恶心呕吐.ppt.ppt

临床诊断学 上海第二医科大学仁济临床医学院 Goals Briefly define Outline 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. 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 Emetic Center Neurotransmitters in CTZ Emetic Center Neurotransmitters 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) Emetic Center 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 History/Background a) Age b) GI history required c) Food intolerance d) Timing with meals e) Consistency f) Content g) Odor h) Frequency i) Fever j) Weight loss k) Precipitating factors l) Myalgias（肌痛）, visual disturbances, headache, pain outside abdomen CAUSES OF NAUSEA/VOMITING Early pregnancy Psychogenesis vomiting Bulimia(易饿病) Pyloric channel ulcer Acute gastritis Gastric retention(潴留） Viral gastroenteritis（中毒性胃肠炎） Acute gastroenteritis Myocardial infarction Peritonitis（腹膜炎） Acute obstruction Neurological emergency Drug toxicity Cancer therapy Drug withdrawal PHYSICAL EXAM Vital signs Skin HEENT （head,eyes,ear,nose,throat) Abdomen Neurological LABORATORY Rule out obstruction and peritonitis HCG Urinalysis Electrolytes, BUN, creatinine, glucose Transaminases, amylase EKG, head CT, upper GI /or endoscopies Constipation Shanghai Second Medical university Renji clinical medical college Constipation Is a Constellation of Symptoms Most commonly reported symptoms Hard, lumpy stools Increased straining Infrequent bowel