小腸中與脂肪分子結合，形成脂肪-膽鹽複合物。
Bile salts bind to fatty acids in the small intestine to form a fat-bile salt complex.
脂肪-膽鹽複合物在小腸中的攪拌作用下，形成微粒。
The fat-bile salt complex forms micelles under the stirring action of the small intestine.
微粒在小腸中的絨毛細胞表面被吸收。
Micelles are absorbed at the surface of villus cells in the small intestine.
微粒的形成對人體脂肪的消化和吸收至關重要。如果缺乏膽鹽，就會導致脂肪消化不良，出現腹瀉、便秘等症狀。
The formation of micelles is essential for the digestion and absorption of fats in the human body. If bile salts are lacking, it can lead to fat malabsorption, resulting in diarrhea, constipation, and other symptoms.
迴腸
位於小腸的後半部，從十二指腸的一部分到結腸之前，處於腹腔中央。
迴腸主要負責吸收食物中的養分，如蛋白質、碳水化合物、脂肪等，將其進行分解並進入血液循環。
迴腸造瘻的大便性狀是水狀或泥狀
The stool consistency of an ileostomy is watery or mushy.
結腸
巨結腸症（Hirschsprung's disease）
是一種先天性的腸道疾病，其特徵是腸道缺乏神經節細胞，導致腸道蠕動功能異常，造成腸道擴張。最常發生在乙狀結腸和直腸的交界處，但也可能發生在結腸的其他部位，甚至全結腸。
Hirschsprung's disease is a congenital disorder of the colon characterized by the absence of nerve cells in a segment of the colon. This lack of nerve cells prevents the affected segment from contracting normally, leading to a dilated bowel. The condition most commonly affects the junction between the sigmoid colon and rectum, but it can also occur in other parts of the colon or even the entire colon.
巨結腸症（megacolon），進行腸道無神經節部位切除，有關術後之護理措施與指導如下：
Following surgery for Hirschsprung's disease, the following care measures and guidance are recommended:
手術後疼痛是常見的，定時評估其疼痛型態，必要時依醫囑給與止痛劑，能有效緩解患者的不適，促進康復。
Postoperative pain is common. Regular assessment of pain type and administration of analgesics as prescribed can effectively alleviate discomfort and promote recovery.
教導並協助定時翻身，以預防肺炎或肺部擴張不全、深靜脈血栓形成等併發症。
Encourage and assist the patient with regular turning to prevent pneumonia, atelectasis, and deep vein thrombosis.
術後觀察肛門狹窄及糞便失禁，此為巨結腸症手術後常見的併發症
Observe for anal stenosis and fecal incontinence, which are common complications after Hirschsprung's disease surgery.
手術後腸道功能尚未完全恢復，過早提供高纖飲食可能導致腸阻塞，反而不利於恢復。術後初期應提供低渣飲食，待腸道功能恢復後，再逐漸增加纖維攝取量。
Initially, a low-residue diet should be provided as the bowel function is recovering. Gradually increase fiber intake as bowel function improves.
分化差（poorly-differentiated）
表示腫瘤細胞的外觀和結構與正常結腸細胞差異較大(腫瘤細胞與正常細胞形態相似度較低)，通常是指腫瘤細胞的分化程度較低，細胞形狀和結構變得不規則，並且失去了正常結腸細胞的特徵。
Poorly-differentiated tumors are characterized by cells that have a significantly different appearance and structure from normal colon cells. This means that the tumor cells are less similar to normal colon cells in terms of their shape, size, and organization. In addition, poorly-differentiated tumors may have lost some of the features that are characteristic of normal colon cells.
分化差的狀況不限於全結腸癌，而是可能發生在任何部位的惡性腫瘤上。 也就是說，無論是結腸的某一段（如升結腸、降結腸、乙狀結腸等），還是其他器官的癌症，都有可能出現分化差的腫瘤細胞。
Poorly-differentiated tumors can occur in any type of malignancy, not just colon cancer. This means that regardless of whether the cancer originates in a specific segment of the colon (such as the ascending colon, descending colon, or sigmoid colon) or in another organ, the tumor cells may exhibit poor differentiation.
