急性腹泻的处理.ppt

Diarrhea Wang,Kan Dec 31,2009 GI Department,SRRSH Definition:increase of fluidity and/or frequency of stool(3 times/d or 250g/d)Acute:14d Chronic:14d Acute Diarrhea Infectious&toxic diarrhea Dietary:alcohol,food allergy,mannitol Miscellaneous:diverticulitis,GI hemorrhage,ischemia colitis,HenochSchnlein purpura,StevensJohnson syndrome Clues to diagnosis of infectious&toxic diarrhea Causative agent Symptoms&History Comments Bacillus cereus refried Chinese food,vomiting is prominent,blood is never present Campylobacter reactive arthritis,Guillain-Barre syndrome,Reiters syndrome E.coli O157:H7 contaminated hamburger meat,Shiga toxin provoking hemolytic uremic syndrome antibiotics and platelet transfusion are contradicted Salmonella Chicken,eggs,dairy products Vibrio parahaemolyticus raw shellfish Vibrio vulnificus raw shellfish,especially in patients with underlying liver diseases iron metabolism disorder.Associated with skin bullea Shigella,Yersinia no clues are strong enough to point the etiology until the results of stool culture Scombroids patients ingesting contaminated fish experiences vomiting,diarrhea,flushing,and wheezing within minutes organism invade,producing then releasing histamine into contaminated fish Viral children in day care canter,absence of blood and WBC Entamoeba histolytica bloody mucus diarrhea,abdominal cramp,fever,liver abscess direct smear Cryptosporidia found in HIV+patients with 50 mOsm/kg),H2 test Remove the dairy products,the resolution of the symptoms will occurs in 24-36h.Chronic panceatitis,celiac disease,tropical sprue,Whipple disease Stethorrea,foul smell,weight loss,Vit A,D,E,K deficiency(hypocalcaemia,bruising),anemia(microcytic macrocytic)Chronic pancreatitis:repeated episodes of pancreatitis CT scan,secretin test replacement of digestive enzymes Celiac disease:dermatitis hepertiformis occures in 10%of the patients.D-xylose test,antigliadin/antiendomysial/antitransglutaminase Ab,biopsy gluten-free diet Malabsorption syndromes Tropical sprue:history of being in a tropic country D-xylose test,finding organism in bowel wall biopsy SMZ,doxycyclin Whipple disease:dementia,arthalgia,ophthalmopelgia D-xylose test,finding organism(Tropheryma whippelii)in bowel wall biopsy,PCR SMZ,doxycycline,ceftriaxone CTD:SLE,RA,Scleroderma,Behet disease Amyloidosis:amyloid proteins build up in organs;biopsy(Congo red positivity)Intestinal lymphangiectasia:protein loss;the biopsy shows enlargement of the lymph vessels Intestine resection:Disease of colon UC CD Diverticulitis Colorectal carcinoma Miscellanneous Addison disease,hyperthyroidism,Diabetes-Mellitus Endocrine tumors(Zollinger-Ellison syndrome,carcinoid syndrome,pancreatic cholera syndrome)Post-cholecystectomy syndrome Hypogammaglobulinemia Drugs:antiacid,antibiotic,MR contrast agent,laxative Addison disease:weakness,restlessness,hypotension,anorexia,abdominal pain,diarrhea,vomiting,hyperpigmentation;Cortrosyn-cortisol Hyperthyroidism:T3,T4,TSH Diabetes-Mellitus:BG Zollinger-Ellison syndrome:Abdominal pain and diarrhea,intractable multiple peptic ulcer Gastrinoma of the duodenum or pancreas producing the hormone gastrin(MEN I,IIA,IIB)Carcinoid syndrome:Neuroendocinal tumors(bronchi,appendix,ileum),which release serotonin Diarrhea,tachycardia,hypotension,flushing,rash,Urinary 5-HIAA Otretide,surgical resection Pancreatic cholera syndrome:VIPoma originates in the pancreas,producing vasoactive intestinal peptide chronic watery diarrhea,dehydration,hypokalemia,achlorhydria,acidosis,flushing Plasma VIP level,CT Otretide,surgical resection Hypogammaglobulinemia:secondary to Giardia infection,respiratory infections,autoimmune disease,malignancy Post-cholecystectomy syndrome:esophagitis and gastritis,diarrhea and colicky lower abdominal pain