欧兽胃肠道内科学

OrganizationChartTherapeuticTherapeutic治疗失Wrong误OrganizationChartTherapeuticTherapeutic治疗失Wrong误Rightdiagnosis治疗错Wrong误

OrganizationChartTherapeutic治疗失Rightdiagnosis治疗错

Rightdiagnosis诊断正确Righttreatment治疗正确

RihtdianosisWrongDEFININGTHE症状辨前驱症

Usually常 No Usually常 NoBile胆 NoDigested便

NoIfitlookslikevomiting,itisprobablyvomitingIfitlookslikeregurgitation,thenyoudon’treallyknowforsure如果它看起来是那八成它就是如果它看起来像在反那我们确实无法确定它在干 TAMUSig:4monthFGermanshepherdCC:Febrile主诉：发热HPI:1monthago:dogfebrile+soft,moistcoughWascuredwithantibiotics3daysagohadsame病史：1个月前：发热，咳嗽弱，带痰；曾使用抗生素治 T=39.7CInspiratorycrackelsinright 右肺吸气阶TAMU TAMUTAMU TAMU Sig10yrM(c)Mixedbreed基本信息：10岁，雄性(已去势），混种CC:Coughing主诉：咳HPI:Coughingbegan2yearsagoandisnotcontrolledwithanymedications.Dogvomitingforlast2 TAMU 2yrM(n)基本信息：2岁，雄性（已去势），柯利 “Vomiting”,coughing主诉 ”，咳HPI:Problemsbean10dasaNowarningwhenthrowsupNobilenoted Otherwisenormal体格检查未见其他异MajorCausesofAcquiredEsophagealWeakness•MyastheniagravisHypoadrenocorticism(usuallyVariousSpirocerca获得性食道迟缓的主要原特发重症肌无力（局部肾上腺皮质机能减退（通常 型多种肌病和神经病狼旋尾线TAMUAntibodiestoAcetylcholine0.1nmol/L(<抗乙酰胆碱受体抗体浓0.1nmol/L(<MYASTHENIA肌无Localizedandgeneralized局灶性和全身MostcommonlydiagnosedcauseofacquiredBesttestisAnti-acetylcholinereceptors最好的检测是抗乙酰胆碱受体（AchR）抗体检Mayneedtorepeattestin6monthsSpontaneousremissionsoften常见自Mustkeepaliveuntil症状缓解之前都需要警THERAPYFOR肌无力的治Localizedandgeneralized局灶性和全身Pridostimine吡斯的NOTphysostigmineorTreattheimmunebasisofthe治疗免疫失AzathiorineImuran–mabe咪唑硫嘌呤（依木兰）-可能NOT禁用类固醇类药TAMUCreatinine肌酐=1.9mg/dl(<2.0)Calcium钙= 11.3mg/dl(9.3-11.8)Glucose葡萄糖=136m/dl60-120)Sodium=Potassium=Albumin白蛋白=

156mEq/L(138-3.0mEq/L(3.8-3.2gm/dl(2.5-ALT谷丙转氨98IU/lTAMURestingcortisol刺激前可的松浓度

0.90.9PostACTHcortisol= 0.9ug/dlACTH刺激后可的松浓度=0.9肾上腺皮质机能减Infre causesmeaesohaus经常引起巨食道症，但是espcommoninpoodles(espblack尤其在贵宾犬中常见（尤其是黑色贵宾犬seldomcauses↓Naor↑Kwhenitproducesmegaesophagus(atypical)当期引起 型）巨食道症时，很少造成低钠或高肾上腺皮质机能减restingcortisol ood 刺激前可的松检测时很好的排查检easyandrewardingto治疗简单且见效don’tusesteroidsastherapeutictrialunlessyouareSUREdoghashypoadrenocorticism肾上腺皮质机能减病病因找CauseTreatTreat治疗疾MajorCauseofCongenitalEsophagealWeakness性食道迟缓的主要原特发贲门失弛缓症样综合反获得性迟

性迟Lookfor

特发病因找

特发

Treat治疗疾THERAPYFORCONGENITAL性食道症的治Dietary Gruel泡软THERAPYFORCONGENITAL性食道症的治Dietary Gruel泡软Meatballs(espwithpartial肉丸（特别是在不完全迟缓的病例中Cannedfood罐Dryfood干NormalfindinginBulldogsandShar斗斗牛犬和沙皮犬的影像学正常表MSUSig:5yrF(s)

