消化系统疾病-30胃肠道中英文8a校haemorrhaghic unterer

UpdateonHGEin StefanClinicforSmallAnimalMedicine,LMU Outline大DefinitionofAHDS急 性腹泻综合征的定Updateonpathogenesis发病机理 进roleofClostridiumperfringensandCltoxins产气荚膜梭菌及其毒素起的作Updateontreatment治疗 进Background-Literature研究背Majorityofpatientswithunknowncauseforhaemorrhagicdiarrhoeadespiteextensivework-up>50%ofcaseswithacutehaemorrhagicdiarrhoeadeclaredidiopathic>50%的急性 犬性胃肠炎 研究方S.UNTERER,T.E.YOO,B.SCHULZ,K.ClinicofSmallAnimalMedicine,ilianUniversityMunich,JournalofVeterinaryInternalMedicine2008;22:1460)Background-Literature研究背景－文Idiopathicacutehaemorrhagicdiarrhoea自发 firstdescribedin1972(Hill1972首次于1972definedasaspecificsyndromein1977:gastroenteritis(HGE)(Burrows, 性胃肠Background-Characteristics研究背景ToyandMiniaturebreeds(Hill,1972;Burrows,1977;PostandFeldman, Acutevomiting,oftenbloody急 ，常带Acutehaemorrhagicdiarrhoea急 性腹(Burrows,1977;TrioloandLappin,Haematocrit (SpielmanandGarvey,Diagnosisofexclusion(ofcommoncausesforacutehaemorrhagicdiarrhoea)排除性诊断（排除急 性腹泻的常见原因PatientwithHGErectalandurinarycatheterOutline大DefinitionofAHDS急 性腹泻综合征的定patientcharacteristics患犬特Updateonpathogenesis发病机理 研究进roleofClostridiumperfringensandCl.产气荚膜梭菌及其毒素所起的作Updateontreatment治疗 进Summaryofnew 研究方向简Question问WhatWhatcharacterizeshaemorrhagicgastroenteritis(=acutehaemorrhagicdiarrhoeasyndrome)? 征犬的急 性腹泻综合征：108F.MORTIER,T.E.YOO,K.STROMEYER,K.HARTMANN,S.ClinicofSmallAnimalMedicine, ilianUniversityMunich,VetRec.2015Studygoals研究目DescriptionofsignalementclinicalcourselaboratorychangesIdentificationofparameterstodifferentiatebetweenHGEandotherdiseasescausinghaemorrhagic找出区 MaterialandMethods材料和方Prospectivepatientrecruitment(n=预定病例招募数量Inclusioncriteria入选条件acutehaemorrhagicdiarrhoea(<3急 性腹泻（<3天Exclusioncriteria排除条件knowncauseforhaemorrhagic已知引 性腹泻的病Controlgroups对照12360patientsduringrecruitmentperiod招募期间12360只患MaterialsandMethods材料和方Diagnosticstoexcludeknowncausesofhaemorrhagicdiarrhoea排除已知病因引起的 物laboratorywork- 检(haematology,chemistryincl.bileacidsandcPLI,coagulation（血液学检查，生化检查包括胆汁酸和犬胰腺炎，凝血功能检查fecalexam粪(helminths,giardia, ,bacteria)（线虫 鞭毛虫，细小毒，细菌diagnosticimaging影像学诊MaterialsandMethods:AHD- ActivityAppetite

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>MaterialsandMethods:AHD-材料与方法：急 ScoringSeverityScore得分0-4-6->notSummary小PraedispositionforAHDS:AHDS易youngtomiddleageddogs青年至中年toyandminiaturebreeds玩具和迷mostlypriortohaemorrhagicdiarrhoea大多数先 性腹泻发Haematocritsignificantlyhigherthanincontroldogs显著高于对照组only1/3ofdogs60只有1/3大于Goodprognosiswithintensivetherapy强化治疗预后良Question问WhichWhichmorphologicmucosalchangescanbefoundindogswithHGE?Endoscopicallyvisualizedlesions,histologicalfindingsandbacterialinvasioninthegastrointestinalmucosaofdogswithacutehemorrhagicdiarrheasyndrome急性 S.UNTERER,K.BUSCH,M.LEIPIG,W.HERMANNS,G.R.K.STRAUBINGER,K.ClinicofSmallAnimalMedicine,LMUMunich,InstituteofVeterinaryPathology,LMUMunich,InstituteforInfectiousDiseasesandZoonoses,LMUMunich,JournalofVeterinaryInternalMedicine2014;28:52-StudyGoal研究目Describe分type类ofendoscopicandhistologicchangesinthegastrointestinaltractofdogswithHGEHGE患犬胃肠道的内窥镜及组织学病MaterialsandMethods材料和方Prospectivepatientrecruitment10dogs预定病例Inclusioncriteriaacutehaemorrhagicdiarrhoea3daysExclusioncriteriaknowncauseofhemorrhagicdiarrhoea已知引起出MaterialsandMethods材料和方PatientshadtobestableforEndoscopicevaluationofgastrointestinaltractandretrivalofleast8biopsiesfromthefollowing