消化系统疾病-30胃肠道中英文2校spitting up unterer

MedizinischeLudwig-ilians-Universität„Spitting”吐出”Dr.StefanUntererDiplomateCase1Cindy病例8months8月龄 Vomitingsince3days,2-4timesdaily,yellow Diarrheasince1day,4timesdaily,softtowaterystool,ratherdarkcolour腹泻1天，1天拉4次，软便Case1Cindy病例PhysicalexaminationDepressed,dehydrated精神沉郁

Howwouldyoutreatthisdog?你如何治疗这Whyisthedogvomiting?狗的原因是什Doweneedadditionaltests?HematologyHematocrit42TotalWBCx4.7–MCHC34–MCV64– etsx130–Band00Segmented2496–119–00–198–1154–42白细胞总数x4.7–MCHC34–MCV64–130–002496–119–00–198–1154–2.5–Glucose4.1–Urea3.8–Creatinine64–56–AlbuminCholesterol29–3.5Alkalinephosphatase20–Amylase377–Alanineaminotransferase20–Sodium152–Potassium4.3–生血糖(mmol/l)2.5–4.1–3.8–64–总蛋白56–白蛋白29–3.5–碱性磷酸酶20–377–20–152–4.3–SpecificgravityGranulatedcastsProtein-creatinineratio

0-

红细胞 0-白细胞/ 0- Additionaltests Abdominalradiographs腹部XWNL Fecalexamnoparasitesfound ParvotestnegativeAssessment Doghasrenaldysfunction Vomitingcanbeexplainedbyuremictoxins呕 Acuterenalfailurehistory,glucosuria,granulatedDiagnosisLeptospirosis钩端螺旋 sv.Icterohemorrhagiae黄疸 sv.australis (Chemoreceptortrigger N.sympathicus交感神Cerebrocortical大脑皮层通 (Chemoreceptortrigger N.sympathicus交感神Cerebrocortical大脑皮层通 (Chemoreceptortrigger

N.sympathicus交感神Cerebrocortical大脑皮层通Extra-alimentarytractdisease消化道外疾 Case#64856 IrishSetterCastratedmale12years12Case#64856 Vomitingforacoupleofdays多Laboredrespiration/dyspnea呼吸费力/MildDyspneaTemp.39,6°C体温Case#64856 Laboredrespiration/dyspnea呼吸费力/ElevatedrectaltemperatureCase#64856 Respiratorytractupper/lower)呼吸道（上/下Parenchymaldzofthelungs(e.g.ponia)肺实质疾（如：Pleuraldz(e.gpleuraleffusion)胸膜疾病(如：胸腔积水Cardiovasculardz(e.gedemathrombosis)（如：水肿，血栓Pain,fever….疼痛，发热Case#64856 Assessment(Interpretation):Respiratorytract(upper/lower)呼吸道（上/下Parenchymaldzofthelungs(e.g. 肺实质疾病(如 Pleuraldz(e.g.pleuraleffusion)胸膜疾病（如：胸水Cardiovasculardz(e.g.edema,Pain,fever疼痛，发热Diagnosticplan:•Thoracicrads胸部X光片•Case#64856 ElevatedrectalHyperthermiavs.truefeverVSInflammation炎Paraneoplastic副肿瘤综合Immunemediated免疫介导Case#64856 Assessment:FeverInflammation(steril/infectious)炎症（无菌性 性RespiratorytractMonitorrectaltemperatureThoracicrads胸部XCase#64856 Case#64856 Case#64856 Case#64856 Case#64856 Aspirationponia排查：吸入ReducedmentalstatusCase#64856 Aspirationponia排查：吸入ReducedmentalstatusNeuromusculardzCase#64856 Aspirationponia排查：吸入ReducedmentalstatusNeuromusculardzPharynxCase#64856 Aspirationponia排查：吸入ReducedmentalstatusNeuromusculardzPharynxIatrogenicCase#64856 Aspirationponia排查：吸入ReducedmentalstatusNeuromusculardzPharynxIatrogenicDiagnosticplan诊断列Case#64856 Aspirationponia排查：吸入ReducedmentalstatusNeuromusculardzPharynxIatrogenicDiagnosticplan诊断列Testpharyngealandesophagealfunction检测咽和食管Case#64856 Case#64856 Esophagealhypomotility食管动力不1.吐Vomiting1.吐Vomiting-Passiveretrogradeexpulsionofprimaryesophageal Definingtheproblem确定症VomitusRegurgitation返signs前驱症 no Bile胆 sometimes偶尔 noDigested noRegurgitationRegurgitationDifferentiationfromvomiting和相鉴别Stillconfusedaftertakingacompletehistory?PerformThoracic +/-bariumRegurgitationDifferentiationfromvomiting和相鉴别Stillconfusedaftertakingacompletehistory?PerformThoracic +/-bariumFall#65142LabradorRetriever7months7Vomitingsince24hours24小Digestedfoodyellowmucous摄入的食Fall#65142LabradorRetriever7months7Vomitingsince24hours24小Digestedfoodyellowmucous摄入的食 吐

