急性腹瀉的處理課件

1、DiarrheaWang, KanDec 31, 2009 GI Department, SRRSH第一頁，共二十八頁。急性腹瀉的處理Definition: increase of fluidity and/or frequency of stool (3 times/d or 250g/d)Acute: 14dChronic: 14d第二頁，共二十八頁。急性腹瀉的處理Acute DiarrheaInfectious & toxic diarrheaDietary: alcohol, food allergy, mannitolMiscellaneous: diverticulitis, GI

2、 hemorrhage, ischemia colitis, HenochSchnlein purpura, StevensJohnson syndrome第三頁，共二十八頁。急性腹瀉的處理Clues to diagnosis of infectious & toxic diarrhea Causative agentSymptoms & HistoryCommentsBacillus cereusrefried Chinese food, vomiting is prominent, blood is never presentCampylobacterreactive arthritis,

3、 Guillain-Barre syndrome, Reiters syndromeE.coli O157:H7contaminated hamburger meat, Shiga toxin provoking hemolytic uremic syndromeantibiotics and platelet transfusion are contradictedSalmonellaChicken, eggs, dairy products 第四頁，共二十八頁。急性腹瀉的處理Vibrio parahaemolyticusraw shellfishVibrio vulnificusraw s

4、hellfish,especially in patients with underlying liver diseases iron metabolism disorder. Associated with skin bulleaShigella, Yersiniano clues are strong enough to point the etiology until the results of stool culture第五頁，共二十八頁。急性腹瀉的處理Scombroidspatients ingesting contaminated fish experiences vomitin

5、g, diarrhea, flushing, and wheezing within 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 HI

6、V+ patients with 50 mOsm/kg), H2 testRemove the dairy products, the resolution of the symptoms will occurs in 24-36h.第十五頁，共二十八頁。急性腹瀉的處理Chronic panceatitis, celiac disease, tropical sprue, Whipple diseaseStethorrea, foul smell, weight loss, Vit A,D,E,K deficiency (hypocalcaemia, bruising), anemia (mi

7、crocytic macrocytic)第十六頁，共二十八頁。急性腹瀉的處理Chronic pancreatitis: repeated episodes of pancreatitisCT scan, secretin testreplacement of digestive enzymesCeliac disease :dermatitis hepertiformis occures in 10% of the patients.D-xylose test, antigliadin /antiendomysial /antitransglutaminase Ab, biopsygluten

8、-free diet第十七頁，共二十八頁。急性腹瀉的處理Malabsorption syndromesTropical sprue: history of being in a tropic countryD-xylose test, finding organism in bowel wall biopsySMZ, doxycyclinWhipple disease: dementia, arthalgia, ophthalmopelgiaD-xylose test, finding organism (Tropheryma whippelii) in bowel wall biopsy,

9、PCRSMZ, doxycycline, ceftriaxone第十八頁，共二十八頁。急性腹瀉的處理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 vesselsIntestine resection: 第十九頁，共二十八頁。急性腹瀉的

10、處理Disease of colonUCCDDiverticulitisColorectal carcinoma第二十頁，共二十八頁。急性腹瀉的處理MiscellanneousAddison disease, hyperthyroidism, Diabetes-MellitusEndocrine tumors (Zollinger-Ellison syndrome, carcinoid syndrome, pancreatic cholera syndrome)Post-cholecystectomy syndromeHypogammaglobulinemiaDrugs: antiacid,

11、antibiotic, MR contrast agent, laxative第二十一頁，共二十八頁。急性腹瀉的處理Addison disease: weakness, restlessness, hypotension, anorexia, abdominal pain, diarrhea, vomiting, hyperpigmentation; Cortrosyn-cortisolHyperthyroidism: T3, T4, TSHDiabetes-Mellitus: BG第二十二頁，共二十八頁。急性腹瀉的處理Zollinger-Ellison syndrome: Abdominal

12、 pain and diarrhea, intractable multiple peptic ulcerGastrinoma of the duodenum or pancreas producing the hormone gastrin (MEN I, IIA, IIB)第二十三頁，共二十八頁。急性腹瀉的處理Carcinoid syndrome:Neuroendocinal tumors (bronchi, appendix, ileum), which release serotoninDiarrhea, tachycardia, hypotension, flushing, rash

13、, Urinary 5-HIAAOtretide, surgical resection第二十四頁，共二十八頁。急性腹瀉的處理Pancreatic cholera syndrome:VIPoma originates in the pancreas, producing vasoactive intestinal peptidechronic watery diarrhea, dehydration, hypokalemia, achlorhydria, acidosis, flushingPlasma VIP level, CT Otretide, surgical resection第二十五頁，共二十八頁。急性腹瀉的處理Hypogammaglobulinemia: secondary to Giardia infection, respiratory infections, autoimmune disease, malignancy Post-cholecystectomy syndrome: esophagitis and gastritis, diarrhe