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1、DiarrheaWang,KanDec 31,2009 GI Department,SRRSH第一页，共二十八页。lDefinition:increase of fluidity and/or frequency of stool(3 times/d or 250g/d)lAcute:14dlChronic:14d第二页，共二十八页。Acute DiarrhealInfectious&toxic diarrhealDietary:alcohol,food allergy,mannitollMiscellaneous:diverticulitis,GI hemorrhage,ischemia c
2、olitis,HenochSchnlein purpura,StevensJohnson syndrome第三页，共二十八页。Clues to diagnosis of infectious&toxic diarrhea Causative agentSymptoms&HistoryCommentsBacillus cereusrefried Chinese food,vomiting is prominent,blood is never presentCampylobacterreactive arthritis,Guillain-Barre syndrome,Reiters syndro
3、meE.coli O157:H7contaminated hamburger meat,Shiga toxin provoking hemolytic uremic syndromeantibiotics and platelet transfusion are contradictedSalmonellaChicken,eggs,dairy products 第四页，共二十八页。Vibrio parahaemolyticusraw shellfishVibrio vulnificusraw shellfish,especially in patients with underlying li
4、ver diseases iron metabolism disorder.Associated with skin bulleaShigella,Yersiniano clues are strong enough to point the etiology until the results of stool culture第五页，共二十八页。Scombroidspatients ingesting contaminated fish experiences vomiting,diarrhea,flushing,and wheezing within minutesorganism inv
5、ade,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 HIV+patients with 50 mOsm/kg),H2 testlRemove the dairy products,the
6、resolution of the symptoms will occurs in 24-36h.第十五页，共二十八页。lChronic panceatitis,celiac disease,tropical sprue,Whipple diseaselStethorrea,foul smell,weight loss,Vit A,D,E,K deficiency(hypocalcaemia,bruising),anemia(microcytic macrocytic)第十六页，共二十八页。lChronic pancreatitis:lrepeated episodes of pancreat
7、itislCT scan,secretin testlreplacement of digestive enzymeslCeliac disease:ldermatitis hepertiformis occures in 10%of the patients.lD-xylose test,antigliadin/antiendomysial/antitransglutaminase Ab,biopsylgluten-free diet第十七页，共二十八页。Malabsorption syndromeslTropical sprue:lhistory of being in a tropic
8、countrylD-xylose test,finding organism in bowel wall biopsylSMZ,doxycyclinlWhipple disease:ldementia,arthalgia,ophthalmopelgialD-xylose test,finding organism(Tropheryma whippelii)in bowel wall biopsy,PCRlSMZ,doxycycline,ceftriaxone第十八页，共二十八页。lCTD:SLE,RA,Scleroderma,Behet disease lAmyloidosis:amyloid
9、 proteins build up in organs;biopsy(Congo red positivity)lIntestinal lymphangiectasia:protein loss;the biopsy shows enlargement of the lymph vesselslIntestine resection:第十九页，共二十八页。Disease of colonlUClCDlDiverticulitislColorectal carcinoma第二十页，共二十八页。MiscellanneouslAddison disease,hyperthyroidism,Diab
10、etes-MellituslEndocrine tumors(Zollinger-Ellison syndrome,carcinoid syndrome,pancreatic cholera syndrome)lPost-cholecystectomy syndromelHypogammaglobulinemialDrugs:antiacid,antibiotic,MR contrast agent,laxative第二十一页，共二十八页。lAddison disease:weakness,restlessness,hypotension,anorexia,abdominal pain,dia
11、rrhea,vomiting,hyperpigmentation;Cortrosyn-cortisollHyperthyroidism:T3,T4,TSHlDiabetes-Mellitus:BG第二十二页，共二十八页。lZollinger-Ellison syndrome:lAbdominal pain and diarrhea,intractable multiple peptic ulcerlGastrinoma of the duodenum or pancreas producing the hormone gastrin(MEN I,IIA,IIB)第二十三页，共二十八页。lCar
12、cinoid syndrome:lNeuroendocinal tumors(bronchi,appendix,ileum),which release serotoninlDiarrhea,tachycardia,hypotension,flushing,rash,lUrinary 5-HIAAlOtretide,surgical resection第二十四页，共二十八页。lPancreatic cholera syndrome:lVIPoma originates in the pancreas,producing vasoactive intestinal peptidelchronic
13、 watery diarrhea,dehydration,hypokalemia,achlorhydria,acidosis,flushinglPlasma VIP level,CT lOtretide,surgical resection第二十五页，共二十八页。lHypogammaglobulinemia:secondary to Giardia infection,respiratory infections,autoimmune disease,malignancy lPost-cholecystectomy syndrome:esophagitis and gastritis,diarrhea and colicky lower abdominal pain第二十六页，共二十八页。THANKSTHANKS第二十七页，共二十八页。内容(nirng)总结Diarrhea。5-SAS,steroids,immunomodulator。SMZ,doxycycline,ceftriaxone。Otretide,surgical resection。THANKS第二十八页，共二十八页。