【文章內(nèi)容簡(jiǎn)介】 便中 WBC, RBC大量增加 嚴(yán)重中毒癥狀 侵襲性腸炎發(fā)病機(jī)制 第 7 版 Virus invasion Pathogenesis3: virus infection recrement? Disacchride Poorly deposed lactose? Osmotic diarrhea Na+ transport block H2O? electrolyte? disaccharidase 第 7 版 病毒性腸炎發(fā)病機(jī)理 病毒侵入小腸粘膜絨毛上皮細(xì)胞并復(fù)制 粘膜受累，絨毛被破壞 絨毛縮短 微絨毛腫脹，紊亂并脫落 線粒體、內(nèi)質(zhì)網(wǎng)膨脹 雙糖酶活性下降 載體減少 消化吸收面積減少 雙糖（乳糖）吸收減少 葡萄糖鈉與載體結(jié)合 偶聯(lián)轉(zhuǎn)運(yùn)吸收障礙 營(yíng)養(yǎng)物質(zhì)吸收減少 部分乳糖分解為小分子的乳酸 滲透壓增加 水樣腹瀉 第 7 版 Pathogenesis4: noninfectious diarrhea Food fermn mydesis Enteric osmotic pressure? Digestive function disorder Osmotic diarrhea Overfeeding, No proper dietary 第 7 版 食物質(zhì)、量不當(dāng) 食物消化吸收障礙而積滯在上消化道 胃酸度下降 腸道下部細(xì)菌上移并繁殖 內(nèi)源性感染 發(fā)酵、腐敗 有機(jī)酸（乳酸、乙酸） 胺類 腸腔內(nèi)滲透壓增高 腸蠕動(dòng)增強(qiáng) 腹瀉、脫水、電解質(zhì)紊亂、酸中毒 分解食物 中毒癥狀 肝解毒功能不全 毒素進(jìn)入血循環(huán) 飲食不當(dāng)引起腹瀉發(fā)生機(jī)理 第 7 版 The RV is posed by 11 geme segments ，NSP4(非結(jié)構(gòu)蛋白4） is the closeness of Pathogenesis The study progression by RV cause diarrhea 第 7 版 A組 RV病毒基因組功能 基因片段 : 1 2 3 4 6 9 編碼 結(jié)構(gòu)蛋白 : VP1 VP2 VP3 VP4 VP6 VP7 (核心 ) (核心 ) (核心 ) (外殼 ) (內(nèi)殼 ) (外殼 區(qū)分 G血清型 114) 裂解 抗原區(qū)分 (AG組 ) VP5 VP8 A組為 Ⅰ,Ⅱ 亞群 （ P血清型 144） 基因片段 : 5 7 8 10 11 編碼 非結(jié)構(gòu)蛋白 : NS53 NS34 NS35 NS28 NS26 (NSP1 NSP2 NSP3 NSP4 NSP5) 第 7 版 ?General introduction ?classification ?Predisposing factor ?Etiology ?Pathogenesis ?Clinical manifestations ?Clinical features of several mon enteritis ?Persistent diarrhea ?Diagnosis ?Differential Diagnosis ?Treatment Content 第 7 版 Digestive tract symptom Water, electrolytes and acidbase disorder ? Dehydration ? Metabolic acidosis ? Electrolytes disorder ? Diarrhea ? vomit ? Abdominal pain Clinical manifestation 第 7 版 Mild and severe diarrhea ? Mild: the times of stool and character change —— stool :frequency ,loose, liquid, color: yellow or greenyellow, smell: sour flavor, shape: egg soup —— vomiting: seldom —— general poisoning symptom: without —— dehydration, electrolytes abnormality and general toxicity symptoms39。: none 第 7 版 ? Severe: acpany dehydration, electrolytes abnormality and general toxicity symptoms — digestive tract symptom : diarrhea serious ,mucus blood sample stool, anorexia, nausea, abdominal pain and abdominal distention — general poisoning symptom : lethargy, dysphoria, unconsciousness and a — dehydration, electrolytes abnormality , acid base imbalance Mild and severe diarrhea 第 7 版 Degree Quality mild moderate Hypotonic +﹤ 130mmol/L Hypertonic +﹥ 150mmol/L Clinical manifestation1: dehydration severe Isotonic +:130~150mmol/L 第 7 版 Severity clinical signs of dehydration mild moderate severe Water loss By weight Spirit Skin Mucous Anterior fontanel and eye ball Tear thirst Urine output Peripheral circulation ＜ 50ml/kg ＜ 5% Slightly dispirited slightly agitated Slightly dry Slightly dry Slightly depressed Normal slightly decreased normal 50～ 100ml/kg 5%～ 10% Dispirited Agitated Dry, pale Very dry depressed Reduced increased Little or no Little cool 100～ 120ml/kg ＞ 10% Extremely dispirited apathy, hypnody, a Gray mottled Parched depressed greatly No Greatly increased No urine output Cool, weak pulse, shock Dehydration 第 7 版 Anuria tachypnea Anterior fontanel and eye ball Depressed No Tear Cool, weak pulse, shock