消化系統(tǒng)疾病癥狀(英文)

SymptomsofDigestiveDiseases

CommonsymptomsofDigestiveDiseasesAbdominalPainHematemesisandHematocheziaDiarrheaJaundiceDefinitionofAbdominalPain

Abdominalpainispainthatonefeelsanywherebetweenhischestandgroin.Painoriginatingfromorganswithintheabdominalcavity(frombeneaththeskinandmuscles).Theseorgansincludethestomach,smallintestine,colon,liver,gallbladder,andpancreas.

Oneofthemostfrequentcomplaintsforwhichpatientsseekmedicalattention.ClassificationofAbdominalpainAcuteabdominalpainChronicabdominalpainEtiologyandpathogenesisAcuteabdominalpainParietalperitonealinflammationbacterialcontaminationchemicalirritationAcuteinflammationofabdominalorgansgastritisenteritisMechanicalobstructionofhollowvisceraobstructionofthesmallorlargeintestineobstructionofthebiliarytreeEtiologyandpathogenesisAcuteabdominalpain

VasculardisturbancesEmbolism,vascularrupture,torsionoftheorgansReferredpainpneumoniacoronaryocclusionAbdominalwall

traumaorinfectionofmuscles,distortionortractionofmesenteryMetabolicandtoxiccausesallergicfactorsetc.EtiologyandpathogenesisChronicabdominalpainChronicinflammationofabdominalorgansrefluxesophagitischroniculcerativecolitisPepticulcerDistentionofvisceralsurfaces

hepaticorrenalcapsules,hepatitis,hepaticcancerEtiologyandpathogenesisChronicabdominalpain

ObstructionortorsionInfiltrationormetastasisoftumorMetabolicandtoxiccausesuremiaNeurogenic

IBSneurosisMechanismsofabdominalpain

VisceralpainSomaticpainReferredpainVisceralpainResultsfromstimulationofautonomicnervesinthevisceralperitoneumwhichsurroundsinternalorgansThemessagemaybetransferredintothespinalcordviasympathicroutePainpoorlylocalizedIntermittent,cramporcolickypainAccompaniedbynausea,vomittinganddiaphoresisSomaticpain

StimulioccurswithirritationofparietalperitoneumSensationsconductedalongperipheralnerveswhichcanlocalizepainbetter

PreciselylocalizedpainPaindescribedasintense,constantWithlocalguardingorrigidityGettingworseaftercoughingorpositionchangesMaybecausedbyinfection,chemicalirritation,orotherinflammatoryprocessReferredpain

PainfeltatadistancefromitssourceThediffusepainarisingfromabdominalvisceralstructurestendstobeprojectedtoamoresuperficialregionwiththesamesegmentalinnervationLocalizationClinicalmanifestationLocalizationClinicalmanifestationLocalizationTendernessoverthediseasedorganObstructionofsmallintestine:

periumbilical(臍周）

supraumbilical（臍上）Obstructionoflargeintestine:infraumbilialarea（臍下）

Acutedistentionofgallbladder:rightupperquadrantwithradiationtotherightposteriorregionofthethoraxorthetipoftherightscapula（肩胛）ClinicalmanifestationLocalizationAcuteepigastricpainreferringtothebackPosteriorlypenetratingpepticulcerBiliarypainAcutepancreatitisDissectinganeurysm夾層動脈瘤Epigastricpain+repeatedvomitingFoodpoisoningAcutepancreatitisAgonizingpainbutinsignificantsignsAcutepancreatitisMesentericthrombosisatearlystageClinicalmanifestationQualityandseverityPerforation:severedullpainoverabdomenObstructionofhollowabdominalviscera:

intermittent,colickyIntraabdominalvasculardisturbances:

suddenandcatastrophicinnatureAcutepancreatitis:severe,steadyupperabdominalpain

PainSeverityUlcerIntestinalColicBiliaryColic,PancreaticClinicalmanifestationProvocationandreliefAcutegastritisandenteritis:eatingunfreshorrawfoodsrelievedbyvomitingordischargePeritoneuminflammation:accentuatedbypressurepalpationmovementcoughingIBSandconstipation:relievedtemporarilybybowelmovementsObstruction:relievedtemporarilybyvomiting

