诊断学课件腹泻

第十四节腹泻 Contentsofthisclass 概述 Overview 病因 Etiology 发病机制 Pathogenesis 临床表现 Clinicalmanifestation 伴随症状 Accompanysymptom 问诊要点 Mainpointsofinquisition 正常大便 200g day1 3times day60 70 定义 increasedliquidity 80 Decreasedconsistency increasedfrequence Diarrhea 分型 Typing Acutediarrhea Chronicdiarrhea Chronicdiarrhea Lastmorethan2months Etiology病因 急性腹泻 Acutediarrhea 慢性腹泻 Chronicdiarrhea 急性腹泻 Acutediarrhea 1 Diseasesofintestine 肠道疾病 肠道感染 IBD 抗生素性胃肠炎2 Acutepoisoning 鱼胆 砷3 Systemicinfection 败血症 伤寒4 Othercauses 过敏性胃肠炎 过敏性紫癜 Chronicdiarrhea 慢性腹泻 消化系统疾病 Digestsystemdisease 全身性疾病 Systemicdisease 消化系统疾病 Digestsystemdisease 1 Gastricdisease2 Intestinalinfection3 Non infectiousintestines4 Intestinaltumor5 Diseaseofpancreas6 LiverandBiliarydisease Crohn sdisease Ulcerativecolitis 全身性疾病 Systemicdisease 内分泌及代谢障碍性疾病hyperthyroidism hypocorticalism VIPomaOtherdisease系统性红斑狼疮 尿毒症 放射性肠炎 药物副作用thyroxine somekindofchemotherapydrugandantibiotic神经功能紊乱irritablebowelsyndrome Pathogenesis发生机制 1 分泌性腹泻 Secretorydiarrhea 2 消化功能障碍性腹泻 Dyspepticdiarrhea 3 渗透性腹泻 Osmoticdiarrhea 4 动力性腹泻 Derangedmotilitydiarrhea 5 吸收不良性腹泻 Malabsorptiondiarrhea Clinicalfeature 1 Alargevolumewater likestool thevolumecanreachedseveralliterperday 2 Stoolcontainalargeamountofelectrolytesothestoolosmoticpressureissimilartothatofplasma 3 Thediarrheacannotberelievedafterfasting 4 Ifthesymptomwascausedbyinflammation Stoolwillcontainmucusandbloodpus 分泌性腹泻 Secretorydiarrhea Dyspepticdiarrhea 消化功能障碍性腹泻 ThesecretionofdigestivejuicedecreasedChronicPancreatitis Gastricresection Obstructionofbiliaryorpancreaticduct1 Thestoolcontainlotsoffoodparticleandelectrolyte 2 Thesymptomcanberelievedbyfasting Osmoticdiarrhea 渗透性腹泻 Clinicalfeature 1 Thestoolislooseorwater withoutexudation 2 Accompanywithabdominalpainandhyperactivebowelsounds Derangedmotilitydiarrhea 动力性腹泻 Clinicalfeature 1 Thereisagreatdealoffoodparticleandelectrolyteinstool 2 Thesymptomcanberelievedbyfasting Malabsorptiondiarrhea 吸收不良性腹泻 临床表现Manifestation 临床表现1 Onsetandcourse 急性 慢性 acute chronic infection no infection 临床表现2 Characterofstool 粘液血便 bacillarydysentery ulcerativecolitis rectalcancer etal量少而次数频繁的大便 rectaldisease大量水样便 VIPoma cholera gastrinomaintestinalandproximatecolondisease果酱样便 amebicdysentery 含有大量食物残渣 pancreas cholecystorliverdisease粘液便 IBS 临床表现3 腹泻与腹痛之间的关系 结肠疾病 relievedafterdefecation小肠疾病 can trelieveafterdefecation分泌性腹泻 withoutabdominalpain 伴随症状和体征1 accompaniedwithfebrile 发热 bacillarydysentery typhoid intestinaltuberculosis septemia2 accompaniedwithtenesmus 里急后重 rectumlesion3 accompaniedwiththinness 消瘦 malabsorptionsyndrome Gastrointestinaltumor4 accompaniedwithskineruption 皮疹 allergicpurpura typhoid septemia 伴随症状和体征5 accompaniedwithabdominalmass 肿块 GItumor Crohn sdiseaseandintestinaltuberculosis6 accompaniedwithseveredehydration 脱水 Secretorydiarrhea Intestinaltuberculosis 问诊要点1 Theonsetandinducementofdiarrhea2 Thesmellandformoffeces3 Historyofclusteringepisode4 Relieve deterioratecausesofdiarrhea5 Generalconditio