降結腸
位於腹腔內，黏膜為單層柱狀上皮，由左上部往下彎曲至左下部，是結腸的一部分。
胰臟
位於腹腔內，靠近胃的後方，橫跨於脊椎前面，連接著脾臟。主要分泌胰液，其中包含消化酵素，這些酵素能夠幫助分解蛋白質、碳水化合物和脂肪，以利於營養物質的吸收和利用。同时胰臟也分泌胰島素等荷爾蒙，調節血糖水平。
腸泌素對胰島素的分泌屬於前饋（feedforward）調節。
前饋（feedforward）調節：
前饋調節是一種生理調節機制，它在刺激或事件發生之前，透過神經或荷爾蒙信號調節相關生理過程。這種調節機制預先準備身體以應對未來的需求。
在腸泌素對胰島素分泌的情境中，前饋調節指的是腸道中的特定刺激（例如食物進入消化道）觸發腸泌素的釋放，進而通過神經或荷爾蒙信號影響胰島素的分泌，以調節血糖水平。
正回饋（positive feedback）：
正回饋是一種機制，其中一個變化導致另一個變化，這些變化相互增強，使系統更加遠離原始的平衡狀態。正回饋通常不常見於生理調節，因為它可以導致系統失控。
負回饋（negative feedback）：
負回饋是最常見的調節機制，它在變化發生時將系統帶回原始的平衡狀態。當某一指標遠離理想值時，負回饋會啟動調節機制，將系統調整回到平衡狀態。這樣的例子包括體溫、血糖、血壓等的調節。
反射：
反射是一種自動且無意識的生理或神經反應，通常涉及感覺器官的刺激和神經系統的傳遞。這些反射通常是瞬間的，例如當手碰到熱物體時，會迅速收回手來。
腎臟
貝他 2-小球蛋白（beta2-microglobulin）： 這是一種存在於幾乎所有細胞表面的蛋白質(一種與細胞表面受體結合的蛋白質)，通常與MHC-I複合體（主要組織相容性複合體 I）相關。它與免疫系統的細胞激素反應有關，並且也與腎功能有關，因此在一些腎臟疾病時可能會升高，可用來評估腎功能。
肝臟與膽囊
位於上腹部，腹膜下，較靠近膈膜，偏右。肝臟製造膽汁由膽囊儲存其濃縮後注入十二指腸，膽汁功能是乳化脂質。
血清類澱粉 A 蛋白質（serum amyloid A protein）： 這是一種在肝臟中合成的蛋白質，如果身體內有細菌感染、發炎或組織損傷時會增加，主要參與免疫反應，來調節免疫細胞的活動。
前白蛋白（transthyreitin/prealbumin）： 這是一種在肝臟合成的蛋白質，是一種在血漿中運輸甲狀腺激素和維生素A的蛋白質。它也被用作衡量蛋白質營養狀態的指標，因為其血清濃度可能在營養不良或發炎時下降。
墨菲氏徵象與急性膽囊炎
Murphy's Sign and Acute Cholecystitis
墨菲氏徵象是什麼？
What is Murphy's Sign?
定義： 墨菲氏徵象是一種檢查方法，用來評估急性膽囊炎的可能性。
Definition: Murphy's sign is a clinical examination technique used to assess the likelihood of acute cholecystitis.
操作方式： 醫師會將手放在患者的右上腹部，壓住膽囊的位置。接著請患者深呼吸，當橫膈膜下降時，發炎的膽囊會碰到醫師的手，引起劇烈疼痛，導致患者無法繼續吸氣，這就是陽性的墨菲氏徵象。
Procedure: The healthcare provider places their hand over the patient's right upper abdomen, pressing on the gallbladder. The patient is then asked to take a deep breath. If the gallbladder is inflamed, it will come into contact with the examiner's hand as the diaphragm moves downward, causing severe pain and forcing the patient to stop inhaling. This is a positive Murphy's sign.
為什麼墨菲氏徵象與急性膽囊炎有關？
Why is Murphy's Sign Associated with Acute Cholecystitis?
膽囊發炎： 當膽囊發炎時，會腫脹且對觸摸敏感。
Inflamed Gallbladder: When the gallbladder is inflamed, it becomes swollen and tender to touch.
深呼吸： 深呼吸時，橫膈膜下降，會將發炎的膽囊壓迫到醫師的手上，引起劇烈疼痛，可能放射到右肩胛骨。
Deep Breathing: During deep inspiration, the diaphragm moves downward, pressing the inflamed gallbladder against the examiner's hand, causing severe pain that may radiate to the right shoulder blade.
陽性徵兆： 如果患者出現疼痛而無法繼續吸氣，就表示墨菲氏徵象陽性，高度懷疑急性膽囊炎。
Positive Sign: If the patient experiences pain and is unable to continue inhaling, a positive Murphy's sign is indicative of acute cholecystitis.