Ulcer:eatingortakingantacids

AssociatedmanifestationsFever:inflammationJaundice:livergallbladderpancreaticdiseaseHematuria:renalstoneDiarrhea/rectalbleeding:intestinalcausesDifferentiationofthreecolickypainTypeLocationOthermanifestationIntestinalperiumbilicalvomiting,nauseainfraumbilicaldiarrhea,bowelsoundsBiliaryrightupperjaundicefeverquadrantMurphy’ssignRenalipsilateralflankchangesinurinetestradiatetogenitalia外陰

hematuriagroin腹股溝,scrotum陰囊Diagnosticpoints“PQRST”:

Provocative-palliativefactors

Quality

Region

Severity

TemporalcharacteristicsCommonAcutePainSyndromes

?Appendicitis?Cholecystitis?Pancreatitis?Perforationofanulcer?Intestinalobstruction?RupturedAAA（abdominalaorticaneurysm）?PelvicdisordersDIAGNOSTICSTUDIES?PlainX-rays(flatplate)?Contraststudies-barium(upperandlowerGIseries)?Ultrasound?CTscanning?Endoscopy：Sigmoidoscopy,colonoscopyCommonsymptomsofDigestiveDiseasesAbdominalPainHematemesisandHematocheziaDiarrheaJaundiceSourcesofGIBleedingUpperGITractProximaltotheLigamentofTreitz70%ofGIBleedsLowerGITractDistaltotheLigamentofTreitz30%ofGIBleedsDefinitionsofGIbleedingHematemesis（嘔血）:vomitingofbloodoralteredblood(coffeegrounds)；indicatesbleedingproximaltoligamentofTreitz(>250ml)Melena（黑便）:Tarrystool.Altered（black）bloodperrectum（50~70ml）Hematochezia（便血）:passageofbrightordarkredbloodperrectum;indicatescolonicsourceormassiveupperGIFaecaloccultblood（糞便隱血）:bleeding<5mlFactorsaffectthewaytomanifestFloraofenterocolonFloraofenterocolonSpeedofbleedingSiteofbleedingAmountofbloodlossPathophysiologyofGIBleedingMucosallesionsAcid-pepticdisease,drug-induced(NSAIDs),Infectious(H.pylori),inflammatoryboweldzPortalhypertensionEsophagealvarices,hypertensivegastropathyCoagulopathy–Hemophilia血友病,hepaticcoagulopathy,Vascularlesions-congestionCommoncausesofUpGIbleedingPepticulcerAcutegastricmucosallesionsAlcohol,

aspirin,NSAIDs,

stressGEvaricesGastriccancerPepticUlcersEsophagitisMallory-WeisstearsEsophagealcarcinomaEsophagusdiseasesMallory-WeisstearsStomach:gastritis:alcoholic,drug-inducedgastriculcer

gastriccarcinoma

benigntumours:leiomyomaDieulafoy’slesionDuodenum:duodenalulcer

duodenitisGastro-duodenaldiseaseDieulafoy'sLesionHematobiliaPancreatitisaorticaneurysmrupturedtoesophagus,stomachandduodenum；MediastinumtumororabscessrupturedtoesophagusVascularmalformation:Telangiectasis(毛細血管擴張)

Rendu-Osler-Weberdisease(遺傳性毛細血管擴張癥）

hematologicaldiseasesConnectivetissuediseaseAnticoagulantfibrinolytictherapyLesscommoncausesofUpGIbleedingwatermelonstomachgastricantralvascularectasias(GAVE)DuodenalvascularectasiaClinicalmanifestationofUpGIBleedingAbdominaldiscomfort:

NauseaHemadynamicchange:

reductioninbloodvolume:10%Hct:light-headedness20%Hct:tachycardia,sweating,orthostatichypotension30%Hct:shockLaboratorychanges:Hb,HCT,BUNHematemesiswithupperabdominalpainHematemesiswithhepatomegalyandspleenomegalyHematemesiswithjaundiceHematemesiswithSkin&mucosahemorrhageHematemesiswithupperabdominalmassOthers:NSAIDs,Stress,Burning,Brainoperation,Trauma,Vomiting

