[基础医学]传染病伤寒、菌痢.ppt

1、试述肠伤寒的典型病理变化。 2、试比较菌痢、阿米巴痢疾的共同点及不同点。 3、名词解释 伤寒肉芽肿 阿米巴脓肿 思考题 细菌性痢疾与肠阿米巴的鉴别 肠阿米巴病 细菌性痢疾 病原体 好发部位 病变性质 溃疡深度 溃疡边缘 溃疡间粘膜 症状 肠道症状 粪便检查 痢疾杆菌 乙状结肠、直肠 弥漫性假膜性炎 浅在、不规则 地图状 炎性假膜 重、常发热 左下腹痛，里急后重 脓血便，脓细胞 溶组织内阿米巴 盲肠、升结肠 局限性坏死性炎 深、烧瓶状溃疡 潜行性、挖掘状 大致正常 轻、发热少 右下腹痛，里急后重轻 果酱便，RBC，滋养体 ＞2月 来自急性、福氏多见 新旧病灶 病理特点 慢性溃疡 慢性炎细胞浸润 肠狭窄：瘢痕、增厚 2、慢性细菌性痢疾 边缘不整齐，底部不平，较多肉芽 慢性溃疡 2-7岁儿童多见 毒力弱的福氏、宋内氏 起病急骤，中毒症状明显，肠病变较轻 3、中毒型细菌性痢疾 阿米巴病 Amoebiasis 血吸虫病 Schistosomiasis 寄生虫病 概 述 寄生虫的致病机理： 1、夺取营养：营养不良和贫血 2、机械性损伤：增生、梗阻 3、毒性作用：嗜酸性脓肿和肉芽肿 4、免疫性损伤。 寄生虫作为病原体引起的疾病称为寄生虫病。 阿 米 巴 病 Amoebiasis 病原体：溶组织内阿米巴原虫 病变特点：结肠伴组织溶解液化的坏死性炎症 阿米巴痢疾：腹痛、腹泻、里急后重 肠外阿米巴：肝、肺、脑。 概 述 1．起病缓慢，无发热，症状轻。 2．大便稀薄，粘液果酱样，特腥臭，粪检 滋养体。 3．抗菌药物治疗无效。 临床特点 包囊体 传染型 抗胃酸 阿米巴原虫 小 滋养体 致病型 伪足侵入 大 病原体 滋养体 包囊体 Infection by Entamoeba histolytica occurs by ingestion of mature cysts ??? in fecally contaminated food, water, or hands.? Excystation ??? occurs in the small intestine and trophozoites ??? are released, which migrate to the large intestine.? The trophozoites multiply by binary fission and produce cysts ???, which are passed in the feces.? Because of the protection conferred by their walls, the cysts can survive days to weeks in the external environment and are responsible for transmission.? (Trophozoites can also be passed in diarrheal stools, but are rapidly destroyed once outside the body, and if ingested would not survive exposure to the gastric environment.)? In many cases, the trophozoites remain confined to the intestinal lumen ( ???: non-invasive infection) of individuals who are asymptomatic carriers, passing cysts in their stool.? In some patients the trophozoites invade the intestinal mucosa ( ???: intestinal disease), or, through the bloodstream, extraintestinal sites such as the liver, brain, and lu