腹瀉病英文-醫(yī)學(xué)課件

InfantileDiarrhea

InfantileDiarrhea

腹瀉病英文-醫(yī)學(xué)課件outlinePrevalenceDefinitionPredisposingfactorsEtiologyPathogenesisManifestationsDiagnosis DifferentialdiagnosisTreatmentPrognosisPreventionrotavirusdiarrheaenterotoxigenicE.coli(ETEC)invasivebacterialenteritisfungusoutlinePrevalencerotavirusdia腹瀉病英文-醫(yī)學(xué)課件Question:What’skindofstoolisnormal?stoolQuestion:What’skindofstoolDefinition——isasyndromewithincreasedstoolfrequencyandchangesofcharacterofstoolwhichcausedbypathogensinfectionorotherreasons.Waterystoolwith/withoutmucous,bloodystoolFrequency≥3timesaday,Stoolvolume>10g/kg.dThemainreasoncausemalnutritionandgrowthretardation

Definition——isasyndromewithPredisposingfactorsImmaturedigestivefunctionGastricacidityDigestiveenzymesRapidgrowthPoorimmunefunction(hostdefenses)ImmunoglobulinsDisturbedentericbacterialfloraFormulafeeding

PredisposingfactorsImmaturedEtiology

infection

diarrhea

non-infection

IntestinalextraintestinaldietallergyweatherEtiologyinfec

InfectiousfactorsVirus(70%)RotavirusAdenovirusAstrovirus,NorwalkvirusCalicivirusNorovirusEnterovirusBacteriaEnteropathogenicE.coliCampylobacterjejuniShigellaSalmonellaStaphylococcus

aureusClostridiumdifficileFungi

CandidaalbicansParasiteInfectiousfactorsViruDevelopedcountryDevelopingcountryDevelopedcountryDevelopin

NoninfectiousfactorsDietWeatherColdHotImproperdietAllergyLactasedeficiencyNoninfectiousfactorsDietPathogenesisOsmoticdiarrheaSecretorydiarrheaExudativediarrheaAbormalmotility

notone,buttogetherPathogenesisOsmoticdiarrheaIntestinalvillicryptepitheliumIntestinalvillicryptepithelivirusenteritis

virusduplicate

mucosalinjury，villidamagedisaccharidaseactivitycarrierglucose,fatabsorption

osmoticpressurewaterydiarrhea

InfectionvirusenteritisInfectionBacterialenteritis

ETECenterotoxinheatlabiletoxinheatstabletoxinACGCATPcAMPGTPcGMPinhibitNa+,Cl-andwaterabsorbtion，promotesecreteCl-Na+,Cl-andwaterinceasedmorethancolonicabsorptionlimitwaterydiarrhea

BacterialenteritisNoninfection

overeatingfoodgatherinUGIPHbacteriamoveandreproduceendogenousinfection

fermentorganicacid(lactose,acetic-acid)amineliverdetoxificationfunctioninsufficiencyosmotictoxinenterintobloodbowelmovementtoxicitysymptomdiarrhea,dehydration,electrolytedisturbances,acidosisNoninfectionManifestationsClinicaltypesActuediarrhea:<2wPersistantdiarrhea:2w-2mChronicdiarrhea:>2mManifestationsClinicaltypesAcutediarrheaAcutediarrheaCommonclinicalmanifestations

Mild：Mainlycausedbydietaryfactorsorextraintestinalinfections.Waterystoolwithsour,foam,milkvalve,nopusorblood.Withoutdehydrationandtoxicitysymptom.Mostofthemrecoverinafewdays.Commonclinicalmanifestationssevere：Causedbyintestinalinfections>10/dwithmucus,pus,bloodStooltest:WBC+,RBC+GIsymptoms:vomit,anorexia,abdominalpain,distentionSystemicsymptoms:toxicity,shock,comaModerate,severedehydrationMetabolismacidosisElectrolytedisturbances：hypokalemia,hypocalcemia,hypomagenesemiasevere：腹瀉病英文-醫(yī)學(xué)課件腹瀉病英文-醫(yī)學(xué)課件Whentoseeadoctor?Age<3mWeight<8kgHistoryofprematurebirth,chronicmedicalconditions,orconcurrentillnessFeverof38oCorhigherininfantsyoungerthan3monthsor39oCorhigherinchildrenaged3-36monthsVisiblebloodinthestoolWhentoseeadoctor?Age<3mHigh-outputdiarrheaPersistentemesisSignsofdehydration,includingsunkeneyes,decreasedtears,drymucousmembranes,anddecreasedurineoutputMentalstatuschangesInadequateresponsestooralrehydrationtherapy(ORT)High-outputdiarrheaManifestationsofsomeenteritisManifestationsofsomeenterit