HematemesiswithothersymptomsliverpalmsspidernevusLab.ExaminationinDiagnosisofUpGIBleedingEndoscopyBariumRadiographsAngiographyRadionuclideimagingDefinitionsofGIbleedingHematemesis（嘔血）:vomitingofbloodofalteredblood(coffeegrounds)；indicatesbleedingproximaltoligamentofTreitz(>250ml)Melena（黑便）:Tarrystool.Altered（black）bloodperrectum（50~70ml）Hematochezia（便血）:passageofbrightordarkredbloodperrectum;indicatescolonicsourceormassiveupperGIFaecaloccultblood（糞便隱血）:bleeding<5mlEtiologyofhematocheziaDiverticular:17-40%Angiodysplasia:9-21%Colitis(ischemic,infectious,chronicIBD,radiationinjury):2-30%Neoplasia,post-polypectomy:2-26%AnorectalDisease(includingrectalvarices):4-10%UpperGIBleed:0-11%SmallBowelBleed:2-9%BarnetJandHMessmannH.NatRevGastroenterolHepatol6,637-646(2009).GastrointestinalBleedingBloodstreaksonthestool:analoutletbleedingBloodmixedwithstool:bleedingsourcehigherthantherectumBloodwithmucus:aninfectiousorinflammatorydiseaseCurrantjelly-likematerial:indicatesvascularcongestionandhyperemia(intussusceptionormidgutvolvulus)HematocheziawithothersymptomsAbdominalpainFeverTenesmus里急后重

SystemicHemorrhageDermalsignAbdominalmassSevereacuteulcerativecolitis.

Novascularpatternisdiscernible.

AseveredegreeofspontaneousbleedingispresentA,LinearulcersofCrohn'scolitis.B,Mucosasurroundingtheulcersisnodular(cobblestoning).Tuberculosis.Linearulcerationrunscircumferentiallyalongtheinterhaustralseptumwithtinysatelliteulcerations.Thismustbedistinguishedfromthelongitudinallinearulcerationsseenininflammatoryboweldisease.

Shigellacolitis.

Patchyareasoferythema,spontaneousbleeding,andlossofthenormalvascularpatternareevidentSalmonellacolitis.Diffuseerythema,spontaneousbleeding,andlossofthevascularpatternwithformationoftelangiectasisarepresent.Pseudomembranous(antibiotic-associated)colitis.Numerouselevatedyellowishplaquesarepresentonthemucosalsurface.Largecoloniculcerinapatientwithischemiccolitis.DiverticulosisColonicPolypsAdvantagecoloncarcinomaLab.ExaminationFordetectingLowGIBleeedingColonoscopy，Anoscopy&sigmoidoscopycapsuleendoscopyBariumEdema(BE)AngiographyRadionuclidescanning：TaggedRBCScanSummaryofAcuteGIBleedingUpperGIsourcebleeding--HematemesisMajorupperGIbleding--Hematemesis&hematocheziaThemoredistantfromtherectum,themorelikelythatmelenaoccursThecolonlesion--FOB+orhemetocheziaThesmallbowllesion--melenaorhemetochezia

ThequestionsshouldbeposedPriorbleedingepisode?FamilyhistoryofGIdiseasesDosethepatienthavetheillnessofulcer?Cirrhosis?cancer?bleedingdisorder?Alcohol?NSAIDs?Anyprecedessymptomsorsigns?CommonsymptomsofDigestiveDiseasesAbdominalPainHematemesisandHematocheziaDiarrheaJaundiceDiarrheaDefinition:increaseinthefrequencyofbowelmovements≥3/dayincreaseinstoolliquidityinsomecasesincreaseindailystoolweight(>200g/d)acute:duration<4wks chronic:duration>8wksEtiologyAcuteDiarrheainfectionFoodpoisoningSystematicdiseases(influenza,sepsis,etc)MiscellaneousInfectiousDiarrheaBacteriaE.coliCampylobacterspp空腸彎曲桿菌

