恶心呕吐宣讲ppt课件

临床诊断学临床诊断学上海第二医科大学仁济临床医学院上海第二医科大学仁济临床医学院 临床诊断学上海第二医科大学仁济临床医学院 1Nausea and VomitingAs the symptoms症状学：恶心与呕吐症状学：恶心与呕吐Nausea and Vomiting症状学：恶心与呕吐2文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。GoalsBriefly defineOutline the prominent disease states associated with nausea and vomiting.Characterize Nausea and Vomiting caused by the prominent disorders Discriminate the accompanying symptoms.Suggest diagnostic strategies of the symptoms.GoalsBriefly define3文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Definition of Nausea and VomitingnNausea：the inclination or feeling of imminent desire to vomit,usually felt in the throat or epi-gastrum.Associated with decreased activity of the stomach.nVomiting：the forceful oral expulsion of gastric contents via retro-peristalsis.nNausea-Vomiting:simultaneity or separateness恶心：紧迫欲吐，通常伴有上腹不适和迷走兴奋的临床征候群。呕吐：胃和/或小肠内容物经食管和口腔排除体外恶心和呕吐常伴随存在，也可单独出现！Definition of Nausea and Vomit4文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Nausea and VomitingNausea and Vomiting51、恶心：咽部及上腹部不适，胃张力和蠕动减弱，幽门和贲门开放。2、干呕：胃窦部和腹壁肌肉收缩，腹压增加，食管及咽部开放。3、呕吐：胃和/或小肠内容物经食管和口腔排除体外。Definition of emesis.(Three phases)呕吐反射过程（三个阶段）1.Nausea-the inclination or feeling of imminent desire to vomit,usually felt in the throat or epigastrum.Associated with decreased activity of the stomach.2.Retching-the labored rhythmic contraction of respiratory and abdominal musculature that frequently precedes or accompanies vomiting.3.Vomiting-the forceful oral expulsion of gastric contents via retroperistalsis.(Abdominal effects).1、恶心：咽部及上腹部不适，胃张力和蠕动减弱，幽门和贲门开放6文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。迷走兴奋表现迷走兴奋表现恶心恶心干呕干呕呕吐呕吐发生机制发生机制迷走兴奋表现恶心干呕呕吐发生机制7文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。呕吐区别于反食呕吐区别于反食呕吐：多数情呕吐：多数情况有恶心的感况有恶心的感觉和呕吐反射觉和呕吐反射的协调动作。的协调动作。反食：无恶心反食：无恶心的感觉和呕吐的感觉和呕吐反射的协调动反射的协调动作。（儿童、作。（儿童、饱餐）饱餐）呕吐区别于反食呕吐：多数情况有恶心的感觉和呕吐反射的协调动作8文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Mechanisms of emesisMechanisms of emesis9文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。CTZ&Emetic Center(Vomiting center)CTZ化学感受器触发带（第四脑室底面）：外源性或内源性化学物质（阿片吗啡、洋地黄、代谢产物）Emetic Center（延髓外侧网状结构背测）接受大脑皮质、消化器官、心血管以及化学感受器触发带（CTZ）的冲动CTZ&Emetic Center(Vomiting 10文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。CTZ&Emetic Center(Vomiting center)孤束核CTZ&Emetic Center(Vomiting 11文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Emetic Center 内脏传入 中脑ICP受体化学感受器触发带边缘系统前庭系统呕吐中枢（Vomiting center)ICP=Inductively Coupled Plasma 感应耦合等离子体Emetic Center 内脏传入 中脑ICP受体化学感受12文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Neurotransmitters in CTZ&Emetic CenterNeurotransmitters involved in stimulating the emetic center,chemo-receptor trigger zone and GI tract include;5-HT,acetylcholine,histamine,dopamine(opiates and receptors for benzodiazepines are also found here)Neurotransmitters in CTZ&Eme13文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。恶心呕吐宣讲ppt课件14文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。恶心呕吐宣讲ppt课件15文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Emetic Center 1、分泌唾液中枢2、血管收缩中枢3、呼吸中枢4、中枢神经脊神经膈神经迷走神经Emetic Center 1、分泌唾液中枢脊神经膈神经迷走16文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。恶心呕吐宣讲ppt课件17文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。nausea and vomiting1.Reflective vomiting 反射性呕吐反射性呕吐2.Central vomiting 中枢性呕吐中枢性呕吐3.Neurological vomiting 神经性呕吐神经性呕吐nausea and vomiting1.Reflecti18文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Reflective vomiting（反射性呕吐）反射性呕吐）咽部刺激胃十二指肠疾病胆道疾病肠道疾病肝胆疾病腹膜肠系膜全身性疾病（五官、心血管、泌尿、盆腔）Pharyngeal MechanismsGastrointestinal MechanismsDisease of biliary tractPeritoneal and mesenterythe five sense organsCardiovascular diseases kidneyPelvicReflective vomiting（反射性呕吐）咽部刺19文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。咽部刺激Pharyngal Mechanisms咽部刺激Pharyngal Mechanisms20文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Gastrointestinal MechanismsGastrointestinal Mechanisms21文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。肝、胆、胰腺肝、胆、胰腺22文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。其他其他23文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Intra-cranial infectionCerebrovascular disordersCraniocerebral injuryEpilepsyMetabolic disorders DrugsCentral vomiting（中枢性呕吐）中枢性呕吐）颅内感染脑血管疾病颅脑损伤癫痫全身疾病（尿毒症、肝昏迷、糖尿病代谢紊乱）Intra-cranial infectionCentral24文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。颅内感染（脑炎、脑膜炎）颅内感染（脑炎、脑膜炎）25文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。