NauseaandVomiting恶心与呕吐讲课文档.pptVIP

Presentation Objectives Define constipation The pathophysiological mechanisms Etiologies of constipation Characterize manifestation Discriminate the accompanying symptoms. Suggest diagnostic strategies of the symptoms. C 第六十页，编辑于星期五：十三点 五十四分。 What is Constipation? Passage of hard, dry, lumpy stools; Infrequent bowel movements, usually fewer than three times a week Symptoms: painful bowel movements straining Uncomfortable（Sensation of incomplete evacuation） bloated sluggish 第六十一页，编辑于星期五：十三点 五十四分。 Rome II Defines Functional Constipation Based on Multiple Symptoms Rome II diagnostic criteria for functional constipation At least 12 wk, which need not be consecutive, over the past 12 months of 2 or more of Straining* Lumpy or hard stools* Sensation of incomplete evacuation* Sensation of anorectal obstruction/blockage* Manual maneuvers to facilitate defecation* 3 defecations/wk Loose stools not present Insufficient criteria for IBS * 1/4 of defecations. Drossman DA, et al. In: Rome II: The Functional Gastrointestinal Disorders. 2000:382-391. C 第六十二页，编辑于星期五：十三点 五十四分。 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 第六十三页，编辑于星期五：十三点 五十四分。 Defecation Process Yield awareness of defecation Anal intra- and extra-sphincter Relaxation Abdominal effects 第六十四页，编辑于星期五：十三点 五十四分。 全身疾病 尿毒症 肝昏迷 酮症酸中毒 各种原因引起的脑水肿和颅内压升高 代谢紊乱 早孕 第二十八页，编辑于星期五：十三点 五十四分。 Drug 抗生素 抗癌药 洋地黄 吗啡 兴奋呕吐中枢或影响胃肠平滑肌运动 Antibiotics Anti-carcinoma Digitalis morphia 第二十九页，编辑于星期五：十三点 五十四分。 Neurologic Psychogenic causes Neurologic and Psychogenic causes 胃肠道神经官能症（Gastrointestinal tract neurosis） 神经厌食症（apositia） 第三十页，编辑于星期五：十三点 五十四分。 Characteristics of Nausea and Vomiting Time Taking food Characteristics Characters of contents 第三十一页，编辑于星期五：十三点 五十四分。 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 第三十二页，编辑于星期五：十三点 五十四分。 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