急性膽囊炎的其他症狀
Other Symptoms of Acute Cholecystitis
除了墨菲氏徵象外，急性膽囊炎患者還可能出現以下症狀：
In addition to Murphy's sign, patients with acute cholecystitis may experience the following symptoms:
右上腹疼痛： 這是最常見的症狀，疼痛可能放射到右肩胛骨。
Right Upper Quadrant Pain: This is the most common symptom, and the pain may radiate to the right shoulder blade.
噁心、嘔吐： 膽囊發炎會影響消化功能，導致噁心、嘔吐。
Nausea and Vomiting: Inflammation of the gallbladder can affect digestive function, leading to nausea and vomiting.
發燒： 感染的情況下，體溫可能會升高。
Fever: Fever may be present if there is an infection.
黃疸： 膽道阻塞嚴重時，可能出現黃疸。
Jaundice: Jaundice may occur if there is severe bile duct obstruction.
膽囊炎的成因與危險因子
Causes and Risk Factors of Cholecystitis
膽結石： 大部分的膽囊炎是由膽結石引起的，膽結石阻塞膽道，導致膽汁淤積，引起發炎。
Gallstones: Most cases of cholecystitis are caused by gallstones, which can block the bile duct, causing bile to back up and cause inflammation.
性別： 女性比男性更容易患膽囊炎，，因為雌激素水平會促進肝臟合成膽固醇，而孕激素會降低膽囊的收縮力，導致膽汁滯留。
Gender: Women are more likely to develop gallstones than men, possibly due to the influence of female hormones.
Estrogen levels promote cholesterol synthesis in the liver, while progesterone reduces gallbladder contractility, leading to bile stasis.
年齡： 中老年人患膽囊炎的風險較高。
Age: The risk of cholecystitis increases with age.
肥胖： 肥胖會增加膽固醇的產生，增加膽結石形成的風險。
Obesity: Obesity increases the production of cholesterol, which can contribute to gallstone formation.
家族史： 有膽囊疾病家族史的人，患病風險較高。
Family History: Individuals with a family history of gallbladder disease are at increased risk.
膽囊炎的治療
Treatment of Cholecystitis
藥物治療： 主要用於緩解疼痛和發炎，如鹽酸配西汀meperidine HCL（Demerol®）或嗎啡等止痛藥。
Medication: Pain relievers and anti-inflammatory medications, such as meperidine hydrochloride (Demerol), are used to manage pain and inflammation.
飲食調整： 減少高脂肪食物的攝取。
Dietary Changes: Reducing the intake of high-fat foods is recommended.
手術治療： 對於反覆發作或併發症嚴重的患者，可能需要手術切除膽囊。
Surgery: Surgical removal of the gallbladder may be necessary for recurrent or severe cases.
總膽管The Common Bile Duct
總膽管是由總肝管與膽囊管會合而成的管路，長約10-12公分，位於十二指腸後方。總膽管的主要作用是將膽汁從肝臟和膽囊傳遞到小腸。
總膽管是由總肝管（Common Hepatic Duct）與膽囊管（Cystic Duct）會合形成的，是肝臟和膽囊分泌的膽汁匯流而成的管路，連接膽囊與胰臟，位於腹腔中央。
The common bile duct is a duct that is formed by the confluence of the common hepatic duct and the cystic duct. It is about 10-12 centimeters long and is located posterior to the duodenum. The main function of the common bile duct is to transport bile from the liver and gallbladder to the small intestine.
The common hepatic duct is a part of the intrahepatic biliary system that collects bile produced in the liver and sends it to the common bile duct. The main function of the common hepatic duct is to transport bile produced by the liver, which contains components that aid in digestion, such as fat-digesting enzymes, bile acids, and cholesterol.
The cystic duct is a duct that connects the gallbladder to the common bile duct. Its main function is to transport concentrated bile stored in the gallbladder to the common bile duct. It helps in the transport, storage, and release of bile to maintain the normal function of the digestive system.
The ampulla of Vater is formed by the union of the common bile duct and the main pancreatic duct. It is located at the distal end of the second segment of the duodenum. The sphincter of Oddi, located within the ampulla of Vater, controls the flow of bile and pancreatic juice into the duodenum.
Bile is produced by the liver and stored and concentrated in the gallbladder. When food enters the duodenum, bile is released from the gallbladder and flows into the duodenum through the common bile duct and the ampulla of Vater to aid in the digestion of fats.