脑血管疾病、颅脑损伤脑血管疾病、颅脑损伤26文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。癫痫癫痫27文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。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28文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。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AntibioticsAnti-carcinomaDigitalismorphiaDrug抗生素兴奋呕吐中枢或影响胃肠平滑肌运动Antibio29文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Neurologic&Psychogenic causesNeurologic and Psychogenic causes胃肠道神经官能症（Gastrointestinal tract neurosis）神经厌食症（apositia）Neurologic&Psychogenic cause30文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Characteristics of Nausea and Vomiting1.Time2.Taking food3.Characteristics4.Characters of contentsCharacteristics of Nausea and 31文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。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32文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。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：提示幽门梗阻呕吐与进食的关系餐后即刻：神经精神性；集体发病系食物中毒餐后33文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。呕吐特点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34文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。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The accompanying symptoms腹痛、腹泻35文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。问诊要点n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n发作时间：晨、夜、与进食、活动、体位的关系n呕吐物性状、味道n伴随症状n诊疗和症状演变情况问诊要点起病情况：诱因、急缓、与进食关系、腹部手术史、育龄妇36文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。History/Backgrounda)Ageb)GI history requiredc)Food intoleranced)Timing with mealse)Consistencyf)Contentg)Odorh)Frequencyi)Feverj)Weight lossk)Precipitating factorsl)Myalgias（肌痛）,visual disturbances,headache,pain outside abdomenHistory/Backgrounda)Ageg)Odo37文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。CAUSES OF NAUSEA/VOMITINGnEarly pregnancynPsychogenesis vomitingnBulimia(易饿病易饿病)nPyloric channel ulcernAcute gastritisnGastric retention(潴潴留）留）nViral gastroenteritis（中毒中毒性胃肠炎）性胃肠炎）nAcute gastroenteritisnMyocardial infarctionnPeritonitis（腹膜炎）nAcute obstructionnNeurological emergencynDrug toxicitynCancer therapynDrug withdrawalCAUSES OF NAUSEA/VOMITINGEarly38文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。PHYSICAL EXAMnVital signsnSkinnHEENT（head,eyes,ear,nose,throat)nAbdomennNeurologicalPHYSICAL EXAMVital signs39文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。LABORATORYnRule out obstruction and peritonitisnHCGnUrinalysisnElectrolytes,BUN,creatinine,glucosenTransaminases,amylasenEKG,head CT,upper GI&/or endoscopiesLABORATORYRule out obstruction40文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。BreakBreak41文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。泸沽湖黄昏泸沽湖黄昏泸沽湖黄昏42文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。泸沽湖黄昏泸沽湖黄昏泸沽湖黄昏43文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。泸沽湖泸沽湖摩梭女摩梭女泸沽湖摩梭女44文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。玉龙雪山玉龙雪山雪月雪月玉龙雪山雪月454646ConstipationShanghai Second Medical universityRenji clinical medical collegeConstipationShanghai Second Me47BackgroundBackground48文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Constipation Is a Constellation of SymptomsnMost commonly reported symptomsnHard,lumpy stoolsnIncreased strainingnInfrequent bowel movementsnSensation of incomplete evacuationnBloating/fullnessnChronic constipationnMore persistent than intermittent or episodicnSeveral months durationCConstipation Is a Constellatio49文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Sandler RS,et al.Dig Dis Sci.1987;32:841-845.n=1128Constipation Is More Than Just Infrequent Passage of Stool53Constipation symptoms reported most oftenSandler RS,et al.Dig Dis Sci50文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Reduced Stool Frequency Is Not the Most Commonly Reported Symptom in ConstipationEPOC=Epidemiology of constipation;BM=Bowel movement.1.Stewart WF,et al.Am J Gastroenterol.1999;94:3530-3540.2.Par P,et al.Am J Gastroenterol.2001;96:3130-3137.Stewart(EPOC)19991Par 20012n=1476n=1149Constipation symptoms reported most oftenCReduced Stool Frequency Is Not51文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Prevalence in the General Population1.Stewart WF,et al.Am J Gastroenterol.1999;94:3530-3540.2.Drossman DA,et al.Dig Dis Sci.1993;38:1569-1580.3.Harris Interactive Study,Wave 2.Data on file.4.Par P,et al.Am J Gastroenterol.2001;96:3130-3137.53PopulationnCriteriaPrevalence,n(%)US110,018 Rome I 461(4.6)US25430 Rome I 195(3.6)US315,183 Rome II2429(16)Canada41149 Rome II 171(14.9)China(18-70ys)?RomeII?