stomachileumcolonResults–Endoscopic结果－内窥镜评GastricmucosanorelevantchangesareawithpronouncedchangeshighcasetocasevariabilityinseverityResults–Endoscopic结果－内窥镜评DuodenumshortenedDuodenumshortened肠绒毛缩necroticvilli肠hyperaemiain H&E,Colonnecrosisofaswellcryptlamina(PictureProf.W.Summary小GastricmucosanorelevanthistologicchangesDuodenalandcolonicmucosaacute,mostlynecrotisingseverityanddistributionvariablebetweenchangesincreaseinseverityfromproximaltointestinalOutline大DefinitionofAHDSAHDS的定Updateonpathogenesis发病机理 研究进roleofClostridiumperfringensandCl.toxins产气荚膜梭菌及其毒所起的作Updateontreatment治疗 进Summaryofnew 研究方向简Futureprojects/studies未来的研究课Question问WhichroledoClostridiumspp.playinEndoscopicallyvisualizedlesions,histologicalfindingsandbacterialinvasioninthegastrointestinalmucosaofdogswithacutehemorrhagicdiarrheasyndrome急性 S.UNTERER,K.BUSCH,M.LEIPIG,W.HERMANNS,G.R.K.STRAUBINGER,K.ClinicofSmallAnimalMedicine,LMUMunich,GermanyInstituteofVeterinaryPathology,LMUMunich,GermanyInstituteforInfectiousDiseasesandZoonoses,LMUMunich,JournalofVeterinaryInternalMedicine2014;28:52-StudyGoal研究目DetectionofC.perfringenshistologyimmunhistologycultureinthesmallintestinaltractof10dogswithAHDS从10AHDS患犬的小肠中取MaterialsandMethods材料和方Biopsyforhistologyandendoscopyofsmallintestinessterilesingle-useforcepsinsertedthoughsterile通过无菌引导器插 firstduodenalbiopsyforculturesubmittedwithin30minutesof活检样本须在30分钟内送检培Results–Histology结果－十二指肠组织学检necroticnecroticvilli肠绒坏withinnecrosishighnumbersofshortdescribed„Clostridialtypebacteria“短杆菌，Giemsa(PictureProf.W.ResultsConfirmationofpresenceofClostridiumspp.insmallintestines(immunohistochemistryorculture确定小肠内出现产气荚膜梭菌（免疫组studygroupin10/10controlgroupin1/11Summary小C.perfringensseemstobeimportantinthediseasepathogenesisindogswithAHDS产气荚膜梭菌似乎对犬significantlymoreoftenpresentinsmallintestinesindogsepitheliallesionscharacteristicforCperfringensinfectioninotherspecies上皮病灶符合典型的产气荚膜梭菌特征（其它动物种presenceofbacteriaandepitheliallesionscloselyassociated细菌noothercauseforepithelialnecrosisidentified没有鉴别出其它导Question问AreArespecificC.perfringensgenotypesresponsibleforAHDS?特 ofC.perfringensisolatesfromeightdogswithacutehaemorrhagicdiarrhoeasyndrome从8只AHDS患犬上分离出产气荚膜梭 S.UNTERER,K.BUSCH,J.VERSPOHL,G.R.K.STRAUBINGER,K.ClinicofSmallAnimalMedicine,LMUMunich,InstituteforMicrobiologyandDepartmentofInfectiousDiseases,UniversityofVeterinaryMedicine,Hannover,GermanyInstituteforInfectiousDiseasesandZoonoses,LMUMunich,ECVIMcongress,StudyGoal研究目GenotyofC.perfringensstrainsisolatedfromduodenumindogswithAHDS对从AHDS患犬十二指肠获得的产气荚膜梭菌分离株进行分型MaterialsandMethods材料和方Biopsyforbacterialculturesmallintestinalendoscopysterilesingle-useforcepsinsertedthroughsterile通过无菌引导器插 initialduodenumbiopsyforculturedonewithin30minutesof活检样本须在30分钟内送检培8/11patientswithC.perfringensclassificationviaMALDI-TOFMS通过MALDI-TOFMaterialsandMethods材料和方MultiplexPCR多元PCRBaumsetalmajor

