12.diarrhea（婴儿腹泻英文）后修.ppt

Differential diagnosis-2: dysentery Epidemiology character Stool culture: a dysentery bacillus discovered Bacillary dysentery Amebic dysentery Madder red jam-like stool Stool : ameba trophozoite discovered Differential diagnosis-3: necrotic enteritis Symptom: ardent fever, severe toxicity symptoms, abdominal pain and distension, vomit frequently. Stool: first, yellow thin or egg soup-like; then, red pasty or adsuki bean soup-like. X-ray of abdomen: local aerate and expansion in small intestine, intestinal wall pneumatosis. General introduction Classification Predisposing factor Etiology Pathogenesis Clinical manifestations Clinical features of several common enteritis Persistent diarrhea Diagnosis Differential Diagnosis Treatment Content Adjust and continue feeding, not abrosia or restricting water, prevent malnutrition. Prevent and cure dehydration. Rational administration: proper antibiotics, microecosystem preparation, assist-digestive drugs, mucosa protectant, antivomit drugs. Usually disusing antidiarrheal. Strengthen nursing, symptomatic treatment, prevent complications. Fluid therapy (next week lesson) Treatment Emphasis Etiology (in/ex/no) Pathogenesis (4+ex/b/v/no) Clinical manifestation Diagnosis Differential Diagnosis (p/d/n) Treatment Predisposing (4) Case example An 8 – month boy had diarrhea and vomited for 3 days, urine stream reduced, irritability. PE: Pulse rate 150/min, weight loss was 10%, blood pressure 65/40mmHg, skin color showed grey and skin turgor looked like tents. Mucous membranes were very dry; eye ball was sunken greatly, anterior fontanel depressed greatly. Abdomen distended, bowel sound diminished. Questions: 1.What is the diagnosis? 2.How to administer the fluid therapy? Answer diagnosis Acute diarrhea severe dehydration hypokalemia 病毒性肠炎发病机理 病毒侵入小肠粘膜绒毛上皮细胞并复制 粘膜受累，绒毛被破坏 绒毛缩短 微绒毛肿胀，紊乱并脱落 线粒体、内质网膨胀 双糖酶活性下降 载体减少 消化吸收面积减少 双糖（乳糖）吸收减少 葡萄糖钠与载体