(6.07)China(60ys)?RomeII?(15-20)Prevalence in the General Popu52文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。EpidemiologynChronic constipation is commonnSlightly more common in women nF/M ratio=range 1.3 to 2.5(China=4:1)nAffects all age groupsStewart WF,et al.Am J Gastroenterol.1999;94:3530-3540.Par P,et al.Am J Gastroenterol.2001;96:3130-3137.Sandler RS,et al.Dig Dis Sci.1987;32:841-845.CEpidemiologyChronic constipati53文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Constipation Affects All Age Groups53Canadian population.Par P,et al.Am J Gastroenterol.2001;96:3130-3137.N=1149n=378n=367n=217n=187Constipation Affects All Age G54文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Profile of a Typical Chronic Constipation Patient in My PracticenGenerally femalenSymptomatic for 10 yrnMajority have tried lifestyle changes,fiber,and OTC laxatives prior to seeking carenManages condition with multiple therapiesnMost often referred by a primary care physician nCopes with condition,but is not completely satisfiedCProfile of a Typical Chronic C55文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Constipation Can Have a Negative Impact on Quality of LifenPeople with CC reported significant impairment in QoL on SF-36 scale(n=126)1nIn Canada,people with self-reported or Rome II constipation had significantly worse SF-36 scores than the normal population(n=472)2nIn Australia,people with constipation had significantly worse SF-12 scores on both mental and physical scales(n=227)31.OKeefe EA,et al.J Gerontol A Biol Sci Med Sci.1995;50:M184-M189.2.Irvine EJ,et al.Am J Gastroenterol.2002;97:1986-1993.3.Koloski NA,et al.Am J Gastroenterol.2000;95:67-71.CConstipation Can Have a Negati56文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Constipation Significantly Impacts Healthcare Utilizationn5.7 million constipation-related outpatient visits annually1,2n4.1 million physician office-based visits n991,000 emergency room visitsn587,000 hospital outpatient visitsn$2752/patient for tertiary care evaluation31.National Ambulatory Medical Care Survey,2001.www.cdc.gov2.National Hospital Ambulatory Care Survey,2001.www.cdc.gov3.Rantis PC Jr,et al.Dis Colon Rectum.1997;40:280-286.CConstipation Significantly Imp57文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Complications related with constipationvColonic and rectal carcinomavOther colon-rectal-anus disordersvhepatic coma vacute myocardial infarctionvmammary gland disordersvpresenile dementia(早老性痴呆）vpsycho-problemsvappearanceComplications related with con58文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Definition:Causes of Chronic ConstipationnSecondarynDrug induced nMetabolic factorsnComorbid conditionsnPrimarynImpaired colonic transit/motility nAltered neuroenteric function and reflexesnFailure of muscular apparatusnIneffective defecation(functional outlet obstruction)nPelvic dyssynergia and anismusnNormal transit constipationDefinition:Causes of Chronic 59文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Presentation ObjectivesnDefine constipationnThe pathophysiological mechanisms nEtiologies of constipation nCharacterize manifestationnDiscriminate the accompanying symptoms.nSuggest diagnostic strategies of the symptoms.CPresentation ObjectivesDefine 60文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。What is Constipation?nPassage of hard,dry,lumpy stools;Infrequent bowel movements,usually fewer than three times a weeknSymptoms:npainful bowel movements nstrainingnUncomfortable（Sensation of incomplete evacuation）nbloatednsluggishWhat is Constipation?Passage o61文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Rome II Defines Functional Constipation Based on Multiple SymptomsRome II diagnostic criteria for functional constipationnAt least 12 wk,which need not be consecutive,over the past 12 months of 2 or more of nStraining*nLumpy or hard stools*nSensation of incomplete evacuation*nSensation of anorectal obstruction/blockage*nManual maneuvers to facilitate defecation*n 1/4 of defecations.Drossman DA,et al.In:Rome II:The Functional Gastrointestinal Disorders.2000:382-391.CRome II Defines Functional Con62文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Normal metabolismnAs food moves through your intestines,it absorbs water while forming waste products nMuscles contract in the colon,pushing the stool toward the rectumNormal metabolismAs food moves63文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Defecation ProcessnYield awareness of defecation nAnal intra-and extra-sphincter RelaxationnAbdominal effectsDefecation ProcessYield awaren64文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Mechanical stimulation1.Yield awareness of defecationMechanical stimulation1.Yield65文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。