beta2 Results12345678(αtoxinα毒素++++++++(βtoxinβ毒素________(β2toxinβ2毒素_++++_+_(εtoxinε毒素________(ιtoxinι毒素________cpe________Summary小C.perfringenstypeAmostimportantgenotypeinAHDS型产气荚膜梭菌是导致AHDS的最重要 ConclusionC.perfringensenterotoxinmostlikelynotresponsibleforepithelialdisruption产气荚膜梭菌Outline大DefinitionofAHDSAHDS的定Updateonpathogenesis发病机理 进roleofClostridiumperfringensandCltoxins产气荚膜梭菌及其毒素起的作Updateontreatment治疗 进incidenceofbacteraemia菌血症的发生indicationsforantibiotics使用抗生素的指Summaryofnewaspects新的研究方向简Futureprojects/studies未来的研究课Question问AreArepatientswithAHDSatanincreasedriskforbacterialtranslocation/sepsis?Theclinicalsignificanceofbacterialtranslocationindogswithhaemorrhagicdiarrhoea急 性腹泻综合征患犬发生细菌迁移的临床意S.UNTERER,E.LECHNER,R.S.MUELLER,G.R.K.STRAUBINGER,B.S.SCHULZ,K.ClinicofSmallAnimalMedicine,LMUMunich,InstituteforInfectiousDiseasesandZoonoses,LMUMunich,VetRec.2015StudyGoals研究目IncidenceofbacteriaemiaindogswithAHDSInfluenceofbacteraemiaonclinicalparametersselectedrelevantlaboratoryparameters有关的survivalrateMaterialsandMethodsBloodculture(studygroupn87controlgroupn21研究组87；对照组2sterilebloodsamplesdrawnfromjugularveinwithin30minutes30分钟内从颈静脉抽取两组无菌血液transfered intobloodculturesystems立即转移到血液培养装置ResultsPatientgroup14/87dogs(16%)withpositivein4/14dogscontaminants4/14例污incidenceofbacteraemia:11Controlgroup3/21dogs(14%)withpositivein0/3dogscontaminants0/3例污in3/3dogsbacterialtranslocation3/3例细菌迁incidenceofbacteriaemia:14ResultsDogswithAHDS(n10阳性(n77阴性pHeartrateRespiratoryrateHospitalization33reportedasmedian记录中ns:notsignificantafterBonferronins：用Bonferroni校正后差异不显Results(n10(n77阴性pLeukocytesx109/l)Bandsx109/l)ALTU/LBilirubinµmol/lTotalproteing/l)Albuming/l)Glucosemmol/lreportedasmedian记录中nsnotsignificantafterBonferronicorrectionns：用BonferroniSummary小IncidenceofbacteraemiaindogswithADHSlowandnotdifferenttothatinhealthydogsAHDS患犬的菌血症发生率低与健康犬相较无差Bacteraemianoinfluenceonclinical菌血症对病程发展无影ConclusionNodiagnosticvalueofbloodculturesindogswithADHSBenefitofantibioticsQuestion问DoDopatientswithAHDSneedTreatmentofasepticdogswithhemorrhagicgastroenteritisamoxicillin/clavulanicacid:aprospectiveblinded使用阿莫西林克拉维酸钾治疗无菌 性胃肠炎犬：前瞻性单盲实S.UNTERER,K.STROHMEYER,B.D.KRUSE,C.SAUTER-LOUIS,ClinicofSmallAnimalMedicine,LMUMunich,ClinicforRuminants,LMUMunich,GermanyJournalofVeterinaryInternalMedicine;25:973-9StudyGoal研究目Evaluationofantibiotictreatmentwithamoxicillin/clavulanicacidindogswithAHDS MaterialsandMethods材料和方ProspectiveblindedtreatmentPatientgroupdogswithAHDS3 Placebo(n=Placebo(n=Treatment(n=AHDSpatients(n=60)AHDS患Results-Treatment结果－治疗Nosignificantdifferenceinclinicalcourselengthofhospitalization(medianindays天数中值treatmentgroupplacebogroupstudydrop-outs/mortalityrate率Results-AHD结果－AHD指Placebo(n= Antibiotics(n=

DayDayDayDayDayDayDaySummary小Amoxicillin/ClavulanicacidhasnobenefitinpatientswiththathavenosignsofsepsisorasystemicinflammatoryAHDS患犬没有帮Closepatientmonitoringnecessaryexclusionofbacterialinfectiondifficultriskofbacterialtranslocationsmallbutpresent细菌迁移的风险小NewInsights新的观Clinicalpresentationandprogression临床表现及病程发goodprognosiswithaggre