RotavirusdiarrheaMaincause<3yRotavirusdiarrheaMainca6m-24mAutumnandwinterFecal-oral/airwaytransmissionIncubation:1-3daysAccompaniedbyfeverandURI6m-24mVomitprecedesdiarrheaWatery,odorless,inlargeamountIsotonicdehydration,electrolyteacid-basedisturbancesTemporarylactoseintoleranceSelf-limiting,lastsfor3-8dVomitprecedesdiarrheaEnterotoxigenicE.coli(ETEC)

maincause>3ysAbruptVomit,nofever,nosystemicsymptomsYellow-greenwaterystoolDehydration,electrolytedisturbances,acidosisSelf-limittingEnterotoxigenicE.coli(ETECInvasivebacterialenteritis

Abruptonset,highfeverDiarrheafrequently,mucousandblood,Nause,vomiting,abdominalpain,cramps,tenesmusSystemictoxemia:chills,malaise,hyperpyrexia,convulsion,shockWBC+，RBC+Stoolculture:+Invasivebacterialenteritis

AFungusWeakness,useantibiotics/cortisteriodforalong-termCandidaalbicans<2ys,sometimesaccompaniedwiththrushWaterystoolwithfoamandmucosa,soy-beanresidue-likethingsFungalspore

andmyceliumFungusWeakness,useantibiotic

Persistingorchronicdiarrhea

PersistingorchronicddiarrheamalnutritonMajorContributortoMalnutritiondiarrheamalnutritonMajorContrDiagnosis

“

soap”Subject:historyObject:physicalexaminationlaboratoryexaminationstoolmicroscopicexaminationstoolcultrure/ELISAelectrolyte/acid-basedisturbances?Assessment:dehydration?malnutriton?PlanDiagnosis“soap”SubjecDifferentialdiagnosisFewWBCinstoolPhysiologicaldiarrheaLactasedeficiencyAllergyManyWBCinstoolShigellosisNecrotizingenterocolitisAmebicdysenteryIntussusceptionDifferentialdiagnosisFewWBCTreatmentRegulatedietIntensivenursingcareSymptomatictreatmentTreatmentRegulatedietMedicationControlinfection:antibiotic?MicroecologytherapyIntestinalmucosalprotectiveagentFluidtherapy,correctwaterandelectrolytedisturbances(nextclass)ZincsupplementWHOandUNICEFrecommendedtakezincfor10-14daysduringdiarrheaespecialinhigh-prevalencearea<6mo:10mg/d;>6mo:20mg/dMedicationSummaryDiarrheaisacommondiseaseininfant,it’sthemaincauseofmortalityRotavirusisthemajorpathogentocauseacutediarrheaMilddiarrheaisself-limitingModerateandseverediarrheamayleadtodehydration,acid-base,electrolytedisturbancesProperfluidtherapyisthekeySummaryDiarrheaisacommondiPreventionRecommendbreastmilkfeedingFormgoodhealthhabitsHandhygieneAvoidlong-termabuseofbroadspectrumantibioticsRotavirusvaccination.Protectiverate>80%PreventionRecommendbreastmilInfantileDiarrhea

InfantileDiarrhea

腹瀉病英文-醫(yī)學(xué)課件outlinePrevalenceDefinitionPredisposingfactorsEtiologyPathogenesisManifestationsDiagnosis DifferentialdiagnosisTreatmentPrognosisPreventionrotavirusdiarrheaenterotoxigenicE.coli(ETEC)invasivebacterialenteritisfungusoutlinePrevalencerotavirusdia腹瀉病英文-醫(yī)學(xué)課件Question:What’skindofstoolisnormal?stoolQuestion:What’skindofstoolDefinition——isasyndromewithincreasedstoolfrequencyandchangesofcharacterofstoolwhichcausedbypathogensinfectionorotherreasons.Waterystoolwith/withoutmucous,bloodystoolFrequency≥3timesaday,Stoolvolume>10g/kg.dThemainreasoncausemalnutritionandgrowthretardation

Definition——isasyndromewithPredisposingfactorsImmaturedigestivefunctionGastricacidityDigestiveenzymesRapidgrowthPoorimmunefunction(hostdefenses)ImmunoglobulinsDisturbedentericbacterialfloraFormulafeeding