2.Anal intra-and extra-sphincter Relaxationintra-sphincterextra-sphincterLevator ani muscle2.Anal intra-and extra-sphin66文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。2.Abdominal effectsgastric contents via anus2.Abdominal effectsgastric co67文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。What Causes Constipation?nEating too little fiber nNot drinking enough liquidsnLack of exercise/physical activityWhat Causes Constipation?Eatin68文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。What Causes Constipation?nChange in routinentravelnOlder agenSlower metabolismnFrequent use of laxativesnCertain diseases or conditionsWhat Causes Constipation?Chang69文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。What Causes Constipation?nCertain diseases or conditionsnRectal and Anal disordersnColonic disordersnSystemic diseases or conditionsWhat Causes Constipation?Certa70文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。What Causes Constipation?npain(narcotics麻药)nantacids containing aluminumnantidepressantsniron supplementsndiuretics(“water”pills)MedicationsWhat Causes Constipation?pain 71文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Classification of etiologiesnEating too little fiber nNot drinking enough liquidsnLack of exercise/physical activitynChange in routinenTravelnpsycho-relatednOlder agenSlower metabolismnFrequent use of laxativesntediously long ColonnMedicationsnTravelnpain(narcotics麻药麻药)nantacids containing aluminumnantidepressantsniron supplementsndiuretics(“water”pills)Functional etiologiesClassification of etiologiesEa72文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。psycho-relatedpsycho-related73文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Tediously long Colon结肠冗长Tediously long Colon结肠冗长74文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Organic constipation(certain diseases or conditions cause constipation)Classification of etiologiesnRectal and Anal disordersnBenign or malignancy tumornTumor or mass outsidenSystemic diseases or conditions(e.g.disorders make dyscinesia:spasm and paralysis）Organic constipation Classifi75文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Rectal and Anal disordersCancerNevusanal fissureanal fistulaProctoptosis(直肠脱垂）Rectal and Anal disordersCance76文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。intestinal obstructionintestinal obstruction77文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Benign or malignancy tumorPolypCancerBenign or malignancy tumorPoly78文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Outside tumor or massOutside tumor or mass79文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Systemic diseases or conditionsGastro-paresisDiabetes mellitus;DMUremiaMyasthenia gravisHypothyroidismHematoporphyriaLead poisoning胃轻瘫糖尿病尿毒症重症肌无力甲状腺机能低下血卟啉病铅中毒Systemic diseases or condition80文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Characteristics of manifestation急性便秘常伴随原发病的表现：腹痛、腹胀、恶心呕吐、排气停止，见于各种原因的肠梗阻。慢性便秘可有消化不良症状：便秘型IBS：大便形状：1.散粒2.团粒3.柱粒4.条形5.堆6.片7.水Characteristics of manifestati81文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Accompanying symptoms1。呕吐、腹胀、肠绞痛，提示肠梗阻2。伴包块：提示肿瘤、肠结核、Crohn病3。便秘腹泻交替：肠结核、IBS、UC4。继发于生活、环境改变：功能性Intestinal obstructionTumor,TB,Crhons diseaseTB,IBS,UCFunctional constipation1.Vomiting,abdominal distention,Intestinal colic2.Mass3.With diarrhea alternatively4.Change in routineAccompanying symptoms1。呕吐、腹胀、82文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。恶心呕吐宣讲ppt课件83文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。恶心呕吐宣讲ppt课件84文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Important information for etiological diagnosisa)Ageb)GI history requiredc)Food habitd)Condition related(living,working,communicating,psychology)e)Consistency f)course of diseasesg)Frequency h)form,texture,Odor,Content,i)Increased straining,Sensation of incomplete j)Weight lossk)Precipitating factorsl)Medicationsm)Disorders outside gastroenterologyImportant information for etio85文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。今天告诉你的事情可要记牢吆！今天告诉你的事情可要记牢吆！86