主诉 HPI:Vomitin bean1weekao.No signs;producesfoodbutnobileorblood PE:Obese,体格检查：肥胖，虚“...manydoctorsinthisspeciality[radiology]relyheavilyonfirstimpression–gestalt–rapidlydistinguishingnormalfromabnormal,drawingconclusionswithinsecondsofviewinganimage.”，看了几秒钟影像结果便得出结论。page179,J.Thenextthreedogsallhavethesamedisease–whatisit?接下来的三只犬所患为同种疾是什么病TAMUSig:2yrM(c)基本信息：2岁去势雄性达尔玛西亚犬CC:“Vomiting”主诉 HPI:Presentsincegotdog1monthago.Dogeatsravenously,thenvomitsfoodwithin3-4minutesofeating.Nobileorbloodseen.Dogdroolsconstantly.Recentlyhastroubleswallowing Not体格检查：未见明显异TAMUSig:5monthFGermanshorthairedCC:“Vomiting”主诉 HPI:Startedvomiting8daysago.Started clearliuid.Nextda vomitedbloodandsticks.Laparotomyshowedinflamed nowvomitsfluid&blood. PENormal体格检查：正TAMU PCV=20%(35-红细胞压积=20%（35-Profile:Albumin=1.9gm/dl(2.5-白蛋白=1.9mg/dl（2.5-TAMU Sig:10yrF(s)基本信息：10岁绝育雌 HPI:Beganvomitingbile21daysago.Surgery–removedlinearforeignobjecton12daysago.Vomitingcontinues:2ndsurgery9daysago–findnothing 异物。吐 ：9天接受二次手术——未发现异常。 Depressed,tight体格检查：情绪低落，腹壁紧Whichdiseasedothesedogs这些患犬患有什么病BEsohaealforeinHiatalhernia食道裂孔

食道异Esophagitis食道Spirocercalupi狼旋尾线E-ESOPHAGITIS:食道炎：病Organisms(especially原（尤其是真菌ESOPHAGITIS:食道炎：病Organisms 原（真菌Foreignobjects异ESOPHAGITIS:食道炎：病Organisms 原（真菌Foreignobjects异ESOPHAGITIS:食道炎：病Organisms 源（真菌Foreignobjects异Causticagents刺激性物质doxycycline多西环素clindamycin克林霉素ESOPHAGITIS:食道炎：病Organisms 源（真菌Foreignobjects异物Gastricacid胃酸Excessivegastricacidity胃酸分泌过ESOPHAGITIS:食道炎：病Organisms 源（真菌Foreignobjects异物Gastricacid胃酸Excessivegastricacidity胃酸分泌过Excessive 过ESOPHAGITIS:食道炎：病Organisms 源（真菌Foreignobjects异物Gastricacid胃酸Excessivegastricacidity胃酸分泌过Excessive 过IatrogenicIatrogenic(postanesthesia)医源性（麻醉后ESOPHAGITIS:食道炎：病Organisms 源（真菌Foreignobjects异物Gastricacid胃酸Excessivegastricacidity胃酸分泌过Excessive 过Iatrogenic(postanesthesia)医源性（麻醉后Spontaneousgastric自发性胃酸反ESOPHAGITIS:CLINICAL食道炎：临床症Milddisease:“spitup”white轻度发病：“吐出”白ESOPHAGITIS:CLINICAL食道炎：临床症Milddisease:“spitup”white轻度发病：“吐出”白Moderatedisease:poorappetite,regurgitatefood中度发病：食欲差，食物反ESOPHAGITIS:CLINICAL食道炎：临床症Milddisease:“spitup”white轻度发病：“吐出”白Moderatedisease:poorappetite,regurgitatefood中度发病：食欲差，食物反Severedisease:anorexiadroolinseverepain,regurgitation,vomiting重度发病：厌食、流涎、剧痛、反流ESOPHAGITIS:食道炎：诊History(e.g.,repeatedvomiting,prior病史（如：术前反 ESOPHAGITIS:食道炎：诊History(e.g.,repeatedvomiting,prior病史（如：术前反 Physicalexamination(oral体格检查（口腔病变ESOPHAGITIS:食道炎：诊History(e.g.,repeatedvomiting,prior病史（如：术前反 Physicalexamination(oral体格检查（口腔病变Radiographs(lesionsmaybeX线检查（病变可能很轻微ESOPHAGITIS:食道炎：诊History(e.g.,repeatedvomiting,prior病史（如：术前反 Physicalexamination(oral体格检查（口腔病变Radiographs(lesionsmaybeX线检查（病变可能很轻微Endoscopy(mostsensitive&内窥镜检查（敏感性和特异性均最佳PRINCIPALSOF治疗原TheesophagusisNOTsensitiveto食道对酸不敏CHEMICAL化学清Theulcerated/erodedesophagusisULTRA-SENSITIVEtoevenminuteamountsofacidYoumusttrytocomple y“clear”thestomachofacid你必须尽量将胃里的酸完全“清除ESOPHAGITIS:食道炎：治Protonpump–质子泵抑制H-2receptorH-2受体拮抗ANTI-ACIDDRUGS:抗酸药：质子泵抑制剂 inhibitors质子泵抑制IrreversiblyinhibitH+-K++Omeprazole(1-2m 奥美拉唑（1-2mg/kgPOPantoprazole(1mg/kgIV泮托拉唑（1mg/kgIVANTI-ACIDDRUGS:抗酸药：质子泵抑制剂Startworkingimmedia y,butrequire2-5daystoachieve aleffect可能引起腹ESOPHAGITIS:食道炎：治Reflux:thetwo-edgedsword反流：双向通Gastroesophagel胃食道反

