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,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,恶心与呕吐,Nausea and Vomiting,Nausea and Vomiting,Definition of Nausea and Vomiting,Nausea ：the inclination or feeling of imminent desire to vomit, usually felt in the throat or epi-gastrum. Associated with decreased activity of the stomach.,Vomiting： the forceful oral expulsion of gastric contents via retro-peristalsis.,Nausea-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！,病因,1.,Reflective vomiting,反射性呕吐,2.,Central vomiting,中枢性呕吐,3,.,Neurological vomiting,神经性呕吐,Reflective vomiting （,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 Mechanisms,Gastrointestinal Mechanisms,Disease of biliary tract,Peritoneal and mesentery,the five sense organs,Cardiovascular diseases,kidney,Pelvic,咽部刺激,Pharyngal Mechanisms,Gastrointestinal Mechanisms,肝、胆、胰腺,其他,Intra-cranial infection,Cerebrovascular disorders,Craniocerebral injury,Epilepsy,Metabolic disorders,Drugs,Central vomiting （,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）,颅内感染（脑炎、脑膜炎）,脑血管疾病、颅脑损伤,癫痫,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,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,Neurologic & Psychogenic causes,Neurologic and Psychogenic causes,胃肠道神经官能症（,Gastrointestinal tract,neurosis）,神经厌食症（,apositia）,迷走兴奋表现,恶心,干呕,呕吐,发生机制,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。,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).,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。,反食：无恶心的感觉和呕吐反射的协调动作。（儿童、饱餐）,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,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,临床表现,Characteristics of,Nausea and Vomiting,Time,Taking food,Characteristics,Characters of contents,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,呕吐的时间,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,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,伴随症状,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,问诊要点,起病情况：,诱因、急缓、与进食关系、腹部手术史、育龄妇女月经史,发作时间,：晨、夜、与进食、活动、体位的关系,呕吐物性状、味道,伴随症状,诊疗和症状演变情况,谢谢！,
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