總膽管是由總肝管（Common Hepatic Duct）與膽囊管（Cystic Duct）會合形成的，是肝臟和膽囊分泌的膽汁匯流而成的管路，連接膽囊與胰臟，位於腹腔中央。
The common bile duct is a duct that is formed by the confluence of the common hepatic duct and the cystic duct. It is about 10-12 centimeters long and is located posterior to the duodenum. The main function of the common bile duct is to transport bile from the liver and gallbladder to the small intestine.
總肝管The Common Hepatic Duct
總肝管是肝臟內部膽管系統的一部分，將肝臟內產生的膽汁收集起來，並將其送往總膽管。總肝管的主要作用是運輸肝臟產生的膽汁，其中包含有助於消化的脂肪分解酵素、膽酸和膽固醇等成分。The common hepatic duct is a part of the intrahepatic biliary system that collects bile produced in the liver and sends it to the common bile duct. The main function of the common hepatic duct is to transport bile produced by the liver, which contains components that aid in digestion, such as fat-digesting enzymes, bile acids, and cholesterol.
膽囊管The Cystic Duct
膽囊管是連接膽囊和總膽管的管道，其主要作用是將膽囊內積存的濃縮膽汁輸送至總膽管。有助於膽汁的運輸、儲存和釋放，以維持消化系統的正常功能The cystic duct is a duct that connects the gallbladder to the common bile duct. Its main function is to transport concentrated bile stored in the gallbladder to the common bile duct. It helps in the transport, storage, and release of bile to maintain the normal function of the digestive system.
肝胰壺腹The Ampulla of Vater
肝胰壺腹是由總膽管與主胰管會合而形成，位於十二指腸第二段的末端。肝胰壺腹的括約肌可以控制膽汁和胰液的流入十二指腸。The ampulla of Vater is formed by the union of the common bile duct and the main pancreatic duct. It is located at the distal end of the second segment of the duodenum. The sphincter of Oddi, located within the ampulla of Vater, controls the flow of bile and pancreatic juice into the duodenum.
膽汁的運輸和分泌Transport and Secretion of Bile
膽汁是由肝臟產生的，在膽囊中儲存和濃縮。當食物進入十二指腸時，膽汁會從膽囊排出，通過總膽管和肝胰壺腹流入十二指腸，幫助消化脂肪。Bile is produced by the liver and stored and concentrated in the gallbladder. When food enters the duodenum, bile is released from the gallbladder and flows into the duodenum through the common bile duct and the ampulla of Vater to aid in the digestion of fats.
總膽管、膽囊管、總肝管與肝胰壺腹是膽道系統的重要組成部分，負責將膽汁從肝臟和膽囊輸送到十二指腸，幫助消化脂肪。
The common bile duct, cystic duct, common hepatic duct, and ampulla of Vater are important components of the biliary system, responsible for transporting bile from the liver and gallbladder to the small intestine to aid in fat digestion.
上皮細胞
巴雷特氏食道（Barrett’s esophagus）是一種食道黏膜的病變，長期胃食道逆流是其主要原因。當食道下段的鱗狀上皮細胞因長期受到胃酸的刺激而轉變成柱狀上皮細胞時，就形成了巴雷特氏食道。這種轉變的柱狀上皮細胞與腸道上皮細胞相似，具有癌變的潛力。
值得注意的是，從巴雷特氏食道惡性化而成的食道癌，最常見的類型是腺癌（adenocarcinoma）。這是因為腸道上皮細胞源自胚胎發育過程中的外胚層，腸道上皮細胞構成了腸道的內膜，它們在吸收營養物質、水分和電解質方面扮演著重要角色。而腺癌正是起源於腺上皮細胞的惡性腫瘤。因此，當巴雷特氏食道中的柱狀上皮細胞發生癌變時，通常會形成腺癌。
Barrett's esophagus is a condition in which the lining of the esophagus changes from squamous to columnar epithelium due to chronic gastroesophageal reflux disease (GERD). This columnar epithelium, similar to that found in the intestine, has a higher risk of developing cancer. Adenocarcinoma, a type of cancer originating from glandular epithelial cells, is the most common type of esophageal cancer arising from Barrett's esophagus. This is because the columnar epithelium in Barrett's esophagus is derived from the same embryonic origin as the intestinal epithelium, which is predisposed to adenocarcinoma.
消化道的梅氏神經叢（Meissner's plexus）
位於腸道壁黏膜下層，是自主神經的一部分，可. 控制消化道之分泌。
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