欧兽胃肠道内科学3mail中文unterer2校spitting up

Dr.StefanUntererDiplomate Clinicalsymptomenotadisease症状-Case1Cindy病例8months8月龄Vomitingsince3days,2-4timesdaily, Diarrheasince1day4timesdaily,softtowaterystoolratherdarkcolour腹泻1天，1天拉4次，软便Case1Cindy病例PhysicalexaminationDepresseddehydratedPulse120bpm ,°CHowwouldyoutreatthisdog?你如何治疗这只狗？ isthedo vomitin?狗 Doweneedadditionaltests?是否需要 HematologyHematocrit(%)TotalWBCx103/μlMCHC(g/dl)MCVetsx103/μl

42 4.7– 34– 64– 130– 0 2496– 119– 0–

198–1154–42白细胞总数x4.7–MCHC34–MCV64–130–杆状中粒002496–嗜酸性粒细胞119–嗜碱性粒细胞00–单核细胞198–淋巴细胞

1154–2.5–Glucose4.1–Urea3.8–Creatinine64–protein56–Albumin29–Cholesterol3.5–Alkalinephosphatase20–Amylase377–Alanineaminotransferase20–Sodium152–PotassiumInorg.phosphate

1.0– 血糖(mmol/l)(μmol/l)淀粉酶(U/l)转氨酶

.

2.5–4.1–3.8–64–56–29–3.5–20–377–20–152– 1.0–SpecificgravityGranulatedcastsProtein-creatinineratio

白细胞/蛋白肌酐比

.Abdominalradiographs腹部XWNLFecalexamnoparasitesfoundParvotestAssessmentDoghasrenaldysfunction canbeexlainedb uremictoxins呕Acuterenalfailurehistory,glucosuria,granulated sv.Icterohemorrhagiae黄疸 sv.australis Humoralpathway

NeuralstimulationN.RenalfailureDiabetic 犬Case#64856犬Case#64856„Mild Case#64856„Case#64856„ Case#64856„(e.g.p Case#64856„ Case#64856„ Case#64856„ Case#64856„Case#64856„ Case#64856„Case#64856„Aspirationp SpittingUp

Regurgitation返Passiveretrogradeexpulsionofprimaryesophageal

signs前驱症状Digestedblood

usually通常有nousually通常有no无sometimes偶尔有no无sometimes偶尔有noDifferentiationfromvomiting和 Stillconfusedaftertakin acomletehistor?PerformThoracic +/-bariumFall#65142LabradorRetriever7months7Vomitingsince24 Digestedfoodyellowmucous摄入的食物，

Dosarefre aftercouhinRuleoutcoughingandrespiratorysignsindogspresentedwith fiCoughing(aspiration Coughing咳嗽fi咳嗽（吸入Coughing咳嗽fi

Extra-alimentarytract Case#3years3••Case#Depressed,Pulse150 脉搏 SoftabdomenonHowwouldyoutreatthisdog?你接下来会如何做？Whyisthedogvomiting? Doweneedadditionaltests?

Hematocrit 42TotalWBCx 4.7–MCHC 34– MCV 64–etsx 130– HalloSchnuck,unserLaborgibtMCHCinmmol/lan,schaudochno alnach,obdieg/dlstimmenoderobdu'sfalschabgeschriebenhast:-)sonstmüssenwirdasnoch 42白细胞总数x 4.7–MCHC 34– MCV 64– 130– HalloSchnuck,unserLaborgibtMCHCinmmol/lan,schaudochno alnach,obdieg/dlstimmenoderobdu'sfalschabgeschriebenhast:-)sonstmüssenwirdasnoch Glucose Urea Creatinine Albumin Alkalinephosphatase Alanineaminotransferase Sodium Potassium

2.5–4.1–3.8–64–56–29–20–20–152–4.3–calcium(mmol/l)Inorg.phosphate(mmol/l)

2.4–1.0– 血糖(mmol/l)(μmol/l)(mmol/l)(mmol/l)无机磷

2.5–4.1–3.8–64–56–29–20–20–152–4.3–2.4–1.0–SpecificgravityErythrocytes/HPFLeucocytes/HPF

.....LackofserosaldetailObstructivepattern(foreign -likeforeignForeignbodyinsmallintestine DetectedonradiographsandultrasoundAzotemiaduetodehydrationVomitingdue possibly

HastdunocheinanderesBild,woalledieMaskenaufhaben??Dasmachtnenschlechten Neural

N.vagus经N.

Gastric GastricmucosalMalpositioningofthestomachDifficulttodiagnoseRadiographsattherightmomentSherry#7years7Vomitingsince Ag-ELISAGiardiapos Sherry#/total/GastricoutflowtractobstructionElectrolyteandacid-baseabnormalitiesduevomitingareAlkalosis regardlessofthesiteofforeignbodiesJVetInternMed2005;19:816–821,A.K.Hypochloremicalkalosis Sherry#Sherry#SmallSherry#Sherry#Enlargedmesentericlymph PartialobstructionSmallSpittingUp

Regurgitation返

Extra-alimentarytractdisease消化道外疾病Gastrointestinaldisease胃肠道疾病8years8岁Vomitingsince1week,oncedailyundigestedfood Depressed -Pulse110

Systolicmurmur HowwouldyoutreatthisdogWhyisthedog Doweneedadditionaltests? Hematocrit(%)TotalWBCx103/μlMCHC(g/dl)MCVetsx

424.7–34–64–130–42白细胞总数x4.7–MCHC34–MCV64–

130– Referencebilirubin Glucose Urea Creatinine Albumin Alkalinephosphatase Alanineaminotransferase Sodium

2.5–4.1–3.8–64–56–29–20–20–152–Potassium(mmol/l)

4.3–2.4– (μmol/l)白蛋白(g/l)(mmol/l)

4.1–3.8–64–56–29–20–20–152–4.3–2.4–SpecificgravityErythrocytes/

Leucocytes/ 原红细胞...FecalexamnoparasitesAbdominalradiographs腹部XVomitingandproteinlossduetoduodenal Fordefinitivediagnosis(infiltrative stic,ulcerative,systemicdisorder)abiopsysampleisrequiredNevermakeamicroscopicdiagnosiswithoutamicroscope!! torybowel Histologicdiagnosis RuleoutparasitesTreatspirochetesifpresentandnootherEnteritisisamuchmorecommoncauseofvomitingthangastritisinboth,dogandcat Enteritisoftencausesvomitingdiarrheaoranyother tionof

Regurgitation返

Extra-alimentarytractdisease消化道外疾病Gastrointestinaldisease胃肠道疾病Visceraldisease内脏疾病Stretch→ isasm Don´tforgettolookforandtreatanyunderlyingdisease寻Anitemeticsareindicatedif若出现以下情况，需要使用止HydrationstatusisdifficulttoPatientisinseverePatienthasacuteself-limitingcauseofPromazine(Chlor-,Prochlor-, ProkineticeffectCereniaisaneurokinin-1(NK-1)receptorInhibitsbindingofsubstanceP,aneurotransmitterinvolvedin NK-1receptorsarelocatedinvariousthroughouttheFundusofthestomach H-2blockersH-2(cimetidine,ranitidine, Ulcert