齐鲁医学急性腹泻的处理.pptx

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1、DiarrheaWang,KanDec 31,2009 GI Department,SRRSH12021/7/27 星期二lDefinition:increase of fluidity and/or frequency of stool(3 times/d or 250g/d)lAcute:14dlChronic:14d22021/7/27 星期二Acute DiarrhealInfectious&toxic diarrhealDietary:alcohol,food allergy,mannitollMiscellaneous:diverticulitis,GI hemorrhage,is

2、chemia colitis,HenochSchnlein purpura,StevensJohnson syndrome32021/7/27 星期二Clues to diagnosis of infectious&toxic diarrhea Causative agentSymptoms&HistoryCommentsBacillus cereusrefried Chinese food,vomiting is prominent,blood is never presentCampylobacterreactive arthritis,Guillain-Barre syndrome,Re

3、iters syndromeE.coli O157:H7contaminated hamburger meat,Shiga toxin provoking hemolytic uremic syndromeantibiotics and platelet transfusion are contradictedSalmonellaChicken,eggs,dairy products 42021/7/27 星期二Vibrio parahaemolyticusraw shellfishVibrio vulnificusraw shellfish,especially in patients wi

4、th underlying liver diseases iron metabolism disorder.Associated with skin bulleaShigella,Yersiniano clues are strong enough to point the etiology until the results of stool culture52021/7/27 星期二Scombroidspatients ingesting contaminated fish experiences vomiting,diarrhea,flushing,and wheezing within

5、 minutesorganism invade,producing then releasing histamine into contaminated fishViralchildren in day care canter,absence of blood and WBCEntamoeba histolyticabloody mucus diarrhea,abdominal cramp,fever,liver abscessdirect smear Cryptosporidiafound in HIV+patients with 50 mOsm/kg),H2 testlRemove the

6、 dairy products,the resolution of the symptoms will occurs in 24-36h.152021/7/27 星期二lChronic panceatitis,celiac disease,tropical sprue,Whipple diseaselStethorrea,foul smell,weight loss,Vit A,D,E,K deficiency(hypocalcaemia,bruising),anemia(microcytic macrocytic)162021/7/27 星期二lChronic pancreatitis:lr

7、epeated episodes of pancreatitislCT scan,secretin testlreplacement of digestive enzymeslCeliac disease:ldermatitis hepertiformis occures in 10%of the patients.lD-xylose test,antigliadin/antiendomysial/antitransglutaminase Ab,biopsylgluten-free diet172021/7/27 星期二Malabsorption syndromeslTropical spru

8、e:lhistory of being in a tropic countrylD-xylose test,finding organism in bowel wall biopsylSMZ,doxycyclinlWhipple disease:ldementia,arthalgia,ophthalmopelgialD-xylose test,finding organism(Tropheryma whippelii)in bowel wall biopsy,PCRlSMZ,doxycycline,ceftriaxone182021/7/27 星期二lCTD:SLE,RA,Scleroderm

9、a,Behet disease lAmyloidosis:amyloid proteins build up in organs;biopsy(Congo red positivity)lIntestinal lymphangiectasia:protein loss;the biopsy shows enlargement of the lymph vesselslIntestine resection:192021/7/27 星期二Disease of colonlUClCDlDiverticulitislColorectal carcinoma202021/7/27 星期二Miscell

10、anneouslAddison disease,hyperthyroidism,Diabetes-MellituslEndocrine tumors(Zollinger-Ellison syndrome,carcinoid syndrome,pancreatic cholera syndrome)lPost-cholecystectomy syndromelHypogammaglobulinemialDrugs:antiacid,antibiotic,MR contrast agent,laxative212021/7/27 星期二lAddison disease:weakness,restl

11、essness,hypotension,anorexia,abdominal pain,diarrhea,vomiting,hyperpigmentation;Cortrosyn-cortisollHyperthyroidism:T3,T4,TSHlDiabetes-Mellitus:BG222021/7/27 星期二lZollinger-Ellison syndrome:lAbdominal pain and diarrhea,intractable multiple peptic ulcerlGastrinoma of the duodenum or pancreas producing

12、the hormone gastrin(MEN I,IIA,IIB)232021/7/27 星期二lCarcinoid syndrome:lNeuroendocinal tumors(bronchi,appendix,ileum),which release serotoninlDiarrhea,tachycardia,hypotension,flushing,rash,lUrinary 5-HIAAlOtretide,surgical resection242021/7/27 星期二lPancreatic cholera syndrome:lVIPoma originates in the

13、pancreas,producing vasoactive intestinal peptidelchronic watery diarrhea,dehydration,hypokalemia,achlorhydria,acidosis,flushinglPlasma VIP level,CT lOtretide,surgical resection252021/7/27 星期二lHypogammaglobulinemia:secondary to Giardia infection,respiratory infections,autoimmune disease,malignancy lPost-cholecystectomy syndrome:esophagitis and gastritis,diarrhea and colicky lower abdominal pain262021/7/27 星期二272021/7/27 星期二