急性腹泻的处理.pptVIP免费

DiarrheaWang,KanDec31,2009GIDepartment,SRRSHDefinition:increaseoffluidityand/orfrequencyofstool(>3times/dor250g/d)Acute:≤14dChronic:>14dAcuteDiarrheaInfectious&toxicdiarrheaDietary:alcohol,foodallergy,mannitolMiscellaneous:diverticulitis,GIhemorrhage,ischemiacolitis,Henoch–Schönleinpurpura,Stevens–JohnsonsyndromeCluestodiagnosisofinfectious&toxicdiarrheaCausativeagentSymptoms&HistoryCommentsBacilluscereusrefriedChinesefood,vomitingisprominent,bloodisneverpresentCampylobacterreactivearthritis,Guillain-Barresyndrome,Reiter’ssyndromeE.coliO157:H7contaminatedhamburgermeat,ShigatoxinprovokinghemolyticuremicsyndromeantibioticsandplatelettransfusionarecontradictedSalmonellaChicken,eggs,dairyproductsVibrioparahaemolyticusrawshellfishVibriovulnificusrawshellfish,especiallyinpatientswithunderlyingliverdiseasesironmetabolismdisorder.AssociatedwithskinbulleaShigella,YersinianocluesarestrongenoughtopointtheetiologyuntiltheresultsofstoolcultureScombroidspatientsingestingcontaminatedfishexperiencesvomiting,diarrhea,flushing,andwheezingwithinminutesorganisminvade,producingthenreleasinghistamineintocontaminatedfishViralchildrenindaycarecanter,absenceofbloodandWBCEntamoebahistolyticabloodymucusdiarrhea,abdominalcramp,fever,liverabscessdirectsmearCryptosporidiafoundinHIV+patientswith<100/mm3CD4cellsGiardiaunfilteredwater,bloodabsent,bloatingandgasGiardiacansimulateaceliacdiseaseintermsoffatandvitaminmalabsorption,ifnoteradicatedClostridiumdifficiledaystoweeksafterantibioticuse,C.difficiletoxintest.Metronidazole,oralvancomycinClostridiumperfringenwaterydiarrhea,abdominalcramps,distention.Fever/vomitingisuncommonAntibioticsarenotusedasaprimarytreatment.Clostridiumbotulinumcontaminatedcanfood,constipation,doublevision,slurredspeech,muscleweaknessC.Botulinumtoxintest,antitoxingent,AntibioticsarenotusedasaprimarytreatmentInfectiousdiarrheaalgorithmNathanetal,NEnglJMed.2004;350:38-47.Chronicdiarrhea-DiseaseofthestomachDumpingsyndromeMénétrierdiseasePerniciousanem...