食道ESOPHAGITIS:食道炎：治Reflux:thetwo-edgedsword反流：双向通Gastroesophagel胃食道反

食道食道

Gastroesophageal胃食道反ESOPHAGITIS:食道炎：治Reflux:thetwo-edgedsword反流：双向通Gastroesophagel 胃食道反 食道食道

Gastroesophageal胃食道反ESOPHAGITIS:食道炎：治ANTACIDS抗酸治PROKINETICS促动力治VolumeCisapride(0.1-0.5mg/kgPOq12-24h)betterthanmetoclopramideMosaprideavailablesoon?Metoclopramide(0.25mg/kgIV,PO,q8-12h)moreeffectiveonliquidsRanitidine(2.2-4.4mg/kgPO,IVq8-容量清 利(0.1-0.5mg/kgPOq12-24h)比甲氧氯普胺好莫沙必利很快可以买到了?甲氧氯普(0.25mg/kgIVPOq8-12h)注射剂更雷尼替丁(2.2-4.4mg/kgPOIVq8-ESOPHAGITIS:食道炎：治ANTACIDS抗酸治PROKINETICS促动力治gesics(esp疼痛管理（尤其是局部ESOPHAGITIS:食道炎：治ANTACIDS抗酸治PROKINETICS促动力治gesics(esp疼痛管理(特别是局部使用 4%viscouslidocaineor2%lidocainejellyat4-5ml/kgPO0.1ml/kgof4lidocaine4%ESOPHAGITIS:食道炎：治ANTACIDS抗酸治PROKINETICS促动力治gesics疼痛管Gastrostomytube(rarelyneeded)胃管(很少用到ESOPHAGITIS:食道炎：治ANTACIDS抗酸治PROKINETICS促动力治gesics疼痛管Gastrostomytube(rarelyneeded)胃管(很少用到ESOPHAGITIS:食道炎：治ANTACIDS抗酸治PROKINETICS促动力治gesics疼痛管Gastrostomytube(rarelyneeded胃管（很少用到Antibiotics/Steroids?抗生素/皮脂类固醇药物ESOPHAGITIS:食道炎：预防 Shouldwebegivingdogs/catspreanestheticdosesofPPI’sand/orWhatdotheseradiographs以下情况在X线片上的征象如何Segmentalesophagealweakness局部食道迟Esophagitis食道DForein 异EStricture狭Diverticulum憩E-LoweresohaealBlindpouchabouttoperforateEsophagealTAMUSig:1yrF(s)基本信息：1绝育雌吉娃 主诉：呼 ，喘鸣HPI:3monthsagowasspayed–noproblems:“soon”afterwardshad