Nausea and Vomiting(恶心与呕吐).ppt

Normal metabolism As food moves through your intestines, it absorbs water while forming waste products Muscles contract in the colon, pushing the stool toward the rectum Defecation Process Yield awareness of defecation Anal intra- and extra-sphincter Relaxation Abdominal effects Mechanical stimulation 1. Yield awareness of defecation Characteristics of Nausea and Vomiting Time Taking food Characteristics Characters of contents 晨起呕吐 早孕反应 功能性消化不良 酒精中毒 胃食管反流病 鼻咽部疾患 夜间或隔夜呕吐 幽门梗阻 贲门失弛缓症 呕吐与进食的关系 （ Timing with meals） 餐后即刻：神经精神性；集体发病系食物中毒 餐后1小时以上：为延迟性呕吐：可考虑为胃张力低下排空障碍 餐后较久、多餐后或隔夜：提示幽门梗阻 呕吐特点 神经性或颅内高压：恶心轻、呕吐频；“喷射性呕吐” 呕吐物性质 发酵、腐臭味：提示胃潴留 粪臭味：提示较低位置的肠梗阻 无酸腐味：贲门失迟缓症或胃酸缺乏 不含胆汁：幽门梗阻 病史较长或量多：提示体液和电解质丢失 The accompanying symptoms 腹痛、腹泻：食物中毒、肠道传染病、胃肠炎；节律性腹痛：消化性溃疡 右上腹痛，伴发热、黄疸：胆囊炎、胆道结石、感染。 头痛、头晕、视力异常、喷射性呕吐：颅内高压性疾病、屈光不正、青光眼。 伴眩晕、眼球震颤：前庭障碍 育龄妇女（停经）：应排除妊娠 与服药有时间关联：应想到药物反应 问诊要点 起病情况：诱因、急缓、与进食关系、腹部手术史、育龄妇女月经史 发作时间：晨、夜、与进食、活动、体位的关系 呕吐物性状、味道 伴随症状 诊疗和症状演变情况 History/Background a) Age b) GI history required c) Food intolerance d) Timing with meals e) Consistency f) Content g) Odor h) Frequency i) Fever j) Weight loss k) Precipitating factors l) Myalgias（肌痛）, visual disturbances, headache, pain outside abdomen CAUSES OF NAUSEA/VOMITING Early pregnancy Psychogenesis vomiting Bulimia(易饿病) Pyloric channel ulcer Acute gastritis Gastric retention(潴留） Viral gastroenteritis（中毒性胃肠炎） Acute gastroenteritis Myocardial infarction Peritonitis（腹膜炎） Acute obstruction Neurological emergency Drug toxicity Cancer therapy Drug withdrawal PHYSICAL EXAM Vital signs Skin HEENT （head,eyes,ear,nose,throat) Abdomen Neurological LABORATORY Rule out obstruction and peritonitis HCG Urinalysis Electrolytes, BUN, creatinine, glucose Transaminases, amylase EKG, head CT, upper GI /or endoscopies Break 泸沽湖黄昏 泸沽湖黄昏 泸沽湖?摩梭女 玉龙雪山?雪月 Constipation Shanghai Second Medical university Renji clinical medical college Background Constipation Is a Constellation of Symptoms Most commonly reported symptoms Hard, lumpy stools Increased