PredisposingfactorsImmaturedEtiology

infection

diarrhea

non-infection

IntestinalextraintestinaldietallergyweatherEtiologyinfec

InfectiousfactorsVirus(70%)RotavirusAdenovirusAstrovirus,NorwalkvirusCalicivirusNorovirusEnterovirusBacteriaEnteropathogenicE.coliCampylobacterjejuniShigellaSalmonellaStaphylococcus

aureusClostridiumdifficileFungi

CandidaalbicansParasiteInfectiousfactorsViruDevelopedcountryDevelopingcountryDevelopedcountryDevelopin

NoninfectiousfactorsDietWeatherColdHotImproperdietAllergyLactasedeficiencyNoninfectiousfactorsDietPathogenesisOsmoticdiarrheaSecretorydiarrheaExudativediarrheaAbormalmotility

notone,buttogetherPathogenesisOsmoticdiarrheaIntestinalvillicryptepitheliumIntestinalvillicryptepithelivirusenteritis

virusduplicate

mucosalinjury，villidamagedisaccharidaseactivitycarrierglucose,fatabsorption

osmoticpressurewaterydiarrhea

InfectionvirusenteritisInfectionBacterialenteritis

ETECenterotoxinheatlabiletoxinheatstabletoxinACGCATPcAMPGTPcGMPinhibitNa+,Cl-andwaterabsorbtion，promotesecreteCl-Na+,Cl-andwaterinceasedmorethancolonicabsorptionlimitwaterydiarrhea

BacterialenteritisNoninfection

overeatingfoodgatherinUGIPHbacteriamoveandreproduceendogenousinfection

fermentorganicacid(lactose,acetic-acid)amineliverdetoxificationfunctioninsufficiencyosmotictoxinenterintobloodbowelmovementtoxicitysymptomdiarrhea,dehydration,electrolytedisturbances,acidosisNoninfectionManifestationsClinicaltypesActuediarrhea:<2wPersistantdiarrhea:2w-2mChronicdiarrhea:>2mManifestationsClinicaltypesAcutediarrheaAcutediarrheaCommonclinicalmanifestations

Mild：Mainlycausedbydietaryfactorsorextraintestinalinfections.Waterystoolwithsour,foam,milkvalve,nopusorblood.Withoutdehydrationandtoxicitysymptom.Mostofthemrecoverinafewdays.Commonclinicalmanifestationssevere：Causedbyintestinalinfections>10/dwithmucus,pus,bloodStooltest:WBC+,RBC+GIsymptoms:vomit,anorexia,abdominalpain,distentionSystemicsymptoms:toxicity,shock,comaModerate,severedehydrationMetabolismacidosisElectrolytedisturbances：hypokalemia,hypocalcemia,hypomagenesemiasevere：腹瀉病英文-醫(yī)學(xué)課件腹瀉病英文-醫(yī)學(xué)課件Whentoseeadoctor?Age<3mWeight<8kgHistoryofprematurebirth,chronicmedicalconditions,orconcurrentillnessFeverof38oCorhigherininfantsyoungerthan3monthsor39oCorhigherinchildrenaged3-36monthsVisiblebloodinthestoolWhentoseeadoctor?Age<3mHigh-outputdiarrheaPersistentemesisSignsofdehydration,includingsunkeneyes,decreasedtears,drymucousmembranes,anddecreasedurineoutputMentalstatuschangesInadequateresponsestooralrehydrationtherapy(ORT)High-outputdiarrheaManifestationsofsomeenteritisManifestationsofsomeenterit

RotavirusdiarrheaMaincause<3yRotavirusdiarrheaMainca6m-24mAutumnandwinterFecal-oral/airwaytransmissionIncubation:1-3daysAccompaniedbyfeverandURI6m-24mVomitprecedesdiarrheaWatery,odorless,inlargeamountIsotonicdehydration,electrolyteacid-basedisturbancesTemporarylactoseintoleranceSelf-limiting,lastsfor3-8dVomitprecedesdiarrheaEnterotoxigenicE.coli(ETEC)

maincause>3ysAbruptVomit,nofever,nosystemicsymptomsYellow-greenwaterystoolDehydration,electrolytedisturbances,acidosisSelf-limittingEnterotoxigenicE.coli(ETECInvasivebacterialenteritis

Abruptonset,highfeverDiarrheafrequently,mucousandblood,Nause,vomiting,abdominalpain,cramps,tenesmusSystemictoxemia:chills,malaise,hyperpyrexia,convulsion,shockWBC+，RBC+Stoolculture:+Invasivebacterialenteritis

AFungusWeakness,useantibiotics/cortisteriodforalong-termCandidaalbicans<2ys,sometimesaccompaniedwiththrushWaterystoolwithfoamandmucosa,soy-beanresidue-likethingsFungalspore

andmyceliumFungusWeakness,useantibiotic

Persistingorchronicdiarrhea

Persistin