Salmonellaspp沙門氏菌Shigellaspp志賀氏菌

Clostridiumdifficile艱難梭狀芽胞桿菌

Aeromonasspp氣單胞菌屬

Plesiomonasspp毗鄰單胞菌屬

Vibriospp弧菌屬VirusAdenovirus腺病毒Rotavirus輪狀病毒Norovirus諾瓦克病毒

ParasitesEntamoebahistolytica溶組織性阿米巴

Giardialamblia藍氏賈第鞭毛蟲

Cryptosporidium隱孢子蟲

Microsporidia微孢子蟲

Cyclospora環(huán)孢蟲

fungalFoodpoisoningbacterial,plants,chemicalpoison(arsenic砷)heavymetals(mercury,zinc)Systematicdiseases(influenza,sepsis,measle,etc)MiscellaneousAllergicdiseasesAllergicpurpura,enteropathyEndocrinicdiseases(ZES,etc.)Drugs:laxatives,5-Fu,etc.EtiologyChronicDiarrheaIntestinalInfections(T.B.,Chronicbacteriadysentery,etc.)parasitics(Amebiadysentery,Giardiasis,etc.)IBD(ulcerativecolitis,Chron’s,etc.)malabsorptionsynd.(lactasedeficiency,etc.)tumorsEtiologyChronicDiarrheaGastric(chronicgastritis,subtotalgastrectomyetc.)Pancreatic(ChronicPancreatitis,PancreaticCancer,etc.)Hepatobiliary(livercirrhosis,obstructivejaundice)Endocronic(Hyperthyroidscrisis,ZES,Carcinoids)

Drugs(Reserpin,Ismelin,Laxatives,etc.)Others(uremia,hypogammaglobulinemia,etc.)functionalcauses:IBSMechanismsofDiarrheaOsmoticSecretoryExudationAbnormalmotilityOsmoticDiarrheaInterfereswithabsorptionofwaterSolutesareingested(fastingstopsdiarrhea)MagnesiumsulfateorcitrateormagnesiumcontainingantacidsSorbitol山梨醇

MalabsorptionoffoodLactasedeficiencyCeliacsprueOsmoticloadwithintheintestineresultinginretentionofwaterwithinthelumen.SecretoryDiarrhea

ExcesssecretionofelectrolytesandwateracrossmucosalsurfaceUsuallycoupledwithinhibitionofabsorptionClinicalfeaturesstoolsverywaterystoolvolumelargefastingdoesnotstopdiarrheaSecretoryDiarrheaBacterialEndogenousExogenousHormoneproducingEnterotoxinsLaxativesLaxativestumorsVibrioCholeraBileAcidsSennaVIPomaToxigenicE.coliHydroxyfattyacidsPhenolpthaleinMedullaryCaMastocytosisGastrinomaExudativeDiarrheaIntestinalorcolonicmucosainflamedandulceratedLeakageoffluid,blood,pusImpairmentofabsorptionIncreasedsecretion(prostaglandins)TheextentandlocationofbowelinvolveddeterminesSeverityofdiarrheaSystemicsignsandsymptoms(abdominalpain,fever,leukocytosis,etc)Tenesmus,urgencyExudativeDiarrheaInfectious,invasiveorganismsShigella,Campylobacter,Yersinia,E.histolytica,EIEC,CdiffCMVIdiopathicinflammatoryboweldiseaseCrohnsdiseaseUlcerativeColitisIschemiaAbnormalMotilityIncreasedcolonicmotilityIrritablebowelsyndromeIncreasedsmallbowelmotilityHyperthyroidism,post-operativedumpingDecreasedsmallbowelmotilityScleroderma,withbacterialovergrowthAnalsphincterdysfunctionIncontinenceGeneralizedMalabsorptionIntraluminalMalabsorption1)defectivelipolysis/proteolysis?pancreaticinsufficiency2)impairedmicelleformation?biliaryobstruction,bacterialovergrowth,ilealdiseaseMucosalMalabsorption1)Lactoseintolerance2)Giardiainfestation3)Celiacdisease4)Whipple'sdisease5)ShortbowelsyndromeDefectiveTransportLymphaticobstruction,frequentlyassociatedwithproteinloosingenteropathy.onset:Abruptfrequent,smallfecaldischargeCrampingabdominalpain,tenesmusstool:increasedRoutinExseverecases:dehydration,electrolytedisturbances,metabolicacidosis,collapsehypovolemia,tetany.AcutediarrheaSymptomsvolumeliquidityflecksofblood,mucusWBC,RBC,pus,destroyedepitheliumOnset:gradual/insidiousDiarrheaofvariableseverityDiarrheaalternatewithconstipationColickyabdominalpain,distentionChronicdiarrheaSymptomsSmallboweldiarrheaLargevolumestoolModeratefrequencyMinimalurgencyNotenesmusLittlemucusPeriumbilicalpainWeightlossSignsofmalnutritionLargeboweldiarrheaSmallamountofstoolHighfrequencyUrgencyTenesmusLargemucus&bloodLIFpainLittleornoweightlossLittleornosignsofmalnutritionHistoryOnsetanddurationofdiarrheaTimingofexposuretopotentialpathogensTravel,ingestionhistory,environment,recentmedications(antibiotics),ageCharacterofstoolVolume,presenceofblood,mucus,orpusAssociatedsymptomsandsignsAbdominalpain,fever,vomiting,dehydrationDiagnosticProceduresinformationinepidemics(Dysentery,v.Cholerae,Typhoid,foodpoisonning,enteritis)foodallergypastillness(antibioticrelateddiarrhea,etc.)medicationtake(corticosteroids,laxatives,etc.)predisposingconditions(surgicalresection,parasiticinfection,etc.)DiagnosticProceduresP.E.Findingsfever,dehydration,malnutrion,anemia,urticaria,jaundice,arthralgia,abdominalmasses,digitalrectalexamination.

