儿科学课件-腹泻液体疗法

1、Infantilediarrhea Objectives emphases difficulty 1 Tomasterthepathogenesisandclinicalmanifestationofinfantdiarrhea2 Tomasterthediagnosisandtreatmentofinfantdiarrhea 8个月婴儿 腹泻3天 每天十余次蛋花汤样便 12小时无尿 呼吸深长 前囟眼窝明显凹陷 皮肤弹性很差 四肢厥冷 11月份就诊 血钠125mmol l 血钾3 2mmol l HCO3 10mmol L 便无臭味 镜检WBC0 2 HP 既往无营养不良Diagnosis Treatment Whichisdiarrhea Types1 2indicateconstipation with3and4beingtheidealstoolsastheyareeasytodefecatewhilenotcontaininganyexcessliquid 5 6and7tendingtowardsdiarrhea Diarrheais Asymptomcharacterize

2、dbyanabnormalincreaseinstoolfrequency liquidityoramount Infants stoolvolume 10g kg dayChildren 2 stoolvolume 200g dayInpractice thistypicallymeansloose to waterystoolspassed4ormoretimesperday consistencyofstoolsisthemoreimportantfeature ISjustalittlecaseofdiarrhea 1 2 1 9episodesperpersonannuallyinthegeneralpopulation2 4episodesperchild 3yearsoldannually EPidemiology Diarrheadiseasemainlyaffectschildrenundertwoyearsold 全世界 150万 我国 5岁儿童每年患腹泻病估计有1 7亿人次 死亡4万多 平均2 01次 人 婴儿为4次左右 Diarrheaisaleadingcau

3、seofmalnutritioninchildrenunderfiveyearsold EPidemiology Worldwide around1billionpeoplelackaccesstoimprovedwaterand2 5billionhavenoaccesstobasicsanitation Diarrheaduetoinfectioniswidespreadthroughoutdevelopingcountries fecal oralrouteingestionofcontaminatedfoodorwaterpersontopersoncontact Howarediarrheapathogenstransmitted Prevalentseasons BacterialenteritisismostprevalentinsummerViralenteritisisinautumnandwintermonths buttheymaybeoccurallyearroundNoninfectiousdiarrheamayoccuratanyseason EPIDEMI

4、OLOGY EPIDEMIOLOGY Factorsthatincreasesusceptibilitytoinfectionwithenteropathogensinclude youngage immunedeficiency measlesmalnutrition traveltoanendemicarea lackofbreastfeeding exposuretounsanitaryconditions ingestionofcontaminatedfoodorwater levelofmaternaleducation child carecenterattendance Predisposingfactors1 Characteristicofdigestivesystem hypochlorhydria digestenzyme enzymaticactivity 2 Fastdevelopingandgrowth3 Organismdefensehypofunction hypochlorhydria immuneglobulin SIgA IgM normalflo

5、ra 4 Non human milkfeed WhatCausesDiarrhea Etiologyofdiarrhea Infectiousfactors1 IntestinalinfectionBacterialinfections Escherichiacoli EnteropathogenicE coli EPEC EnterotoxigenicE coli ETEC EnteroinvasiveE coli EIEC EnterohemorrhagicE coli EHEC Enteroaggregative EAEC Campylobacterjejuniyersinia Salmonella Viralinfections rotavirus Norwalkvirus astrovirus echorirus entericadenovirusParasites Giardialamblia Entamoebahistolytica andCryptosporidium Fungus candidaalbicans 2 Extraintestinalinfections

6、 Otitismedia upperrespiratoryinfection meningitis pneumonia urinaryinfection cutaneousinfectionorotheracuteinfectiousdiseasesmayassociatewithdiarrheaandvomiting causeatemporaryupsetofgastrointestinalfunction toxin fever Pathogensinfectintestinedirectly Localirritationoftherectum bladderinfection 3 Antibiotic associateddiarrhea AAD Someantibioticsdecreasecarbohydratetransportandintestinallactaselevels Eradicationofnormalgutfloraandovergrowthofotherorganismsmaycausediarrhea Etiologyofdiarrhea Exce

7、ssorirregularfeedingAllergicdiarrhea Climaticfactor cold Hot Noninfectiousfactors Foodintolerance lactose Dietaryfactor Viral 70 80 ofinfectiousdiarrheaindevelopedcountriesBacterial 10 20 ofinfectiousdiarrheabutresponsibleformostcasesofseverediarrheaProtozoan lessthan10 Etiologyofdiarrhea SecretoryDiarrhea Excesssecretionofelectrolytes fluidacrossmucosa ExudativediarrheaIncreaseinintestinalpermeability leadingtoincreasedlossofwaterandelectrolytes Abnormalintestinalmotility Increaseinintestinalmo

8、tility Osmoticdiarrhea Increaseinunabsorbableosmoticallyactivemoleculesintheintestinallumen DisaccharidaseGlucose Na transporter Secretorycell undifferentiatedcell Intestinalcrypt GobletcellAbsorptivecell Viralinfectiveenteritisrotavirusinvadetheepithelialcellsofsmallintestinemicrovilliareirregularvillidestroyswollenandshortenedactivityofdisaccharidase Glucose Na transporter Areaofabsorption lactosecannotbeAbsorptionofAbsorptionofdigestedandabsorbedGlucoseandNa carbohydrateandlipid Organicacid o

9、smolarity Waterydiarrhea Pathogenesis Figure1 Pathogenesisofrotaviralenteritis 轮状病毒非结构蛋白4的作用 作用固有层细胞 激活cl 的分泌和水的外流改变上皮细胞的完整性 影响细胞膜的通透性形成通道或激活钙激活通道 导致分泌增加通过旁分泌效应作用于未感染的细胞 直接作用于肠道神经系统 产生类似霍乱毒素引起的腹泻 New Invasivepathogens invadeandmultiplywithinintestinalmucosa inflammatorychanges congestion swollen inflammatorycellinfiltration effusionandulcer waterandelectrolytearenotabsorbedentirely diarrhea WBC RBCincreaseseveregeneral instoolstoxicsymptoms Figure3 Pathogenesisofinvasiveenteritis 四 非感染性腹泻 Diarrh

10、eaClassification Duration Acutediarrhea 2w Chronicdiarrhea 2m Persistentdiarrhea 2w 2m pathogeny Infected Noninfected Pathophysiology OsmoticSecretoryExudationAbnormalmotility Pathogeneticcondition MilddiarrheaSeverediarrhea ClinicalManifestations Gastrointestinalsymptoms Disturbanceofwater electrolyte andacid basebalance Diarrhea Vomiting Abdominalpain Dehydration Metabolicacidosis Hyponatremia Hypokalemia Hypocalcemia Hypomagnesemia Whenapersonlosesmorethan10 oftheirbodyfluidstheycandie Dehydr

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