Spitting CoughingSpitting吐

鉴 CoughingCoughingwithexpectoration咳嗽伴有痰Dogsarefrequentlygaggingaftercoughing犬在咳嗽后常发RuleoutcoughingandrespiratorysignsindogspresentedwithVomitingCoughing(aspirationp咳嗽（吸入性Coughing咳嗽Spitting1.1.- --Spitting1.1.- -- Extra-alimentary GastrointestinalCase#Mixedbreeddog混3years3Castratedmale去势 HistoryVomitingsinceweeks,initiallyfood,nowwaterand多周，最开 食物，现在是水和胆Weightloss体重减轻Case#Depressed,Pulse150 脉搏 SoftabdomenonHowwouldyoutreatthisdog?你接下来会如何做？Whyisthedogvomiting?的原因是什么？Doweneedadditionaltests?是否需要的检查Hematocrit42TotalWBCx4.7–MCHC34–MCV64–etsx130–围42白细胞总数x4.7–MCHC34–MCV64–130– Glucose Urea Creatinine Albumin Alkalinephosphatase Alanineaminotransferase Sodium Potassium Totalcalcium Inorg.phosphate

2.5–4.1–3.8–64–56–29–20–20–152–4.3–2.4–1.0– 围总胆红素2.5–4.1–3.8–64–总蛋白56–29–碱性磷酸酶20–20–152–4.3–总钙2.4–无机磷110–1SpecificgravityErythrocytes/HPFLeucocytes/HPF

0-

.....0-0-Abdominalradiographs腹部XAbdominalradiographs腹部XAbdominalradiographs腹部XLackofserosaldetailObstructivepattern(foreign AbdominalultrasoundS-likeAssessment评 ForeignbodyinsmallintestineDetectedonradiographsandultrasound Azotemiaduetodehydration Vomitingdueto原DiagnosisPathophysiology病理生理 Neural

N.vagusN.NeoplasticAlimentarytractobstruction消化ForeignbodyInvaginationTissueproliferation组织增GastriccancerGastricmucosalMalpositioningofthestomachDifficulttodiagnoseRadiographsattherightmomentSherry#Signalement基本信Europeanshorthair7years7SpayedfemaleVomitingsincemonths数Previoustreatment/total/Sherry#/total/GastrointestinalObstructionGastricoutflowtractobstructionGastrointestinalObstruction胃肠道梗Electrolyteandacid-baseabnormalitiesduetovomitingareunpredictableHypochloremia(51%)低氯血症Alkalosis(45%) Hypokalemia(25%)低钾血症Hyponatremia(20%)低钠血症mostcommonelectrolyteandacid-baseabnormalitiesregardlessofthesiteofforeignbodies JVetInternMed2005;19:816–821,A.K.HypochloremicalkalosisSherry#Sherry#Sherry#SmallSherry#Sherry#Sherry#Enlargedmesentericlymph PartialobstructionSmallSpittingUp1.-呕吐-SpittingUp1.-呕吐-2.

Extra-alimentarytractdisease消化道外疾病Gastrointestinaldisease胃肠道疾病GastrointestinalobstructionCase8years8岁Female雌 History病Vomitingsince1week,oncedaily,undigested1周，每天1次，吐未消化的Previouslyseveralepisodesof之前间歇性的发生Reducedappetite食欲下Depressed精神沉OnfurosemideandACE-inhibitor(Mitralvalve正在服 和ACEI药物（二尖瓣闭锁不全CasePhysicalexamDepressed, Pulse110

Systolicmurmur HowwouldyoutreatthisdogWhyisthedog DoweneedadditionaltestsHematocrit42TotalWBCx4.7–MCHC34–MCV64–Plaetsx130–围42白细胞总数x4.7–MCHC34–MCV64–130– Reference Glucose Urea Creatinine Albumin Alkalinephosphatase Alanineaminotransferase Sodium Potassium Totalcalcium

2.5–4.1–3.8–64–56–29–20–20–152–4.3–2.4– 总血红蛋白2.5–血糖4.1–3.8–64–总蛋白56–29–20–20–152–钾4.3–总钙2.4–SpecificErythrocytes/HPFLeucocytes/HPF

0-尿..原.红细胞0-Additionaltests Fecalexamnoparasites Abdominalradiographs腹部X Abdominalultrasound Vomitingandproteinlossduetoduodenal Fordefinitivediagnosis(infiltrativeinflammatory,neoplastic,ulcerative,systemicdisorder)abiopsysampleisrequired确诊需要活检（浸润性炎症，肿瘤，溃疡，全身性疾病Nevermakeamicroscopicdiagnosiswithoutamicroscope!!DiagnosisInflammatorybowelVomitingGastrointestinalInflammation胃肠道炎GastrointestinalInflammation胃肠道炎RuleoutparasitesFoodallergyTreatspirochetesifpresentandnootherEnteritisisamuchmorecommoncauseofvomitingthangastritisinboth,dogandcatEnteritisoftencausesvomitingwithoutdiarrheaoranyothersigns InflammationInflammationof„visceral Inflammationof„visceral Stretchingof„visceral内脏包膜的牵Spitting1.-呕吐-Spitting1.-呕吐-2. Extra-alimentarytractdisease消化道外疾病 Gastrointestinaldisease胃肠道疾病 StretchInflammationTreatment治 Vomitingisa Don´tforgettolookforandtreatanyunderlyingdisease寻 Anitemeticsareindicatedif若出现以下情况，需要使用止HydrationstatusisdifficulttoPatientisin Patienthasacuteself-limitingcauseofAntiemetics止吐Promazine(Chlor-,Prochlor-,Veryeffective止吐效果Vasodilatatory,hypotensive,sedative扩张血管，低血压，效 Prokineticeffect促动力效 VerypotentandveryAntiemetics止吐Maro