DiagnosticProceduresLab.ExaminationsStoolBloodUrineMicroscopyRadiology

AccompaniedSymptomsseveredehydration

(cholera,pancreaticcholera-WDHA,etc.)fever(Acutebacillarydysentery,Typhoid,TBenteritis)Tenesmus

(Acutedysentery,proctitis,etc.)markedlyweightloss(cancerofgut,malabsorption,etc.)Arthralgia/Arthritis(IBD,connectivetissuediseases,etc.)Masses(malignantcancerofGI,TB,peritonitis,etc.)

CommonsymptomsofDigestiveDiseasesAbdominalPainHematemesisandHematocheziaDiarrheaJaundiceDefinitionofJaundiceAccumulationofbilirubininthebloodstreamcausesyellowpigmentationoftheskin,mucosaandsclera

NormalSerumBilirubin:

1.70-17.1umol/L

(0.1~1.0mg/dl)Conjugatedbilirubin:0-3.42umol/L;Unconjugatedbilirubin:1.70-13.68umol/L.

Occultjaundice：17.1~34.2μmol/L

Clinicaljaundice:>34.2μmol/LBilirubinRBCsSenescentRBCsIronhemoglobinGlobinBilirubinBiliverdinheme

HepaticHemoproteins

nonhemoglobinhemenonhemoglobinhemoproteinPrematuredestructionofnewlyformedRBCs

CMHO

RCBR1-5%Chiefly80+%15%Bilirubinformation120dsBypassbilirubinBilirubinformationTransportofbilirubininplasmaHepaticbilirubintransportHepaticuptakeConjugationBiliaryexcretionEnterohepaticcirculationBilirubinMetabolismPathophysiologicclassificationofJaundiceHemolyticJaundiceHepaticJaundiceCholestasisJaundice(Obstructive)CongenitalJaundiceJaundiceclassification

predominantlyunconjugatedhyperbilirubinaemiapredominantlyconjugatedhyperbilirubinaemiaHemolyticJaundice

PathogenesisOverproductionHemolysis(intraandextravascular)inheritedorgeneticdisordersacquiredimmunehemolyticanemiaAutoimmunehemolyticanemianonimmunehemolyticanemia(PNH)OverproductionmayoverloadtheliverwithUBSymptomsFever,weakness,Darkurine,anemia,Icterus,splenomegalyLabUB

withoutbilirubinuriafecalandurineurobilinogen

hemolyticanemiahemoglobinuria(inacuteintravascularhemolysis)Reticulocytecounts

HemolyticJaundiceDuetoadiseaseaffectivehepatictissueeithercongenitaloracquireddiffusehepatocellularinjuryHepaticJaundicePathogenesisAcquireddisordershepatocellularnecrosisintrahepaticcholestasisHepatitis,Cirrhosis,Drug-relatedHepaticJaundiceSymptomsweakness,lossappetite,hepatomegaly,palmarerythema,spiderLabFindingsliverfunctiontestsareabnormalb